The Emerging Impact of the Information Age on Orthopaedic Surgery

In the early 1980s, orthopaedic surgeons made the transition from reviewing patient cohorts on paper to storing patient data in computerized databases. These databases have proven to be useful tools for documenting patient care, performing clinical research, and fostering continuing education. Patient databases will play an even more important role in the future as orthopaedic surgeons and software developers further exploit the power of the Internet. In this paper, we review our experience with use of a patient database at a single institution, the strides being taken to create a registry that can be used by many centers, and the potential to accelerate these efforts through the widespread use of the Internet. Patient databases store information collected from instruments designed to measure components of patient care. We have used a system model (Fig. 1) to consider these individual components. In the model, patient care comprises the continuous and recurring cycle of evaluation, decision, and intervention, and the interactions among these three elements. Each of these components can be measured independently. Validity, reliability, and sensitivity are measures of evaluation. Appropriateness is a measure of the decision, and outcome is a measure of the intervention. Satisfaction is a measure of patient care as a whole. Fig. 1: System model for patient care. Patient care comprises the continuous and recurring cycle of evaluation, decision, and intervention, and the interactions among these elements. To demonstrate the use of one of these measures with a patient database, consider the example of a study that we conducted to determine the appropriateness of total hip replacement. We measured the change in the physical scales of the Short Form-36 (SF-36) from a point immediately before hip replacement surgery to two years after surgery in a consecutive group of 200 patients1. The patient population was divided into three groups …