December 2002 Bulletin

Orthopaedic integration of evidence-based practice

Focus on quality musculoskeletal care

By Michael P. Dohm, MD

During the 1990s, the AAOS’ clinical quality improvement focus was on the development of guidelines and outcome studies. In 2001–acting upon the recommendations of the Clinical Quality Improvement Task Force–the Guidelines and Outcome Studies Committees were dissolved in favor of the development of a new committee–the Evidence-Based Practice Committee (EBPC).

The EBPC was charged with reviewing and evaluating the Academy’s existing clinical quality improvement initiatives and integrating a clinical quality improvement cycle to encourage implementation of evidence-based practice (EBP) by the AAOS fellowship.

The EBPC held its first meeting in March 2002 at the AAOS headquarters in Rosemont, Ill. A strategic planning session defined the mission of the EBPC: To improve patient health and safety by promoting quality musculoskeletal care through implementation of evidence-based practice.

EBP is the integration of the best research evidence with clinical expertise and patient values.

The EBPC continues to address clinical guideline development/revision and outcome issues. Now, it is beginning the development of evidence-based physician clinical performance measures to assist physicians in assessing and continuously improving patient care.

EBPC charges

The charges for this committee include: reviewing, planning and oversight for all Academy activities related to quality improvement in orthopaedic practice; identifying formal mechanisms for integrating existing guidelines and outcomes into evidence-based guidelines and performance measures; acting as a resource and advisor for physicians, clinicians and other musculoskeletal organizations and special interests regarding quality improvement activities.

The AAOS’ EBPC has begun to integrate this discipline through continued support of outcome studies, evidence-based clinical guideline development, performance measure development, and programs directed at educating members about the importance of EBP.

IMCA project

Improving Musculoskeletal Care in America (IMCA) is a project of the EBPC. It is intended to build a foundation of information that is based on published, scientific literature. The goal of IMCA is to increase awareness of musculoskeletal conditions in the U.S. For each selected condition, a series of informational modules is being developed for AAOS members, patients, the public at large and policymakers. Osteoarthritis of the knee is the focus of the first set of modules. They include sections on general condition overview, burden and cost of the condition, evidence-based resources, treatment options, leading questions for future research, AAOS resources available, and joint replacement. The modules are designed to provide readers with the evidence supporting why we practice what we practice.

EBPC survey results

As one of their first projects in 2002, the EBPC surveyed the AAOS membership to ascertain their knowledge and understanding of issues in EBP. What the survey found was that the EBPC has much work to do. The survey found that much confusion exists about the definition, usefulness and implementation of EBP. The survey also indicated that fellows want to know more about what constitutes evidence in practice.

Most AAOS members rated their knowledge and understanding of EBP as only "fair"(4.7/10.0), with nearly one-half (48 percent) of members rating themselves as "low" in EBP knowledge (1 to 4 on the scale); and only 18 percent rating themselves as "high" (8 to 10 on the scale).

AAOS members believe practicing evidence-based medicine is pretty important (7.0/10.0), with one-half of the AAOS membership (49 percent) rating EBP as "high" in importance; and only 12 percent considering it "low" in importance.

Members indicated that the Academy is doing only a "fair" job in educating the members about EBP (4.7/7.0), with only 12 percent of members rating the Academy as doing a good job of educating them about EBP. The balance is split between a "low" evaluation of the effort and a fair or "middling" value on the effort.

Collaborative efforts

In the spring of 2002–in response to a request for information from the Centers for Medicare and Medicaid Services (CMS)–the EBPC, in collaboration with representatives of the Council on Health Policy and the AAOS Washington, D.C. office provided information on how to develop quality indicators for total joint replacement, and how such indicators could be used appropriately for physician quality improvement.

In its continuing dedication to clinical quality improvement, the EBPC is currently involved in a collaborative project with the American Medical Association’s Physician’s Consortium for Performance Improvement (Consortium). The Consortium is a physician-driven group devoted to quality improvement and performance measurement.

The Academy has been working with the Consortium since the 1990s in providing feedback to other specialty groups in developing other performance measures. This fall, CMS approached the Consortium and the AAOS about taking the lead in developing a set of performance measures for osteoarthritis.

The Academy–in cooperation with other organizations with osteoarthritis expertise–will have the opportunity to identify measures to be used by CMS and provide information about appropriate implementation of these measures.

For more information

AAOS fellowship are encouraged to learn more about EBP by attending the symposium, "Saving Time and Money with Evidence-Based Practice," at the 2003 AAOS Annual Meeting in New Orleans on Feb. 7, 2003. Please visit the EBPC’s Web site: Click on Research, click on commitees, select EBPC.

Michael P. Dohm, MD, is a member of the Evidence-Based Practice Committee. He is in group practice at Rocky Mountain Orthopaedics in Grand Junction, Colo. He is. He can be reached at (970) 242-3535 or via e-mail at

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