April 1996 Bulletin

Academy proceeds on outcomes database

Will be useful for individual practice, research

The Academy's Board of Directors has given the green light to phase two of an outcomes data collection program that will lead to development of a national database useful for individual practice assessment and research.

Eventually the database may be managed by an independent organization of all musculoskeletal providers.

Such is the vision of the Task Force on Data Management that was approved by the Academy Board of Directors in February 1995. The goal is to create a reliable, consistent, and widely-endorsed mechanism for collecting outcomes data from practicing physicians and to use the data to improve quality of care provided to patients.

One year later, the task force is right on target with the plan to establish a standard series of "core" instruments used by orthopaedic practices to collect data and transmit the data electronically to a central site where it would form a national database. It would allow the participating practices to compare their outcomes with national data.

To measure outcomes

The Academy, in a joint project with at least 16 other orthopaedic and nonorthopaedic specialties, designed questionnaires to measure patient outcomes for pediatric, spine, upper extremity, and lower extremity conditions. The questionnaires score patients' responses on physicial function, social/role function, pain, and expectations or satisfaction resulting from treatment.

In the spring of 1995, the Academy asked for proposals from software developers to adapt the questionnaires on spine and lower extremity treatments so that the information could be collected electronically.

Six vendors agreed to participate in a pilot study: Axis Clinical Software, Inc., Portland, Ore.; Brigham Orthopedic Foundation, Boston; Cedaron Medical, Davis, Calif.; DocuMed, St. Paul, Minn; Ortho-Graphics, Inc., Salt Lake City, Utah; and Summit Medical Systems, Inc., Minneapolis.

The vendors agreed to develop the software free-of-charge and to train the practice personnel who would collect the information from patients. While each vendor developed their own software, all the files with the data to be transmitted to the Academy had to be compatible.

Test questionnaire

Sixty orthopaedic practices in the U.S. were identified to test the questionnaires; 30 practices were volunteers from the membership, and 30 were selected by the vendors.

Personnel from the orthopaedic practices were trained at the Academy or vendor-supplied sites. Where needed, the Academy supplied some practices with the computer hardware needed to collect the data.

The pilot test officially got underway Sept. 15, 1995 and by Dec. 15 more than 32,400 patient records were sent to the Academy. Only six of the practices failed to complete the three-month test.

Debriefing sessions conducted in January found that the practice participants said the experience was worth the time and costs and they would like to continue collecting the data, but some wanted the questionnaires to be simplified.

The participants said that patients didn't object to providing the information. Twenty-seven out of 45 practices (60 percent) said the study made their job more difficult, however, 61 percent said they spent the same amount of time with their patients and 27 percent said it improved the interaction with the patients.

In phase two, enrollment will be opened for all orthopaedic practices to share their patient information and have access to the national data. There will be a practice assessment track, collecting information of patients for any orthopaedic treatment. By the end of the second year, the task force hopes to have 600 practices in this track.

Focused data

Two hundred other practices in the first year will participate in a focused data collection track that will last for two years. These practices will collect data on specific common conditions such as carpal tunnel syndrome, back pain, anterior cruciate ligament and/or meniscus tear, and forearm fractures in children. The task force has not finalized the categories, yet. The practices in the focused track also will be able to send data on other conditions.

The annual subscription fee for participating in the practice assessment track and focused-data collection track will be based on a sliding scale linked to practice size.

Enrollment in the practice assessment track will be open; training will be quarterly. The focused data collection track will begin July 1, Oct. 1, Nov. 1, and Dec. 1.

Another dimension to the data system under development by the task force is the collection of resource utilization data. It is accomplished by identifying all the resources-by CPT code through existing billing software-that are directly attributable to services provided by the orthopaedic surgeon for a condition. The information would automatically be transmitted to the national database. Once pooled, clusters of CPT codes could be linked to specific patients by a patient identification number assigned during the clinical outcomes data collection process and during the routine billing process. "Medical episodes" could be created by looking at clusters of CPT codes and clinical outcomes data.

The information would give orthopaedic surgeons a measure of the intensity of service they provide that can be compared locally, regionally and nationally.

The task force will oversee the implementation of phase two until a new independent corporation has been created and funded. The corporation will appoint a Board of Advisors including third-party payers, industry, physician and advocate groups, and a scientific board with representation from specialty societies that will be responsible for interpreting data.

(As this is being written, a meeting of 23 musculoskeletal health care providers was scheduled for March 28 to discuss each organization's involvement in outcomes research and whether there is an interest in sharing resources and costs of research.)

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