The Path Forward
Surgeons are making these decisions using the best tools available to them at the time, usually based on research published in scientific journals. But this model for decision-making is inherently flawed, because those surgeons may never reach the skill level of the surgeons who authored the articles. So, even though the literature may state that the best procedure is Surgery A, for the given circumstances, the surgeon who is physically performing that procedure may actually have a better outcome with Surgery B, because of their own inherent surgical skills. Just because they’re very good at a procedure does not necessarily mean they have fewer complications. The only way to accurately measure that is via patient-reported outcomes or ePRO. If you’ve never checked your own results, you don’t really know how good you are.
Tracking data such as infection rates, mortality, or deep vein thrombosis (DVT) is standard while the patient is in the hospital. But that visibility disappears when the patient goes home; the only chance for the surgeon to know of any complications after that is if the patient goes directly back to that doctor or her staff. Most of the time, that’s not how it works. Especially in orthopedic trauma, because the majority of your patients will fall off the map once they are no longer in pain.
The solution is adding real-world evidence (RWE) – patient-reported data on outcomes for your own population, the population that’s actually being treated by you. That allows the surgeon to weigh their own surgical skills against the trends affecting their patient population, and compare it to the general population, or even other surgeons. For example, researchers at the university I used to work for created an outcomes-tracking system for orthopedic procedures, which collected data such as pain scores, sleeping scales, infection rates, peri-prosthetic fractures, and quality-of-life measures. That allowed surgeons to refine their practices and improve clinical decision-making – and, in some instances, ceasing to perform procedures that the data showed they weren’t quite as good at as they thought they were.
The REDCap Cloud platform enables the remote collection of patient-reported outcomes before procedures, streamlining workflows and reducing patients’ in-clinic time. After the procedure, the platform can collect critical data such as infection rates, hospital re-admissions, and deaths, allowing surgeons to adjust their practices to lower those rates. Patients and care providers can enter data into the system using a simple, easy-to-use website, either with a computer or smart phone, via email, or automated integrations that will pull complication data directly out of electronic medical records.
The information is stored in the cloud on a secure and compliant database that can be mined for insights into best practices, with automated workflows that generate improved decision-making models. For you, the patient with the broken leg, that means surgeons will take your specific health issues, demographics, and circumstances into account in tailoring your treatment plan, specifically around their own skills and surgical outcomes, vastly increasing the likelihood of a positive outcome.
In one example, researchers studying aqueous skin antisepsis before surgical fixation of open fractures used REDCap Cloud to collect data on surgical site infections from thousands of patients at 18 hospitals, tracking them for 90 days post-surgery.
In another example, REDCap Cloud was used by researchers examining the use of cognitive behavioral therapy to optimize recovery after fracture surgery. The platform collected data on post-surgical pain over 12 months post-fracture, for 1,000 patients at 10 hospitals.