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Framework - More Patient Input, Better Spine Outcomes
Framework Fall 2014
More Patient Input, Better Spine Outcomes
Date: October 1, 2014
The goal of Richard Skolasky’s research is to help surgeons and patients speak the same outcomes language.
Not long ago, researchers measured spine surgery outcomes based on technical expertise, fusion rates, deformity correction and equipment failure. But that only told half the story, says health services researcher Richard Skolasky, an associate professor of orthopaedic surgery and director of The Johns Hopkins Hospital’s Spine Outcomes Research Center. “Patients,” he says, “are the experts in their own experience.” Yet despite a greater focus on patient-reported outcomes measures in recent years, attempts to identify factors that influence patient satisfaction have been limited, says Skolasky, “so we need to identify the domains that are most important to patients and find ways to make their assessment a part of clinical care.”
The challenge, he notes, is doing so without being disruptive and burdensome to patients and providers. To that end, Skolasky, who holds degrees in health policy management and experimental psychology, has launched a pilot study in the Johns Hopkins spine clinic and continually seeks ways to engage patients in their care.
Informed by questionnaire responses from an earlier study on spine outcomes, Skolasky and his colleagues assembled a data collection process that involves asking patients about pain, disability, function, depression and anxiety. Questions include: “Are you anxious about surgery?” and “How confident are you that you’ll be able to participate in physical therapy after surgery?”
Skolasky is finding that patients appreciate the opportunity to stop and gather their thoughts. Spinal dysfunction, he says, is not only a complex medical condition, it’s a complex health care process that involves primary care, a surgeon and a physical therapist. Following method standards, Skolasky and colleagues use the NIH-developed Patient-Reported Outcome Measurement Information System (PROMIS) to assess the patient’s state of well-being, suffering and function before and after major operations. He envisions putting touch-screen tablets in waiting rooms to capture data and return results in real time.
So far, the data collection has been used primarily for research purposes. The next step, says Skolasky, is to put that data into clinicians’ and patients’ hands to encourage conversation about treatment and recovery. Ideally, he says, physicians should identify beforehand what patients hope to get out of the surgery and compare those expectations with the level of medically anticipated improvement—and possible barriers.
Most surgeons, adds Skolasky, “don’t want to proceed if the patient’s expectations aren’t realistic.” Having a conversation about expected outcomes, he says, “will put everyone in a good standing for surgery.”