CINCINNATI—In the data-driven world of medical outcomes, two
streams of information are needed to produce accurate assessments of success:
one from physicians and one from patients.
patient’s side of the equation was the focus of a poster presentation by a
University of Cincinnati (UC) College of Medicine faculty member today (Tuesday, April 8, 2014) at the International Forum on Quality and Safety in Health Care in
Paris. The presentation served as an addendum to a 2009 study in which Andrew Ringer,
MD, and colleagues published the outcomes of thousands of procedures
collectively performed by 19 physicians.
reporting requires verification, and that means getting data from patients as
well as physicians,” says Ringer, a professor in the UC Department of
Neurosurgery and a Mayfield Clinic neurosurgeon.
and disability can be judged subjectively. An outcome that a physician
considers highly successful may not reflect a
patient’s own experience. We may say that a patient has recovered
without disability, according to our standards, but the patient might consider
himself moderately disabled. In this case, it is not right for me to say, ‘He’s
doing great, he’s perfect,” when he doesn’t feel that way.”
In 2009, amid a growing national focus on the role of patient
outcomes in improving quality and containing costs, Ringer and his UC
colleagues took a leadership role by publishing the outcomes of more than 5,000
consecutive procedures. The results were published in the Journal of Neurosurgery. http://thejns.org/doi/full/10.3171/2012.7.JNS111622?prevSearch=&searchHistoryKey.
presentation, Ringer unveiled new outcomes data within the same neurosurgical
practice. While the success of documentation by neurosurgeons continued to
surpass 90 percent, capturing of patient reporting lagged at 64.4 percent for
1,483 surgeries during a three-month period (third quarter) of 2013. It turns
out that capturing functional outcomes reported by patients or their caretakers
is the more challenging half of the outcomes equation.
want the patient’s participation, you need a different type of effort or
education than simple physician-entered data,” Ringer says. "You need a two-pronged
attack. You have to educate office staff to work with physicians and patients,
and you have to educate patients.”
the collection of patient-centered data varied widely among individual
physician practices. Collection was far lower in practices where associates had
not been trained to collect the information and in practices whose patients
experienced greater disability (e.g., from stroke or brain trauma).
ability to have our patients tell us what our outcomes truly are is powerful data,”
Ringer says. "The message to me is that training for outcomes data collection
cannot focus simply on the physicians and staff, but on our ability to
encourage and educate patients in the process too.”
challenge, Ringer says, is that patients and physicians don’t always use the
same terminology when describing recovery or disability. "Both parties probably
need to understand the goals of the other to understand the meaning of
By tracking outcomes, the physicians hoped to promote quality of
care and better decision-making while establishing data that would be helpful
for patients, families, and healthcare providers. An electronic medical records
system (EMR) helped facilitate the gathering, interpreting and reporting of
data. Information gathered during each patient interaction was recorded into
the EMR by physicians, nurses, medical secretaries and medical assistants.
Outcomes were based on the health and functional status of
patients immediately after surgery and at later post-operative periods. Data
was tracked in the following categories:
• Length of hospital stay.
• Major and minor complications.
• Return to work.
• Symptom severity.
• Scores by validated scales (i.e., the Oswestry Disability Index
for patients with spinal disease; the Karnofsky Performance Scale and Eastern
Cooperative Oncology Group Performance Status for patients with tumors; and the
modified Rankin Scale for patients with vascular conditions and trauma).
Ringer’s co-authors are Philip Theodosopoulos, MD, now at the
University of California San Francisco; and Christopher McPherson, MD, Ronald
Warnick, MD, Charles Kuntz IV, MD, Mario Zuccarello, MD, and John Tew Jr., MD,
all faculty members at UC and members of the UC Neuroscience Institute, a
partnership of the UC College of Medicine and UC Health.
The authors report no conflicts of interest.