Outcomes tell surgery patients what to expect
Orthopedic group puts data in patients' brochures
Three months after total knee replacement surgery, patients at Tucson (AZ) Orthopaedic Institute finally feel pain is under control, general health has improved, and energy has returned. Yet in some areas, such as walking or stair climbing, patients may not feel back-to-normal for up to six months.
In layman's terms, those are the outcome findings of the group. Now, that information has been incorporated into a brochure to help shape the expectations of patients. And as the practice develops a site on the World Wide Web, even more specific outcomes data will become available to patients, says Chris Arslanian, PhD, RN, director of research.
Arslanian thinks it's only logical to share outcomes with those patients preparing to undergo such major procedures as total knee and hip replacements and anterior cruciate ligament repair. "What's the sense of gathering outcomes information if you're not going to share it with the people who need it the most, which is the patient?" she says.
Arslanian drafted the brochure with the help of patient David Long, a 53-year-old former National Football League player who had two total knee replacements a month apart.
Long was in excellent physical shape before the surgery and saw the procedure as a way to reduce chronic pain. So he set his own goals for rehabilitation and was determined to get up and around quickly after surgery.
But he recalls other patients feeling discouraged by the difficulty of physical therapy and the lingering pain. "It seemed like they thought they wouldn't have to do a lot of work to get better," says Long. "The doctor was going to fix their knees, and everything would be OK."
In fact, says Arslanian, "Sleeping through surgery is the easiest part of it." Most patients spend about a week in the hospital then continue physical therapy and pain medication.
When the institute surveys patients for both satisfaction and health status three months after surgery, some 60% say they would not do it if they could go back and make the decision again. However, at six months and after, as the pain and difficulty of the recovery diminish, that response improves.
"A mismatch between expectations and outcomes can lead to lower satisfaction," says Arslanian.
The patient's brochure offers "four D's" to guide them through the total knee replacement:
· Decision.
· Data.
· Determination.
· Discipline.
The brochure emphasizes the importance of a positive mental attitude and realistic expectations. "You cannot take a passive attitude toward therapy and rehabilitation. You must make the effort every day to develop your independence and be responsible for your self-care."
Patients largely determine their outcomes
The overriding message: Patients influence their own outcomes. Tucson Orthopaedic Institute hopes to improve outcomes through patient education and encouragement.
Few would argue with the need to engage patients in their own treatment and recovery. But when it comes to sharing specific outcomes data, some concerns arise.
"Do not use superlatives. Ever," advises Alice G. Gosfield, Esq., health care lawyer and chairwoman of the board of directors of the National Committee for Quality Assurance in Washington, DC. Calling yourself the "best" means you can be legally held to a higher standard, she says.
Gosfield also suggests adding a disclaimer to any publicly available outcomes reports, such as: "These are recent results for XYZ procedure at XYZ Medical Group. They are not a guarantee of future results."
Arslanian points out that patients sign consent forms which detail various possible side effects. The patient brochure stresses that patients will have different recovery patterns. "Never think that you are behind if someone is a bit farther along on the rehabilitation trail than you are," it reads. "It just means that they have a different body than you, and their response time is a bit different."
"There's never been a question that they're guaranteed a positive outcome," says Arslanian. In fact, education about other patients' outcomes may help patients realize that they're not alone in their struggles. "Setting up realistic expectations is our main focus," she says.
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