CERortho Repository
An evaluation of ‘‘value’’ in orthopaedics requires the collection of information and development of assessments that has not traditionally been part of routine clinical practice and research. The CERortho partnership includes academic faculty, clinicians, industrial researchers, graduate students, medical residents, and orthopaedic fellows engaged in advancing musculoskeletal health and wellness through research, education, outreach and clinical translation.
This Figure illustrates the database structure required. For each patient the database must have the ability to measure at diagnosis baseline the factors that lead to treatment choice. At baseline, CER/PCOR requires measures of (1) patient-specific clinical distinctions including medical history that may affect diagnosing and treatment choice (red box); (2) patient-reported outcomes prior to treatment (blue box); and (3) patient goal preferences, effectiveness beliefs, resiliency and constraints (pink box). Next, the database requires detailed descriptions of the treatments chosen (e.g. surgery (green box), physical therapy (orange box) with dates of treatment. Lastly, the database requires the ability to measures the outcomes of treatment choice including patient-reported outcomes (blue box) and an exhaustive list of the healthcare resources by the patient during follow-up (purple box).
Information on patient preferences, beliefs, resiliency, and constraints that may have affected treatment choice are captured and presented to care providers to advance Patient Centered Care.
We are researching the best means of obtaining and offering this valuable input.
The database must also have the ability to measure clinically meaningful differences in the treatments chosen. Clinicians have defined discrete data elements sufficient to define identified factors leading to diagnosis.
Patient Reported Outcomes are the vital signs for orthopaedic medicine. Designed by practitioners in collaboration with scientists, this series of questionnaires offered before, during and after the episode of treatment provide us with the results of patient care. Questionnaires include: 1) General Health - VR12 and SANE; 2) Joint Specific - Shoulder, PENN and Night Pain - Elbow, Hand & Wrist, Quick Dash - Knee, Tegner, IKDC, Marx - Hip, HOS, iHOT - Ankle, FAAM
The Database includes a discrete set of data elements determined to describe each unique surgical case
The database also contains measures describing the consequences of treatment choice including patient-reported outcomes from baseline diagnosis to the end of clinically meaningful follow-up and an exhaustive list of the healthcare resources consumed by the patient during this follow-up period.
Descriptions of physical therapy are included and detailed within the episode of care so that these critical steps can be evaluated in relation to outcomes and resource utilization