Knowing the functional outcomes of patients is of primary importance if orthopaedic surgeons are to significantly improve patient care and the decision-making process about the treatments, says Michael Graham, MD.
But the "darker reason" is that the employers who are buying health care want to know that they are getting value for the money they are paying for health care, Dr. Graham says on the audiotape, "Viewpoints on Outcomes." The audiotape presents discussions by five individuals on the importance of measures to assess the quality of patient care and the relative value and effectiveness of various medical and surgical interventions. Funded with an unrestricted educational grant from Merck & Company, the audiotape is being given to everyone who attends an Academy continuing medical education course.
"Collecting good outcomes data and information is not an easy job, but it is something that virtually everyone, whether they want to or not, is going to be involved with," said Dr. Graham, former chairman of the Academy's Council on Health Policy and Practice.
John Ware, a psychometrician at the Health Institute at New England Medical Center, describes the development of generic outcomes which measure "what people do in everyday life and how they feel and how those things are affected by disease and treatment." Ware says orthopaedic surgeons may be nervous about generic health care outcomes, "but of the first 100 studies that have used standard outcomes in the last year or so, several of the most effective interventions are orthopaedic surgeries. When indicated, these interventions have a dramatic affect on physical performance and capacity in everyday life. What these generic tools do is confirm that in terms of a common denominator that can be compared with other diseases and treatments."
Ameritech, a telecommunications and information services company, spends $550 million a year on health care for its 66,000 active employees and 56,000 retirees. Alan Peres, manager of health care policy in Ameritech's human resources group, says "we're interested in outcomes because we want to know that the $550 million we're spending is contributing to the health of our people." The goal is not for Ameritech to use the information to choose among doctors, but to give the information to Ameritech's health plans to use in their quality improvement activities. Eventually, the information will be used for referrals and for choices by people, Peres said.
Others on the audiotape are John Kleinman, MD, chief medical officer for Allina Health System, Minneapolis; and John Harris, director of research and development, Brigham Orthopaedic Foundation, Boston.