Jerry Day
Introduction: Individual surgeon measurement of patient outcomes is a highly desirable component of practice. Combining patient reported outcomes with surgeon recorded outcomes is the most valid way to measure the effect(s) of surgical intervention. Increasingly, internationally and nationally, the expectation is that” standard of care” includes the collection, analysis, and reporting of outcome data. This expectation comes not only from governmental bodies, insurance and payer sources but increasingly from patients. We, as providers of specialized health care services, need to ensure that we, either individually or through our specialty society groups commit to a routine collection of standardized outcomes data. Method: e-Fellow is a digital program specifically targeted for spine surgery. It is an iPad, cloud-based data collection system. E-Fellow collects demographic details, medical history, patient generated outcomes, and surgeon generated outcomes. Patient generated outcomes (PGO’s) are obtained pre-operatively, post-operatively and ongoing through continued follow-up. PGO’s consist of a pain drawing, Visual Analogue Scores (VAS) for axial neck or back pain, appendicular scores for arms or legs, functional measurements utilizing Neck Disability Index (NDI) or Oswestry Disability Index (ODI). Patient post-operative satisfaction responses are also collected. Additional QOL surveys such as EQ-5, SF-36 etc. can be added at the request of the individual surgeon. Surgeon generated outcomes (SGO’s) include pre-op diagnoses, operative procedure details, date of surgery, approach, levels, implants used – including bone graft and/or biologics, operating time, Medical Benefits Schedule (MBS) i coding, estimated blood loss, intra-operative complications, and hospital stay. Post-operative measurements can include implant status, fusion status, motion status, and complications. E-Fellow was integrated into my Practice in August 2013. The database now includes 1,892 patients as of March 5th, 2017. (can update if needed) Demographic patient information is entered into the program by the office secretarial staff or practice Registered Nurse then each patient individually completes a pre-consultation survey composed of general health history; ODI (thoracolumbar) and/or NDI (cervical); pain, weakness and numbness diagrams; and VAS neck, arms and/or back, legs. The scored results are immediately available and viewed by me- PRIOR to the patient entering the consultation room. (insert image of e-fellow screens) Immediately post-operatively, Operation report within that individual patients file and also include representative images. (insert image of e-fellow op report) For each post-operative office consultation, patients repeat the surveys, and when relevant, representative images were recorded and annotate them to show implant position, range of motion, and/or fusion. Additionally, the survey can be completed remotely by telephone when necessary. (insert image of e-fellow image screen) Via the secure e-Fellow website, we can create demographic, case type, case specific outcome results, and/or comparison charts and graphs by comparing my results alone, or if desired, to the entire E-Fellow user group. (insert image of e-fellow image screen) Discussion: Collecting patient and surgeon reported outcomes in a prospective and efficient digital program format has improved efficiency within my office based clinic. It has improved patient flow from the triaging process, at every consultation to finalization of care. It allows the surgeon to preview invaluable, immediately available history and Quality of Life (QOL) scores when reviewing the e-fellow data prior to consulting with the patient. This tool has provided significant insight at the time of consultation. The delivery of the surveys utilizing the iPad requires minimal instruction. Despite my original concern that patients would be resistant to participating in completing the survey and history on a tablet, positive feedback and only one patient that refused to complete the survey. Patients have embraced the concept that the practice is tracking, analysing and reporting the outcome of their treatment plan utilising modern technology. The QOL results in correspondence was routinely reported. Referring doctors and allied health practitioners have shown interest in our routine collection of patient reported outcomes. Valid longitudinal outcome measurement facilitates comparison of my individual results to my peers and published results, assisting with regular Quality Assurance efforts (QA) within the practice. Having data immediately available enhances clinical research potential, allowing efficient data preparation for presentations and publications. We have also received interest from manufacturers and distributors wanting to analyse the results from use of their products and new technology. Prospective pre-and post-op functional status and outcome are thus measured and can be specified for any procedure and/or implant type.
