The Patient-Centered Outcomes Research Institute (PCORI) has awarded a research award of $6.3M to develop a real-time, decision support tool with evidence-based data. The goal is to provide individualized, patient-centered information to guide optimal knee and hip care, including joint replacement and non-operative care decisions.
PCORI: $6.3M to Develop Real-Time Decision Tool
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According to the May 20, 2016 news release, “The contract will build upon the work of FORCE-TJR, the most comprehensive U.S. database on total hip and knee joint replacement patients and their surgical outcomes. FORCE-TJR is currently being used by surgeons and hospitals across the country as a care management system and patient outcomes reporting tool. Originally funded by the Agency for Healthcare Research and Quality (AHRQ), FORCE-TJR provides for independent assessment of TJR effectiveness in terms of both implant performance and improvement in patient pain and physical function.”
Principal investigator Patricia D. Franklin, M.D., M.B.A., M.P.H., co-lead of FORCE-TJR and Professor and Director of Clinical and Outcomes Research in the Department of Orthopedics and Physical Rehabilitation at the University of Massachusetts Medical School, will lead the contract.
“The information gathered by FORCE-TJR over the past four years from more than 30, 000 TJR patients and 280 surgeons across the country has established a valuable database. We’ve been able to develop the only risk-adjusted, US national benchmarks for peri-operative adverse events, patient-reported outcomes (PROs), and early implant failure in both CMS patients, as well as the 45% of TJR patients who are under 65 years of age, ” said Dr. Franklin in the news release. “The PCORI contract is recognition that such information is the cornerstone for comparing the effectiveness of different approaches in TJR and will transform the data into actionable information for individual patients and physicians making care decisions.”
As indicated in the news release, “The PCORI contract will be used to refine and test the existing FORCE-TJR web-based care management system as an automated care plan for patients and surgeons to use together when making decisions about TJR or further non-operative care. The care plan will include FORCE-TJR’s individualized pain and function measures, trended over time, estimated benefits and risks of TJR, evidence-based information and patient goals.”
Dr. Franklin told OTW, “This award will develop two new tools to improve patient information when making decision for keep/hip arthritis care. The first are patient reports using patient-defined terms—not just PRO (patient reported outcome) scores used by physicians. The second are predictions of likely individual outcomes. Using the national database, we can estimate how the specific patient will improve with surgery based on other patients like them. “
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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