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Challenges in Outcome Measurement: Discrepancies Between Patient and Provider Definitions of Success

  • Symposium: ABJS Carl T. Brighton Workshop on Outcome Measures
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Clinical Orthopaedics and Related Research®

Abstract

Background

Some orthopaedic procedures, including TKA, enjoy high survivorship but leave many patients dissatisfied because of residual pain and functional limitations. An important cause of patient dissatisfaction is unfulfilled preoperative expectations. This arises, in part, from differences between provider and patient in their definition of a successful outcome.

Where Are We Now?

Patients generally are less satisfied with their outcomes than surgeons. While patients are initially concerned with symptom relief, their long-term expectations include return of symptom-free function, especially in terms of activities that are personally important. While surgeons share their patients’ desire to achieve their goals, they are aware this will not always occur. Conversely, patients do not always realize some of their expectations cannot be met by current orthopaedic procedures, and this gap in understanding is an important source of discrepancies in expectations and patient dissatisfaction.

Where Do We Need to Go?

An essential prerequisite for mutual understanding is information that is accurate, objective, and relevant to the patient’s condition and lifestyle. This critical information must also be understandable within the educational and cultural background of each patient to enable informed participation in a shared decision making process. Once this is achieved, it will become easier to formulate similar expectations regarding the likely level of function and symptom relief and the risk of adverse events, including persistent pain, complications, and revision surgery.

How Do We Get There?

Predictive models of patient outcomes, based on objective data, are needed to inform decision making on the individual level. This can be achieved once comprehensive data become available capturing the lifestyles of patients of diverse ages and backgrounds, including data documenting the frequency and intensity of participation in sporting and recreational activities. There is also a need for greater attention to the process of informing patients of the outcome of orthopaedic procedures, not simply for gaining more meaningful consent, but so that patients and providers may achieve greater alignment of expectations and increased acceptance of both the benefits and limitations of alternative treatments.

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Acknowledgments

The authors thank Dr Ken Mathis, Dr Walter Lowe, Dr Melvyn Harrington, Dr Richard Kearns, Dr Greg Stocks, Dr Vas Mathews, Dr. Brian Parsley, Prof Justin Cobb, Dr. Aaron Rosenberg, Prof Alister Hart, Dr Sarah Muirhead-Allwood, Dr Michael Heggeness, Dr Jesse Dickson, Dr Andrew Shimmin, Dr Ormonde Mahoney, Dr Pat McCullough, Dr Jan Victor, Dr David Lintner, Dr Aaron Rosenberg, Dr Tony Hedley, Dr Richard Field, Dr Glenn Landon, Dr Steve Incavo, Dr Mark Brinker, Dr Roger Levy, Dr Jim Benjamin, Dr Gil Scuderi, Dr Jim Pritchard, Dr Sam Tarabichi, Dr Kim Bertin, Dr Ashok Rajgopal, and Dr Richard Moore for their valuable and insightful discussions on the topic of patient and surgeon expectations.

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Authors and Affiliations

  1. Institute of Orthopedic Research and Education, 6550 Fannin, Suite 2503, Houston, TX, 77030, USA

    Philip C. Noble PhD & Sophie Fuller-Lafreniere MPH

  2. Baylor College of Medicine, 6620 Main Street, Suite 1325, Houston, TX, USA

    Philip C. Noble PhD

  3. The Methodist Hospital, 6550 Fannin Street, Suite 2503, Houston, TX, USA

    Morteza Meftah MD

  4. Kaplan Joint Center, Newton Wellesley Hospital, 2000 Washington Street, Suite 361, Newton, MA, 02462, USA

    Maureen K. Dwyer PhD

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  1. Philip C. Noble PhD
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This work was performed at the Institute of Orthopedic Research and Education, Houston, TX, USA.

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Noble, P.C., Fuller-Lafreniere, S., Meftah, M. et al. Challenges in Outcome Measurement: Discrepancies Between Patient and Provider Definitions of Success. Clin Orthop Relat Res 471, 3437–3445 (2013). https://doi.org/10.1007/s11999-013-3198-x

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