{"id":38718,"date":"2021-03-25T10:13:06","date_gmt":"2021-03-25T16:13:06","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=38718"},"modified":"2021-03-25T14:41:46","modified_gmt":"2021-03-25T20:41:46","slug":"how-patient-outcomes-survey-helps-measure-effectiveness-of-orthopedic-procedures","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/how-patient-outcomes-survey-helps-measure-effectiveness-of-orthopedic-procedures\/","title":{"rendered":"How patient outcomes survey helps measure effectiveness of orthopedic procedures"},"content":{"rendered":"
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Growing up outside Cleveland in the 1970s, Randy Voss spent plenty of time playing competitive sports on the football field and basketball court. He endured plenty of nicks and dings as a result, and often hobbled about on crutches, both during and after high school.<\/p>\n

His ankles took the most abuse. \u201cI had a lot of sprains,\u201d he said, adding that he simply pushed through them. There wasn\u2019t much in the way of sophisticated medical care, and slow healing wasn\u2019t his goal anyway.<\/p>\n

\"Randy
Randy Voss rehabs at UCHealth Steadman Hawkins Clinic \u2013 Denver<\/a> after his successful ankle replacement surgery last year. Photo courtesy of Randy Voss.<\/figcaption><\/figure>\n

\u201cYou just tried to get back on the field as soon as you could,\u201d Voss said.<\/p>\n

The result was severe damage to the joint tissue in the right ankle, as well as spurs and bone chips. Voss underwent several ankle procedures over a roughly 30-year period, culminating in a 2006 surgery that removed bone from his heel, placed it underneath the ankle and secured it with pins and screws. That helped to stabilize the joint for a while, he said. Gradually, though, the support deteriorated, and his ankle and foot became severely misaligned. Activities became potential misadventures, \u201ceven comic,\u201d as he put it.<\/p>\n

\u201cMy stability was very poor,\u201d Voss said. \u201cI had to watch what I was doing so I didn\u2019t fall over.\u201d<\/p>\n

A new approach to ankle repair<\/strong><\/h2>\n

Early in 2020, Voss sought care from Dr. Kenneth Hunt<\/a>, medical director of the UCHealth Foot and Ankle Center \u2013 Central Park<\/a>. Hunt, who had implanted a 3D-printed talus, the large bone in the ankle, in 2019<\/a> \u2013 the first such procedure at UCHealth University of Colorado Hospital on the Anschutz Medical Campus<\/a> \u2013 explored with Voss the possibility of a total ankle joint replacement. Hunt would surgically remove the damaged bones and tissue and implant a titanium and polymer device to serve as a new ankle stand-in.<\/p>\n

Voss opted for the surgery, which Hunt conducted in late July 2020. It was a success \u2013 more on that later \u2013 but his procedure was more than a stand-alone case. Rather it is part of a systematic effort to gather data from patients on a variety of orthopedic procedures and measure their outcomes.<\/p>\n

\"Voss
Voss is bike riding and staying active without ankle pain after a surgery he said was carefully planned, with a closely monitored recovery period. Photo courtesy of Randy Voss.<\/figcaption><\/figure>\n

The effort, which began in October 2019, is a collaboration between UCHealth and PatientIQ<\/a>, a Chicago-based company that provides a national platform for automated collection of \u201cpatient reported outcomes,\u201d or PROs. The idea is to glean from patients how they perceive the care they receive and use the insights to improve it.<\/p>\n

Ask the patients, improve the outcomes<\/strong><\/h2>\n

The value of PROs lies in their reflection of people\u2019s everyday experiences with surgeries and other procedures. Has the care diminished pain? Did a procedure achieve the improvements in daily function that patients expected? Do they feel isolated because of their recovery time or have they improved their social interactions?<\/p>\n

To assess what patients report, PatientIQ uses a variety of \u201cpatient reported outcome measures,\u201d or PROMs, that have been validated for specific areas providers want to assess, including patients\u2019 pain and their general, physical and mental health. Other PROMs include tests for specific diseases and injuries<\/a>. For example, a foot and ankle specialist like Hunt might use two validated tests, the Foot Function Index<\/a> and the Foot and Ankle Ability Measure<\/a>, to objectively assess patients\u2019 injuries before and after a procedure.<\/p>\n

As Hunt explained in a 2019 article he co-authored for Foot and Ankle Orthopaedics<\/em><\/a>, PROMs \u201creflect the patient\u2019s perceptions of their health status and help quantify the impact of conditions and injuries as well as improvement following treatment.\u201d<\/p>\n

In addition, by aggregating data \u2013 the UCHealth system includes information from some 23,000 patients treated by 40 orthopedic surgeons \u2013 providers have a better chance of understanding the successes and failures of procedures and holding themselves accountable for their patients\u2019 outcomes, Hunt said.<\/p>\n

\u201cOur goal is to create a system where we can track every patient who comes through the door,\u201d he said. The tracking doesn\u2019t cease when a patient leaves the clinic or hospital, Hunt added.<\/p>\n

\u201cA patient might experience persistent or worsening symptoms even if they aren\u2019t rehospitalized,\u201d he said. \u201cWe want to know how a patient actually does following treatment, even after they have completed their treatment.\u201d<\/p>\n

The patient outcomes survey says\u2026<\/strong><\/h2>\n

The system relies on a series of short patient surveys, available from mobile devices or computers, to track their progress, noted Michael Tuffiash, quality data manager for the University of Colorado Department of Orthopedics<\/a>. (See box for further details.)<\/em><\/p>\n

\u201cWe get both a general and specific picture of where each patient sees their health before, during, and after their course of care,\u201d Tuffiash said. He emphasized that the surveys require a total of only about five minutes of time to complete, an important consideration for patients already dealing with burdensome injuries. Patients who do not complete a survey before a clinic visit for any reason can complete it at the clinic on a secure iPad or a kiosk, much like one passengers use to get an airline boarding pass.<\/p>\n

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About the patient outcomes surveys<\/strong><\/p>\n

Patient outcomes surveys used as part of the PatientIQ program include the following, said Michael Tuffiash, quality data manager for the CU Department of Orthopedics:<\/p>\n