One of the most powerful forces influencing American healthcare today is the increased push for transparency across the continuum of care. While transparency in the cost of care is generally the more popular topic under the umbrella of “transparency in healthcare,” there is an equally strong push among clinicians and patients alike to improve transparency in clinical outcomes. Consider this analogy: if you are shopping for, say, a new cell phone, knowing the price of the models you are comparing is only half the battle; in order to accurately compare them, you must also have a good idea of the comparative quality, durability and craftsmanship of the items in question. The same is true in healthcare. In order to be fully-informed consumers of medical care, patients need to know the full cost of a given procedure, but also the physician and/or facility’s track record on clinical quality and outcomes.
At a macro level, federal programs like CMS’ Hospital Compare tool have begun incorporating elements of clinical outcome transparency into their transparency efforts. These programs primary aim is to inform patients on the quality of care they can expect to receive at any given hospital. To accomplish this, CMS tracks and publishes measures like complication rates and the effectiveness of procedures at all hospitals that accept Medicare payments--which is basically all of them! However, large-scale efforts to track clinical outcomes at the physician level have not widely caught on across the country to date.
At O’Grady Orthopaedics, we believe that tracking and displaying clinical outcomes is absolutely vital to engendering our patient’s trust. Furthermore, openly sharing the results of our clinical research efforts with colleague clinicians allows the strides we make internally to impact patients well outside the scope of our practice. For that reason, Dr. O’Grady is proud to use a product called Surgical Outcomes System (SOS) to track the clinical outcomes for his patients undergoing surgical procedures. Specifically, we use the SOS system to track outcomes for patients undergoing shoulder, knee and hip arthroplasty (replacements) and arthroscopy procedures.
What is SOS data?
The Arthrex SOS global registry collects patient-reported outcomes (PROs) from patients who have undergone orthopaedic or sports medicine procedures. The system is designed to contact patients at critical junctures along their road to recovery, from the pre-operative period after they have been indicated for surgery but before they undergo the procedure, all the way through to more than a decade after the surgery was done. This wide-ranging timeframe allows physician/researchers to grasp the long-term impacts of the procedures they perform on important areas of patients’ lives like pain levels, mobility and overall quality of life. Patient-reported outcomes are exactly what they sound like: subjective and objective outcome measures of a given procedure as reported by the patient themselves, as opposed to outcomes that are reported by a healthcare provider or clinical-laboratory test.
There are almost as many patient-reported outcome measures out there as there are patients. While we obviously say that in jest, its absolutely true that there are countless measures a clinician must wade through in order to identify the measures that are most useful to their research. The Arthrex SOS system has identified the following primary patient-reported outcomes for use in the system:
KOOS/HOOS/SOOS (Knee/Hip/Shoulder and Osteoarthritis Outcome Survey) - questionnaires specifically designed to assess the short- and long-term outcomes of knee, hip and shoulder pain. This questionnaire applies both to patients suffering from osteoarthritis and those who are not. It is separated into five outcome categories: pain, symptoms, activities of daily living (ADL), sport and recreation function, and knee/hip/shoulder-related quality of life.
WORC (Western Ontario Rotator Cuff Index) - a questionnaire designed to evaluate the condition of patients suffering from rotator cuff pathology. It investigates five critical domains: physical symptoms, sports and recreation, work, social function, and emotions. Scoring ranges from 0 (no symptoms) to 2100 (worst possible symptoms); raw numerical scores are generally subtracted from 2100, divided by 2100 and multiplying by 100 to give a percentage (0-100%) of functional status.
VAS (Visual Analog Scale for Pain) - a measurement tool that allows patients to report their levels of pain based on visual analogs, as opposed to numerical values.
MARX - a questionnaire designed to determine a patient’s general level of physical activity. It is based on four categories of activity: running, deceleration, cutting and pivoting. The survey asks patients to indicate how many times in the past twelve months they have performed the four activities, and scores are added up to a maximum of 16 points, with higher scores indicating a higher level of physical activity.
SANE (Single Assessment Numerical Evaluation) - a simple assessment that asks patients to rate the current status of their injured body part on a scale of 0-100. This measure reduces the overall burden on clinicians and patients in collecting outcome data from patients, as it is incredibly straight-forward.
VR12 (Veterans RAND 12 Item Health Survey) - a global health measure used to determine a patient’s perspective of their overall health. The questionnaire corresponds to seven specific health domains: general health, physical functioning, role limitations due to physical and emotional problems, bodily pain, energy/fatigue levels, social functioning, and mental health. Scores are segmented into two categories: a Physical Component Scores and a Mental Component Score, allowing researchers to differentiate between physical and psychological health status.
Why is SOS data so important?
What sets Arthrex SOS data apart from the other clinical data collected by Dr. O’Grady during the course of treatment is that SOS data comes directly from patients. As such, it represents the success or failure of a given procedure on the one outcome that really matters: whether or not a procedure has improved a patient’s quality of life, from their perspective. A patient’s perspective on the effectiveness of their care is critically important in determining whether or not a procedure is successful because it stands apart from the objective clinical measures used as a proxy for the success of a procedure. In other words, a patient’s confidence and ability to move through their daily lives following a procedure is arguably more important in determining the success of a procedure than measuring flexion in the knee or shoulder. If a patient feels good and is able to live their life better than before, but their flexion remains below “acceptable” levels, don’t you think that the procedure is still a success? We do!
How do we use SOS data?
At the end of the day, we track, analyze and act on SOS data at O’Grady Orthopaedics for two primary reasons: to gauge the overall effectiveness of our clinical interventions and to inform our research efforts. As stated above, SOS data is critically important because it provides the patient’s perspective on the outcome of their care, which is arguably the most important data in gauging the success of a procedure. Furthermore, monitoring and evaluating our patients long after they have been discharged from our practice—up to fifteen years in some cases!—allows us to provide top-notch orthopaedic care. If our patients are having issues in the years following their procedure, the SOS system enables us to better catch those complications and work proactively to help patients.