Do your patients expect too much from surgery?
Outcomes data help manage expectations
A few months after surgery, some knee surgery patients at the Tucson (AZ) Orthopedic Institute wondered if their recovery was over. Would they ever feel better?
Thanks to outcomes data collected before and at intervals after surgery, director of research Chris Arslanian, PhD, RN, can answer "yes." Arslanian taps into the experience of more than 1,000 patients in a database at the practice, with pre-op and post-op information about such issues as stiffness, ability to climb stairs, pain, and emotional health. She shares her findings with Tucson Medical Center, where the 20 physicians in her practice do much of their surgery.
"We want to help [patients] set up realistic expectations for outcomes," Arslanian explains.
Tracking difficult cases
As the database grows, Arslanian hopes to sort out patients with more difficult cases and compare their outcomes. "We’d like to predict who’s going to need therapy a little longer than others, depending on comorbidities," she says.
After patients complete their three-month and six-month follow-up questionnaires, Arslanian provides them with their results and a comparison to the database. (See questionnaires, inserted in this issue.) The Tucson Orthopaedic Institute obtained the questionnaires from an orthopedic database, the Musculoskeletal Outcomes Data Evaluation and Management System (MODEMS) of the American Academy of Orthopaedic Surgeons in Rosemont, IL, which provides extensive data collection tools and access to national comparisons. (Any Same-Day Surgery reader planning to use the enclosed questionnaires should contact MODEMS for permission. See note at bottom of first page of insert. No fee likely will be charged for limited use.)
The MODEMS information supplants anecdotes patients hear about recovery after procedures such as anterior cruciate ligament (ACL) repair. "At least we have some data that supports what we’re telling our patients," Arslanian says.
More clinics collect outcomes
The quality of that patient-oriented data is rapidly expanding with the growth of MODEMS. Since January 1997, 112 physicians in 29 clinics have joined the project. Surgery centers are welcome to participate, as long as they have a physician-member of the academy. (The database is open only to members of the academy and several affiliated societies. See editor’s note at the end of this story for more information on joining the database.)
The "modules," or sets of questionnaires, are specific to parts of the body, such as lower limb, hip/knee, or disabilities of the arm, shoulder, and hand. The academy also has a sports knee module. Modules include a current health assessment with comorbidities, demographic questions, functional assessment, and the SF-36 health status questionnaire developed by The Health Institute of the New England Medical Center in Boston.
Using such questionnaires allows physicians and surgery managers to gauge the patient’s perspective of their problem, recovery, and ability to function, says Cynthia Shewan, PhD, director of the academy’s research and scientific affairs department.
"In the past, much of the [outcomes] data that has been collected has had to do with impairments. The shift now is to find out how the reduced range of motion affects the patient’s ability to function," she explains. "It may be that you can’t walk upstairs. If you live in a house where the bathroom is on the upper level, that would create a very significant problem."
On the basis of data collected, physicians and nurses at surgery centers can then tell patients specifically what they might expect in terms of improved functioning after surgery. The academy recommends monitoring outcomes preoperatively and then at three, six, 12, and 24 months and five years, depending on the type of surgery. Based on a pilot project using the MODEMS forms, Shewan suggests giving patients the follow-up questionnaires at postoperative visits. But Arslanian says she has a 60% response rate when mailing the questionnaires.
The mailings cost about $2.50 per patient, she says. Patients complete the pre-op forms on a computer kiosk in the office while waiting for their appointments. Collecting the data takes about eight staff hours each week, she estimates. "We think the benefits far outweigh the costs," she says.
The first national report from the MODEMS database is expected to be released in spring 1998 to MODEMS participants only. With detailed information, physicians and same-day surgery managers can determine whether differences in procedures or post-op therapies impact outcomes. Same-day surgery managers also may use the information to demonstrate outcomes to managed care organizations. Arslanian says she doesn’t consider it a marketing advantage, but rather a business necessity.
"If you’re not doing outcomes studies and gathering your own data, then somebody along the line is going to gather your data for you," she says. "You won’t have any control over the questions that are asked, the quality of the data, and the conclusions that are drawn. If you’re not doing your own data collection, then you have to live with the consequences."
[Editor’s note: the Musculoskeletal Outcomes Data Evaluation and Management System (MODEMS) is open to members of the American Academy of Orthopaedic Surgeons and affiliated societies. Subscribers pay a one-time fee of $500 and an annual fee of $500 for each participating practitioner using the database. The academy provides a list of approved vendors, which sell software or a service to process questionnaires. National comparisons are reported once a year. For more information, contact MODEMS, P.O. Box 2354, Des Plaines, IL 60017-2354. Telephone: (800) 288-0018. World Wide Web: http://www.MODEMS.org.]
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content