PMID- 37537577 OWN - NLM STAT- MEDLINE DCOM- 20230807 LR - 20231122 IS - 1472-6947 (Electronic) IS - 1472-6947 (Linking) VI - 23 IP - 1 DP - 2023 Aug 3 TI - Leveraging web-based prediction calculators to set patient expectations for elective spine surgery: a qualitative study to inform implementation. PG - 149 LID - 10.1186/s12911-023-02234-z [doi] LID - 149 AB - BACKGROUND: Prediction calculators can help set outcomes expectations following orthopaedic surgery, however effective implementation strategies for these tools are unknown. This study evaluated provider and patient perspectives on clinical implementation of web-based prediction calculators developed using national prospective spine surgery registry data from the Quality Outcomes Database. METHODS: We conducted semi-structured interviews in two health systems, Vanderbilt University Medical Center (VUMC) and Duke University Health System (DUHS) of orthopedic and neurosurgery health care providers (VUMC: n = 19; DUHS: n = 6), health care administrators (VUMC: n = 9; DUHS: n = 9), and patients undergoing elective spine surgery (VUMC: n = 16). Qualitative template analysis was used to analyze interview data, with a focus on end-user perspectives regarding clinical implementation of web-based prediction tools. RESULTS: Health care providers, administrators and patients overwhelmingly supported the use of the calculators to help set realistic expectations for surgical outcomes. Some clinicians had questions about the validity and applicability of the calculators in their patient population. A consensus was that the calculators needed seamless integration into clinical workflows, but there was little agreement on best methods for selecting which patients to complete the calculators, timing, and mode of completion. Many interviewees expressed concerns that calculator results could influence payers, or expose risk of liability. Few patients expressed concerns over additional survey burden if they understood that the information would directly inform their care. CONCLUSIONS: Interviewees had a largely positive opinion of the calculators, believing they could aid in discussions about expectations for pain and functional recovery after spine surgery. No single implementation strategy is likely to be successful, and strategies vary, even within the same healthcare system. Patients should be well-informed of how responses will be used to deliver better care, and concerns over how the calculators could impact payment and liability should be addressed prior to use. Future research is necessary to determine whether use of calculators improves management and outcomes for people seeking a surgical consult for spine pain. CI - (c) 2023. BioMed Central Ltd., part of Springer Nature. FAU - Lentz, Trevor A AU - Lentz TA AD - Department of Orthopaedic Surgery, Duke University, 300 W. Morgan Street, Durham, NC, 27701, USA. trevor.lentz@duke.edu. AD - Duke Clinical Research Institute, Durham, NC, USA. trevor.lentz@duke.edu. FAU - Stephens, Byron F AU - Stephens BF AD - Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA. AD - Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA. FAU - Abtahi, Amir M AU - Abtahi AM AD - Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA. AD - Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA. FAU - Schwarz, Jacob AU - Schwarz J AD - Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA. AD - Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA. FAU - Schoenfeld, Andrew J AU - Schoenfeld AJ AD - Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. FAU - Rhoten, Bethany A AU - Rhoten BA AD - School of Nursing, Vanderbilt University, Nashville, TN, USA. FAU - Block, Shannon AU - Block S AD - Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA. FAU - O'Brien, Alex AU - O'Brien A AD - Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA. FAU - Archer, Kristin R AU - Archer KR AD - Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA. AD - Department of Physical Medicine & Rehabilitation, Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, TN, USA. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20230803 PL - England TA - BMC Med Inform Decis Mak JT - BMC medical informatics and decision making JID - 101088682 SB - IM MH - Humans MH - Prospective Studies MH - *Motivation MH - *Lumbar Vertebrae/surgery MH - Pain MH - Internet PMC - PMC10399016 OTO - NOTNLM OT - Counseling OT - Decision-making OT - Expectation OT - Musculoskeletal OT - Prognosis OT - Surgery COIS- The authors declare no competing interests. EDAT- 2023/08/04 01:07 MHDA- 2023/08/07 06:42 PMCR- 2023/08/03 CRDT- 2023/08/03 23:37 PHST- 2023/02/02 00:00 [received] PHST- 2023/07/12 00:00 [accepted] PHST- 2023/08/07 06:42 [medline] PHST- 2023/08/04 01:07 [pubmed] PHST- 2023/08/03 23:37 [entrez] PHST- 2023/08/03 00:00 [pmc-release] AID - 10.1186/s12911-023-02234-z [pii] AID - 2234 [pii] AID - 10.1186/s12911-023-02234-z [doi] PST - epublish SO - BMC Med Inform Decis Mak. 2023 Aug 3;23(1):149. doi: 10.1186/s12911-023-02234-z.