New Data-Based TJR Tool for Patients
Thanks to work from the University of Massachusetts Medical School (UMMS)-led Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement (FORCE-TJR), patients will someday be able to compare their personal information with nationwide data to help decide if and when to undergo TJR.
The five-year study, which will be using information from dozens of orthopedic sites, is being funded by a $6.4 million grant from the Patient-Centered Outcomes Research Institute. Twenty-five surgeons are participating and the hope is that they will be able to enroll 8,000 patients in the study. Arthritis care through Shared Knowledge (A.S.K.) promises to help clarify guidelines on if and when to have surgery.
Patricia Franklin, M.D., M.B.A., M.P.H., professor of orthopedics and physical rehabilitation and principal investigator in the study, told OTW, “Good data. We want to calculate likely predicted outcomes using high quality, nationally representative data. FORCE-TJR is a wonderful resource as it is a national representative sample from 28 states/>200 surgeons with little data missing. Other data bases are skewed—for example, the EMR [electronic medical record] may have data only from one health system or a convenience sample of users of one commercial EMR or patients who are doing well do not come to the office (so the EMR is missing the outcome data). FORCE routinely collects outcomes on all patients—whether they go to the office or not—using direct-to-patient contact.”
“It was also challenging to integrate the new reports into the office flow for optimal use. To get the best value from the new, shared reports, patients answer the A.S.K surveys before the office visit so the real-time report is available for the patient and clinician to view.”
“The information technology is the easy part—it scores and does the statistical modeling in seconds. However, patients must complete the survey before arriving at the office or on arrival at the office. Our system sends the survey via email to the patient home, and reminds them to complete it in advance of the visit. If not completed at home, many surveys are completed in the office because the EMR did not have an updated email, or the patient does not use in home technology. These challenges will be resolved in the future as adults routinely use phone apps, web, etc.”
As for what about the care decision process patients struggle with, Dr. Franklin told OTW, “Timing. Patients ask, ‘When is optimal? Are my symptoms severe enough to warrant surgery?’ The report places their symptoms in context with others who elected surgery. This helps patients understand ‘when.’ They also ask, ‘What are the benefits and risks of other treatment options?’ We provide evidence-based information on alternatives (physical therapy, medications, injections).”
“They want to know about their personal risk factors that may affect their outcomes. The surgeon is the best person to review the risks with the patient, but the report lists the key factors for each individual.”
“In addition, they want to know, ‘How do patients like me benefit from surgery?’ The report provides individualized likely surgical benefits in lay language.”
“Patients are very willing to complete the symptom and risk assessment (including patient-reported outcome measures) when the data inform their care.”
“Because we can translate the surveys into real-time personalized information, patients are very engaged partners. We interviewed many patients during the report development phase to assure that we present the information as clearly as possible for patients.”
“Collecting key data once can serve both shared individual decisions, and also be aggregated for quality incentives and bundled payment programs. The same data are used in both.”
