Use cases in Orthopaedics

Why use patient-reported outcomes in orthopaedics

The majority of orthopaedic conditions are treated to improve functional outcomes and ultimately quality-of-life. This makes orthopaedics a prime candidate for patient-reported outcome measurement, as the outcomes of interest are ideally measured from the patient’s perspective. Some of the most commonly used and widely validated measures are in orthopaedics and some are now being incorporated in to payment models and quality reporting requirements.

What measures are out there?

There are a wide variety of available measures that cover the spectrum of orthopaedic conditions. The HOOS and KOOS, for hip and knee osteoarthritis and dysfuynction respectively, are widely used and validated. Shorter versions also exist in the form of the HOOS-JR and KOOS-JR, developed by the Hospital for Specialty Surgery. The DASH and QuickDASH can be used to assess upper limb function and disability and measures like the FAOS can be used for foot & ankle. To see a full list check out our measures list.

Starting a program in your practice

Getting started is easy and we’d encourage you to register on the platform and start testing it with a few of your patients to gain familiarity. In order to stand up a comprehensive outcomes program we recommend a few key steps that we summarized in a short infographic that can be downloaded here.

Illustrative Use Case: Total Joint Replacement

With the goals of joint replacement surgery to provide symptomatic relief, functional improvement and improved quality-of-life, it makes natural sense to start systematically measuring those longer-term outcomes and feeding that data back to the front-line to aid in clinical decision-making and quality improvement. Only recently has technology and the ubiquity of mobile devices made it feasible to do so at scale with minimal impact on clinical workflows. Furthermore, the march of value-based models make it a necessity to align around longer-term patient-centered outcomes and have the data to demonstrate the effectiveness of care.

An orthopaedic center that was seeing an increasing percentage of their business shift to value-based models decided to start collecting patient-reported outcomes across all of their TJR patients. They already had some experience collecting paper PROs for research but needed a way to scale up their program and wanted to make the data available in real-time. After implementation they were able to use PROs to risk-stratify pre-operative patients and plan personalized recovery programs. PROs during the recovery period helped the team identify patients for active outreach. Data was used internally to discuss areas for quality improvement and externally to showcase their commitment to patient outcomes. As a bonus, they’ll be using the data to report to the CJR program for the coming performance year.

Illustrative Use Case: Osteoarthritis

Osteoarthritis is a chronic and debilitating disease that affects over 30 million US adults and is growing rapidly in prevalence. Treatment typically starts with conservative measures such as encouraging physical activity, symptomatic relief with pain killers, physical therapy, weight loss and the use of support devices. Should those treatments fail surgical treatment is often an option.

An orthopaedic clinic that routinely saw a lot new presentations of OA wanted a way to better manage these patients throughout the spectrum of treatment. They started tracking functional outcomes across all patients, not just those proceeding straight to surgery. They used the patient-reported outcomes data to help guide decisions to treat and helped their practice forge longer lasting relationships with patients to ensure they stayed with the practice. The longitudinal data also provides strong rationales behind treatment decisions in light of the growing Medicare Recovery Audit Program.

Illustrative Use Case: CJR Reporting

The Comprehensive Care for Joint Replacement model is a mandatory bundled-payment program that applies to 790 hospitals across the United States and went in to effect April 1, 2016. The bundle target price and access to reconciliation payments is determined by the hospital’s composite quality score that is based on 1) a risk-standardized complication rate 2) a HCAHPS survey measure and 3) voluntary reporting of Patient-Reported Outcomes.

The voluntary PRO reporting accounts for 10% of the overall composite score and, depending on where you sit on the other two components, could make a step-change difference in reimbursement. A hospital that wanted to set themselves up for success under this new program started collecting PRO data for hip and knee patients included in the CJR program. To fulfill the requirements of reporting they need to capture one pre and one post-operative PRO using a standard measure for at least 50 patients or 50% of qualifying patients. With minimal effort, they’re now well on their way to bumping their score and securing the best possible reimbursement so they can focus on delivering great care.

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