Patient Osteoarthritis Careplan to Inform Optimal Treatment
- Ronald Scott
- Allison Ripa
- Hazel and Richard DeNeeza
- Meg Waldron-Evers, Citizens for Patient Safety, LLC
- Warren Ferguson, MD
- Joanne Calista, Area Health Education Center
Other Stakeholder Partners
- FORCE-TJR orthopedic surgeon network
- FORCE-TJR Stakeholder Committee
- Representatives of American Academy of Orthopedic Surgeons
- Representatives of American Association of Hip and Knee Surgeons, Centers for Medicaid and Medicare Services, Food and Drug Administration, patient safety, and federal research organizations
- Carol Oatis, PT, PhD
- Ewa Roos, PT, PhD
Two-thirds of adults over 65 years of age suffer with knee or hip osteoarthritis (OA) and its associated pain and disability. When the pain is no longer controlled with medication and physical therapy, OA patients face the decision of whether to undergo total joint replacement surgery (TJR). OA patients report that it is difficult to know how their individual symptoms will benefit from surgery, or what risks TJR brings. We propose to automate an OA Careplan for patients and surgeons to use together when making decisions about TJR or further non-operative care. The OA Careplan will include individualized pain and function measures trended over time, estimated benefits and risks of TJR, evidence-based information to guide patient–surgeon decisions, and patient goals. In addition, patients report that peer and primary care support are important when making TJR decisions. Patients and clinicians need new system solutions to provide individualized, patient-centered information to guide care decisions in advanced knee and hip OA.
We propose to refine and test an existing web-based, individually tailored system to inform OA patient and surgeon decisions. Patients, orthopedists, physical therapists, and primary care clinicians will refine the design, content, and usability of a real-time, web-based individual OA Careplan to guide TJR and non-operative OA care decisions. The OA Careplan uses enhanced clinical information technology to deliver a real-time, decision support tool with evidence-based data to inform optimal knee and hip OA care, including TJR and non-operative strategies. The OA Careplan is based on standardized patient-reported measures.
OA Careplan use and impact will be evaluated within the established FORCE-TJR orthopedic network with over 230 surgeons in 28 states. In the initial phase of the study, a random sample of 40 surgeons with 4,000 patients will receive (or not) the tailored OA Careplan. In the second phase, community-based peer and primary care physician (PCP) support will be added to the standard OA Careplan and the combined impact evaluated in another 4,000 patients. We hypothesize that the OA Careplan will improve the interaction of informed, activated patients and prepared clinicians to enhance decision process and quality and that informed decisions will improve the quality of OA care and outcomes. Second, we hypothesize that the OA Careplan plus peer and PCP support will enhance the impact. Results will guide future OA Careplan implementation to ensure optimal health care for patients with advanced knee and hip OA, and lessons can be extrapolated to other elective surgical decisions.