Outcomes pioneer finds need for outside data

Joint Implant Surgeons in Columbus, OH, is a standard-bearer in outcomes management with an in-house outcomes database that dates back to 1980. Led by Thomas H. Mallory, MD, the practice has conducted extensive research of such issues as which prosthesis performs better or which surgical approach leads to fewer complications.

So what more can the medical group learn with the Musculoskeletal Outcomes Data Evaluation and Management System (MODEMS) from the American Academy of Orthopaedic Surgeons in Rosemont, IL?

"This is a way for us to compare ourselves one-on-one with other practices," says Stephen M. Herrington, ME, director of research services. "Rather than simply saying our patients do well, we will measure variables that will tell us how well [compared to other centers]."

The academy will provide reports electronically, which gives each practice the option of deciding how much detail it wants. For a group with a sophisticated outcomes program, the national comparisons promise a gold mine of information.

MODEMS will provide outcomes information by age, gender, and the five most common comorbities. The data collection tools incorporate the SF-36, so practices can use MODEMS to monitor changes in health status and functional outcomes. (See assessment tool, enclosed in this issue.)

"In the past, much of the data that have been collected have had to do with impairments," says Cynthia Shewan, PhD, director of the academy’s research and scientific affairs department. "‘How much is your range of motion reduced?’ The shift now is to determine how your reduced range of motion affects your ability to function."

The SF-36 also covers other issues, such as mental health and social functioning. For example, using the outcomes modules, a physician may discover not only that a patient can’t climb stairs or walk more than a block, but that the patient is becoming depressed.

With their experience in outcomes management, Joint Implant Surgeons hopes to influence the standard for measure in orthopedic procedures. But, at the same time, the data will reshape the group’s program.

Herrington says as outcomes management evolves, with the help of national comparisons, he hopes to be able to move into a "quality control system. Rather than asking questions [to develop outcomes studies], we could actually detect trends," he says.