Category: Federal Forum Posters
Purpose: Chronic post-surgical pain (CPSP) affects up to 58 percent of patients following orthopedic surgery. The risk is especially high in Veterans due to the prevalence of concurrent mental health diagnoses. Developing CPSP can lead to prolonged opioid therapy. To track post-operative clinical progress, opioid usage and CPSP risk factors, the Veterans Administration (VA) Salt Lake City Healthcare System Transitional Pain Service (TPS) developed the Follow-Up Report (FUR), a health information technology (HIT). The FUR calculates and chronologically sorts follow-up dates for pre-specified intervals to prioritize care delivery. We investigated the proportion of Veterans completing follow-up at each interval.
Methods: We performed a retrospective cohort study to evaluate the role of the FUR on care coordination after discharge from surgery. We identified all Veterans discharged from an orthopedic surgical procedure at the VA Salt Lake City Healthcare System between 01/17/2018 and 06/01/2018, and included those that were assigned to receive peri-operative and follow-up care from TPS. The data source for this investigation is the VA Corporate Data Warehouse, a repository of medical and pharmacy records. The primary outcome was the proportion of Veterans with a completed follow-up visit, defined by entry of both a TPS progress note and pain scores in the electronic medical record, at each of the pre-specified intervals as shown on the FUR. The secondary outcome was the proportion of Veterans with a completed follow-up visit at each interval, based on surgical procedure. Confidence interval (CI) estimates were calculated using the Clopper-Pearson exact test for both the primary and secondary outcome.
Results: The investigation cohort is comprised of 96 Veterans, accounting for 100 orthopedic surgical procedures: 12 ankle, 14 hip, 38 knee, 29 shoulder and 7 other orthopedic procedures. For the primary outcome, we observed the following proportions for completed follow-up; day-2: 82 percent (95 percent CI: 73 to 89); day-7: 82 percent (95 percent CI: 73 to 89); day-10: 74 percent (95 percent CI: 64 to 82); day-14: 79 percent (95 percent CI: 69 to 86); day-21: 69 percent (95 percent CI: 58 to 78); day-30: 78 percent (95 percent CI: 67 to 86); day-60: 75 percent (95 percent CI: 64 to 85); day-90: 69 percent (95 percent CI: 54 to 81); day-120: 75 percent (95 percent CI: 53 to 90). In the secondary outcome, we observed variations in completion rates at each interval, based on surgical procedure. However, the overlap of confidence intervals did not highlight any specific surgical procedure(s) as outliers for completed follow-up.
Conclusion: A customizable HIT has allowed TPS to efficiently and effectively track clinical progress, opioid use and pain scores for Veterans undergoing orthopedic surgery. We report a high proportion of Veterans with completed follow-up at each evaluation interval. The synergy between HIT and dedicated population-health programs holds immense potential for optimizing care delivery. Our model of TPS and the FUR can be replicated to direct care delivery in other service lines within VA, and beyond.
Shardool Patel– Clinical Pharmacist â€“ Informatics, Salt Lake City VA Medical Center, Salt Lake City, UT