Hospital for Special Surgery (HSS) in New York is announcing that it has signed a four-year agreement to provide a wide range of consulting services to Hospital Alvorada (São Paulo, Brazil), focusing on its Department of Orthopedic Surgery. The partnership with Alvorada is the second collaboration with a Brazilian hospital. In 2013, HSS signed a multi-year agreement with Amil, Brazil’s largest managed healthcare organization, to provide services in quality management, clinical pathways and academic training at its newly opened orthopedic specialty hospital, Hospitalys Ortopedia, in Rio de Janeiro.
HSS Signs Agreement With Hospital Alvorada in Brazil

Hospital Alvorada is also part of the Amil network. The partnership between HSS and Hospital Alvorada will focus on clinical pathways and quality initiatives to grow its orthopedic surgery department and establish its reputation as a leader in the field. The Alvorada collaboration will have an emphasis on total joint replacement.
Fernando Moisés José Pedro, technical director of Hospital Alvorada said, “Our goal is to develop Hospital Alvorada’s reputation as a leading provider in orthopedic surgery.” The establishment of patient registries and data to track outcomes is an important part of the relationship, Dr. Pedro adds.
Educational programs will be available year-round to Hospital Alvorada staff via access to HSS eAcademy, which offers a variety of symposia, seminars, videos and continuing medical education courses online. Special offerings will also be developed for physicians, physical therapists and nurses affiliated with the hospitals owned by Amil.
Asked what made this particular hospital (Hospital Alvorada) a great choice for HSS, Louis A. Shapiro, president and CEO of Hospital for Special Surgery, told OTW, “First of all, there is our 2013 agreement with Amil. Hospital Alvorada, part of the Amil network, is an established general hospital interested in growing its orthopedic surgery department and establishing its reputation as a leader in the field in Sao Paulo, Brazil. One of the areas we will focus on with Hospital Alvorada is total joint replacement, where we have a great deal of experience. We perform almost 10, 000 joint replacements annually at Hospital for Special Surgery. We are very interested in continuing to expand our partnership with Amil, as we have parallel missions and values, and we have a strong commitment to advance the field of musculoskeletal medicine.”
As for their first steps regarding the clinical pathways, Shapiro told OTW, “The first steps involve a comprehensive assessment of Hospital Alvorada’s Department of Orthopedic Surgery. The clinical pathway is an interdisciplinary/multi-disciplinary guide to patient care that involves universal best practices, however it is also much influenced by the individual hospital system. Our team will adapt our knowledge and experience appropriately for Hospital Alvorada’s culture and organization.”
Regarding the quality initiatives, Shapiro commented to OTW, “The main quality initiative of this partnership is the Quality Management and Outcomes Fellowship. A physician from Hospital Alvorada will be trained at HSS in quality improvement and patient safety through didactic, clinical, and administrative experience. This physician will be completely immersed in quality improvement and its practical application, with the goal of leading quality improvement initiatives within Hospital Alvorada. Throughout the two-year fellowship, this physician will spend time at both HSS and Hospital Alvorada.”

Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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