Volume 05 / Issue 01 / March 2017
Page 32
boa.ac.uk
JTO Features
Pro One (Amplitude Clinical): a solution for clinical outcome data collection? Dennis Kosuge
Patient reported outcome measures (PROMs) are collected routinely and are published in the public domain1. They have limitations, but most would agree that PROMs overcome clinician bias and the problems with the use of revision rates, in isolation, as a measure of success2. Individual surgeons need to take ownership of their own data collection to ensure accuracy. Soon after being appointed as a Consultant I started to use Pro One (Amplitude Clinical), a web-based outcome data collection system. Patient demographics, including an e-mail address, are inputted. Patients are e-mailed questionnaires, such as the EQ5D and Oxford Hip and Knee Score, pre-operatively. Additional information such as medical co-morbidities, operation notes in NJR format and complications are also recorded. Postoperatively patients are sent PROMs questionnaires at defined
Dennis Kosuge
intervals. A ‘Friends and Family’ test and patient recorded complications are sent in the first year. Reminders can be sent through the system. I download all of this data onto an Excel spreadsheet for analysis. Initially my main concern was whether e-mail was going to be reliable. However, I have 214 patients in my database and only 11% are unable to provide an e-mail address. Overall 71% of primary total hip arthroplasties (THA) and 91% of primary total knee arthroplasties (TKA) have completed their one-year followup data (Tables 1 and 2). I am recently appointed, and consequently the numbers are small. Nevertheless, I believe it is a start – my aim is to develop my own, career-long, ‘joint registry’. I can input complications at any time. Patients on the other hand are e-mailed to record complications at six weeks and six months. The system flags up any patient reported complications and I can amend the information. I have had one dislocation following THA. The TKAs were complicated by one intra-operative lateral condyle fracture, three patients MUA’s and two superficial wound infections. The data allows me to reflect on my practice. For example, the three TKAs requiring MUA were probably due to a combination of time required to reacquaint myself with the implant my hospital had on shelf and my more conservative approach to bone cuts initially – all were cases within six months of my
Table 1
Pre-op
6 months
Initial number of patients
% patients completing
THA – Oxford Hip Score
15.5
39.1
70
64
TKA – Oxford Knee Score
19.1
36.9
70
70
Pre-op
1 year
Initial number of patients
% patients completing
THA – Oxford Hip Score
16.4
40.1
48
77
TKA – Oxford Knee Score
19.5
37.9
47
91
Table 2
Tables 1 & 2: Mean PROM scores for THA and TKA at 6 months and 1 year
commencement. I am also trying to improve my TKA PROMs – I have focused attendance on TKA conferences in the past year and I have concentrated on others’ advice on how to achieve knee scores over 40. I accept this is only short-term data but continuous analysis will allow me to monitor my performance in the mid- and long-term. It allows me to explore ways in which I can enhance patient care. The prospectively captured data will hopefully allow me to present and publish in the future, as well as use the data for appraisal and revalidation. We work in a world where our practice and its outcomes are examined under a microscope. Pro One helps answer these concerns. I would recommend that any surgeon who wants to monitor his or her performance to take a look at Amplitude Clinical.
Other than being a user, I have no affiliations with Amplitude Clinical. n Dennis Kosuge was appointed as Consultant in Trauma and Orthopaedics at The Princess Alexandra Hospital in Harlow in 2015. Dennis was formerly on the Percival Pott Orthopaedic Rotation and at the end of his training, to pursue his subspecialty interest further, he spent a year at Royal Adelaide Hospital doing a hip arthroplasty fellowship.
References 1. NJR Surgeon and Hospital Profile. National Joint Registry (2016) at www. njrsurgeonhospitalprofile.org.uk 2. Rolfson, O. & Malchau, H. The use of patient-reported outcomes after routine arthroplasty: beyond the whys and ifs. Bone Joint J. 97B, 578–81 (2015).