Thursday, March 31, 2016

New measures help quantify improvement patients experienced following knee and spine surgery

New data from the Minnesota Department of Health (MDH) and Minnesota Community Measurement (MNCM) indicate most Minnesota patients enjoyed increased mobility following knee and spine surgeries, but the degree of improvement varied across medical groups.

Minnesota is the first state in the nation to collect and publicly release outcome data for three orthopedic surgeries: total knee replacement, lumbar fusion surgery and herniated disk surgery. The data are collected as part of Minnesota's Statewide Quality Reporting and Measurement System.

The results from providers who submitted data to MNCM show most patients improve in their ability to complete activities such as sitting, walking and getting in and out of bed after surgery. MNCM publicly reports these results at

Spine surgeries were measured on a 100-point scale. Patients on average saw a 16.7-point change after lumbar fusion surgeries and a 22-point change after herniated disk surgery. A higher number of points indicated greater improvement in a patient's pain, function and mobility after surgery.

Knee replacement outcomes were measured on a 48-point scale, on which the top score represented a fully functioning knee. The statewide average change in score after knee surgery was 17.1 points. Again, a higher number of points indicated greater improvement after surgery.

According to Minnesota Health Commissioner Dr. Ed Ehlinger, getting Minnesotans quality information about the outcomes associated with common medical procedures helps empower them to increase ownership of their health care. Given the aging of the state's population, he said it will become even more important in the years ahead to have solid data about the outcomes associated with knee and spine surgeries.

"It is important to understand the effectiveness of these surgeries because the demand for them is growing," Commissioner Ehlinger said. "I am pleased that Minnesota has taken the lead by providing patients with quality information about the degree to which these procedures have helped to alleviate pain and to improve mobility and function."

More than 700,000 knee replacements are performed each year in the United States, and with an aging population staying active and working longer, that number is expected to rise above 3 million by 2030. Meanwhile, the number of spine surgeries in patients older than 65 is expected to rise 59 percent by the year 2025.

For the spine and knee procedures, Minnesota's statewide quality reporting system uses measures based on Patient Reported Outcome (PRO) tools. The measures, developed by MNCM, are unique in that they are based on the patients' own accounts of changes in their physical and mental health status before and after the surgeries, including their ability to do normal household and job-related activities.

"These measures are an ideal way for clinics to measure function, pain and quality of life from the best source of the information – their patients," said Jim Chase, MNCM President. "Measures based on PROs are an increasingly sought-after type of health care performance measure."

A total of 31 medical groups submitted data for total knee replacements; 13 medical groups for lumbar fusion surgeries; and 16 medical groups for herniated disk surgeries.

"We are very excited about these first-year results and are a believer in transparency," said Dr. Paul Huddleston, a consultant with the Department of Orthopedic Surgery at Mayo Clinic, which had better than average results for the total knee replacement measure. "We can't get these type of results without the proper protocols, standardization and teamwork in place. As patients get older and sicker, the challenge will be to maintain our level of results."

Chase thanked the providers who participated for helping to advance patient knowledge and acknowledged the process was new for many of the specialists involved.

"We understand that sharing this information on outcomes with the public is a relatively new concept to specialties like orthopedics," said Chase. "The primary care community has been measured for over a decade and has come to value the measures and indicate extensive use of the results to improve care."

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