Measuring Outcomes in Orthopedic Care J.C. Clark, M.D. ORA Orthopedics
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2 Measuring Outcomes in Orthopedic Care J.C. Clark, M.D. ORA Orthopedics
3 Father of Shoulder Surgery End Result Idea The common sense idea that every hospital should follow every patient it treats, long enough to determine whether or not the treatment has been successful, and then to inquire, If not, why not? with a view to prevent similar failures in the future. - E. Amory Codman circa 1905
4 What does it mean to be the best?
5 It s Easy in Sports Jordan Spieth: stroke average Bryce Harper:.338 batting average
6 What about medicine?
7 How do we determine it? Nicest, most friendly Quickest, fastest Sees the most/least clinic patients Performs the most/least surgeries Has the greatest patient satisfaction Holds the most noble hospital positions Word of mouth/reputation...
8 Good Bedside Manner Good Surgeon Good Bedside Manner Bad Surgeon Bad Bedside Manner Good Surgeon Bad Bedside Manner Bad Surgeon
9 Good Bedside Manner Good Surgeon Good Bedside Manner Bad Surgeon Bad Bedside Manner Good Surgeon Bad Bedside Manner Bad Surgeon
10 Good Bedside Manner Good Surgeon Good Bedside Manner Bad Surgeon Bad Bedside Manner Good Surgeon Bad Bedside Manner Bad Surgeon
11 Good Bedside Manner Good Surgeon Good Bedside Manner Bad Surgeon Bad Bedside Manner Good Surgeon Bad Bedside Manner Bad Surgeon
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13
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15 This is How We Determine Patient-Reported Outcome Measures (PROMs): Method or questionnaire used in a clinical setting, where the responses are collected directly from the patient Patient Reported Experience Measures (PREMs): Focuses more on a patient's experience versus outcomes Shows how satisfied they are
16 What are these PROMs/PREMs? Questionnaires aka: instruments, measures, scales, tools Psychometric properties: valid, reliable, responsive Characteristic being measured aka: constructs i.e. shoulder, knee, hip function Examples Western Ontario WOSI WORC WOMAC Constant Score ASES scores SF-12 DASH HOOS/KOOS IKDC
17 Currently at ORA Patient Related Outcome Measure (PROMs) Hip replacement: HOOS Knee replacement: KOOS outcomes based electronic research database Central Region Missouri Orthopaedic Institute Hinsdale Orthopaedics The Orthopaedic Center of St. Louis Midwest Orthopaedics at Rush Michigan Orthopaedic Institute Union Memorial Hospital Tennesse Orthopaedic Clinics Rockford Orthopaedic A.T. Still University
18 American Shoulder & Elbow Surgeons Shoulder Score Introduced in 1994 by ASES 2 major sections Patient reported section Physician reported section Has been modified over the years Patient reported section most commonly used (pases) 0 (worst) 100 (best)
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20 What s Normal?
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22 185 male and 158 female subjects mean ASES score was 92.2
23 Arthroscopic Repair of Small- Medium (<3cm) Cuff Tear Mean Pre-op ASES Duration of Follow-up Mean Post-op ASES >1 year Averages taken from meta-analyses and systematic reviews
24 Steve Snyder, M.D. Van Nuys, CA ASES: 92.9
25 Bob Burks, M.D. Salt Lake City, UT ASES: 85.9
26 Peter Millet, M.D. Vail, CO ASES: 90.3
27 Tony Romeo, M.D. Chicago, IL ASES: 91.5
28 Richard Hawkins, M.D. Greenville, SC ASES: 88.0
29 Evan Flatow, M.D. New York ASES: 81
30 Hiroyuki Sagaya, M.D. Japan ASES: 92.9
31 Gilles Walch, M.D. France Constant: 67.6 Hiroyuki Sagaya, M.D. Japan ASES: 92.9
32 Currently at ORA Patient Related Experience Measures (PREMs) Patients fill out satisfaction form Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CGCAHPS) Standardized tool to measure patient perceptions of care delivered by a provider in an office setting Part of the requirements for Physician Quality Reporting System (PQRS) participants
33 PREM Questions What was your wait time in the clinic after your scheduled appointment time to see the provider? Was the person who scheduled your appointment as helpful as you thought that they should be? Did the person who scheduled your appointment treat you with courtesy and respect? How would you rate your ability to get an appointment within the timeframe you needed to be seen? Were front desk receptionists as helpful as you thought they should be? Did the front desk receptionists treat you with courtesy and respect? Were the clinical staff as helpful as you thought they should be? Did the clinical staff treat you with courtesy and respect? Did the provider explain things in a way that was easy to understand? Did the provider listen carefully to you? Did the provider give you easy to understand information about your health questions and concerns? Did the provider seem to know the important information about your medical history? Did the provider show respect for what you had to say? Did the provider spend enough time with you? Using any number from 0 to 10, where 0 is the worst provider possible and 10 is the best provider possible, what number would you use to rate your provider? 0 Worst provider possible 10 Best provider possible
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35 NPS Score Does Patient Volume Match PREM? 100 We have satisfaction scores.and. We know patient volume Series Yearly Volume (Arrived Patients)
36 Axis Title Draw a Best Fit Line Series1 Linear (Series1) Axis Title y = x
37 NPS score y = x Series1 Linear (Series1) Yearly Patient Volume
38 NPS Score y = x Series1 Linear (Series1) Yearly Patient Volume
39 NPS Score y = x Series1 Linear (Series1) Yearly Patient Volume
40 Equations for Each Line 2013 y = x y = x y = x + 93 Slope = Negative correlation between patient satisfaction and number of patients seen For every 1000 patients you see, a provider will drop 1.8 points on NPS scale
41 What does that tell us? Clinics run 8am-12pm and 1-5pm
42 Cost to medical practice Drawbacks/Cons to Measuring Outcomes Direct cost of outcome measures/it Indirect cost of time to collect & synthesize data Time for patients to fill out forms Response rates Rationing of healthcare Obese Diabetic Worker s comp Smoking Greater physician risk
43 So What, Clark, Who Cares? PROMs PREMs
44 Pay for Volume vs. Pay for Value
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46 Ideally Rapid Access High Quality Low Cost
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49 thank you! J.C. Clark, M.D. ORA Orthopedics
50 I prefer to win titles with the team ahead of individual awards or scoring more goals than anyone else. I m more worried about being a good person than being the best football player in the world. When all this is over, what are you left with? When I retire, I hope I am remembered for being a decent guy. -Lionel Messi
Introduction 2/8/2016. Selection of Shoulder Outcomes Scores and Where From Here to the Future Richard J. Hawkins, M.D.
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