Board approves expert witness compliance program, advisory statement, revised clinical guidelines
By Susan A. Nowicki, APR
The Board of Directors (BOD) of the American Academy of Orthopaedic Surgeons and the American Association of Orthopaedic Surgeons (AAOS) met June 11-12, 2004 in Rosemont, Ill., and took the following actions:
AAOS Expert Witness Professional Compliance Program approved. The Expert Witness Project Team presented business and implementation plans for an AAOS Expert Witness Professional Compliance Program, which the BOD approved. Under this program, AAOS fellows and members will be permitted to file complaints against other fellows or members regarding all ethical issues for which the AAOS has Professional Principles. Among the first of these professional principles will be expert witness testimony.
Those charged with violating the Professional Principles will have substantial due process, with at least two opportunities to be heard. The AAOS BOD will be the final decision-making body in all membership matters, including professional compliance. Finally, it provides for wide notification of all fellows of disciplinary actions taken by AAOS.
Several steps, including amending Association bylaws to allow implementation of an assessment and disciplinary program, must occur before this program can be implemented. The fellowship vote on the proposed bylaws amendments would occur during March and April 2005. The earliest possible start date for the AAOS Expert Witness Professional Compliance program would be summer 2005, assuming the fellowship votes to adopt it. To read more about the program, see the related article, “Professional compliance program to be created.”
AAOS president, Robert W. Bucholz, MD, listens intently to the EBPC presentation during the AAOS Board meeting.
Board amends Opinion on Ethics. The BOD voted to revise the current AAOS “Opinion on Ethics and Professionalism: Gifts and the Orthopaedic Surgeon’s Relationship with Industry” to make it consistent with voluntary guidelines adopted by the Pharmaceutical Research and Manufacturers Association (PhRMA) and the Advanced Medical Technology Association (AdvaMed) regarding interactions between industry representatives and health care professionals. The revised code is posted on the AAOS Web site.
Board endorses advisory statement. At the recommendation of the Infections Committee and the Council on Research, the BOD endorsed an advisory statement, “Recommendations for the Use of Intravenous Antibiotic Prophylaxis in Primary Total Joint Arthroplasty (TJA).” The main goal of this statement is to improve the selection, timing and duration of antibiotic prophylaxis, specific to their use in patients undergoing primary TJA. It resulted from the recommendations set forth by the National Surgical Infection Prevention Project that was endorsed by the AAOS BOD in late 2003. For more information on this topic, please see the related article on page 15. The full text of the statement is posted on the AAOS Web site.
Low back, hip pain, wrist guidelines approved. At the recommendation of the Evidence-Based Practice Committee (EBPC) and the Council on Research, the BOD approved revised evidence-based clinical guidelines addressing the treatment of hip pain and wrist pain by first-contact physicians and low back pain by first-contact physicians and musculoskeletal specialists. The revision process included the following:
• The EBPC’s Spine Evidence Analysis Work Group performed a comprehensive review and assessment of literature related to the “AAOS Clinical Guideline on Low Back Pain/Sciatica (Acute)—Phases 1 and 2” and revised the 1996 version of the guideline and support document.
• The EBPC’s Hip Evidence Analysis Work Group performed a comprehensive review and assessment of literature related to the “AAOS Clinical Guideline on Sub-Acute (Non-Traumatic) Hip Pain in Adults (>50 years of age)” and revised the 1996 version of the guideline and support document.
• The EBPC’s Hand/Wrist Evidence Analysis Work Group performed a comprehensive review and assessment of literature related to the “AAOS Clinical Guideline on Wrist Pain” and revised the 1996 version of the guideline and support document.
All revised guidelines are posted on the EBPC Web site and the National Guidelines Clearinghouse Web site (http://www.guideline.gov/)
Code of Ethics on Governance adopted. At the recommendation of the Professional Conduct Board Project Team, the BOD adopted an “AAOS Code of Ethics for Governance and Management.” Although such a code is not legally mandated, its adoption is viewed as a “best practice” by many not-for-profit organizations. This AAOS Code of Ethics applies to members of the Board of Directors, Council chairs, Committee chairs, the executive team and the senior management team.
AAOS in 2010. Stuart L. Weinstein, MD, AAOS first vice president and chair of the “AAOS in 2010” initiative, presented a project update. He reviewed the work accomplished to date, including a SWOT (strengths, weaknesses, opportunities, threats) analysis and External Environment Survey. The next step in this strategic planning process will be the preparation and dissemination of a member needs assessment survey. To read more about the “AAOS in 2010” project, see the related article.
Patient outreach. Upon recommendation of the Council on Communications, the BOD approved establishing a liaison with the National Health Council as a way to build relationships with patients in the orthopaedic community.
Annual Meeting. The BOD approved conducting a Town Hall session during the 2005 Annual Meeting in Washington, D.C.
Committee structure review. The BOD approved a plan developed by the Committee Structure Review Project Team for transitioning and streamlining AAOS committees. The process will involve looking for overlaps of charges and reviewing lengths of terms for committee members. Committees will be evaluated as to whether they can be sunset, merged or converted into a project team or a shared interest group.
Volunteer appointments. David A. Wong, MD, was reappointed chair of the Patient Safety Committee. Richard H. Gelberman, MD, was appointed chair of the 2005 Nominating Committee. Norman Johannsen, MD, was appointed as a member of the American Joint Replacement Registry Oversight Board. Bernard Pfeiffer, MD, was appointed the AAOS representative to the American Medical Association Specialty Society Relative Value Update Committee.
Strategic discussion on evidence-based practice held. The BOD participated in a comprehensive strategic discussion on evidence-based practice (EBP). The goals of the session, which was moderated by Michael J. Goldberg, MD, chair of the Evidence-Based Practice Committee, were to discuss the challenges of implementing evidence-based practice, to reaffirm the Academy’s commitment to EBP and to develop an action plan to encourage members to implement EBP. EBP is defined as the integration of best research evidence with clinical expertise and patient values. The Board approved the development of a position statement reflecting AAOS support of the development and implementation of evidence-based guidelines, highlighting the attributes of evidence-based guidelines and performance measures. An in-depth article about the issue of evidence-based practice will published in a future issue of the Bulletin.