Integrating Data Collection Into Office Work Flow and Electronic Health Records for Clinical Outcomes Research

Abstract

he ability to demonstrate measurable improvement after clinical interventions in the United States has become increasingly important in the past decade with the advent of pay-for-performance and publicly reported outcomes measures. 1 This trend promises to continue as the Centers for Medicare & Medicaid Services (CMS) moves from a volume-based payment model to a value-based payment model and as outcomes and quality indicators are more explicitly tied to reimbursement. 2 The Triple Aim Project, published by the Institute for Health Improvement in 2008, exemplifies this goal: the project's mission is to improve population-level health, enhance the experience and outcomes of the patient, and reduce per capita cost of care, all contributing to a value-based model. 3 Under the value-based payment paradigm, otolaryngologists have a particularly thorny responsibility: as specialists who treat conditions that often produce only subjective symptoms, providing objective outcomes metrics will require dedicated data collection and analysis. This responsibility could be viewed narrowly as a burden; however, it also gives otolaryngologists an opportunity to systematically collect and interpret data on clinical questions that have not heretofore been explicitly studied. The American Academy of Otolaryngology-Head and Neck Surgery has supported this idea by the creation of Reg-ent, a registry of outcomes data that can be extracted from electronic health records (EHRs) across institutions, and by providing access to the registry service to contributing member organizations. 4 By streamlining, automating, and standardizing parts of data collection for patients at specific times throughout their clinical course, we have designed a process by which we are able to easily collect and store data at multiple time points from patients at our institution who undergo functional septorhinoplasty. Data include subjective patient symptoms preoperatively and postoperatively and granular detail, such as type of grafts used and other aspects of operative decision making. In the short term, these data can be used to justify the cost of an elective procedure on the basis of subjective and objective patient improvement. However, in the long term, we anticipate being able to mine these data to make better, more evidence-based decisions about what preoperative patient characteristics prove to be optimal, for example, for one type of graft vs another. In this article, we describe our system and how it has been integrated into our EHR to facilitate data collection and organization. MethodsThis study was performed at the Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts. The electronic data-basewasinitiatedinJuly2013,patientscontinuetobeactivelyenrolled, andfollow-updatacontinuetobecollected.TheMassachusettsEyeand Ear infirmary deemed that institutional review board approval was not required because patient information was not used.

Unilateral Nasal Obstruction Causes Symptom Severity Scores Similar to Bilateral Nasal Obstruction

“…incorporates physical exam grading scales for multiple areas including the septal deviation, internal nasal valve narrowing, external nasal valve narrowing, and lateral wall insufficiency. 9,12,18,19 Measurements are reported for both the left and right sides of the nose. For the septal deviation component of the NAW, a Likert scale from 0 to 3 was used so that 0 was used to describe no septal deviation.…”

“…The subjects completed a preoperative NOSE survey in the clinic electronically and underwent a standardized nasal history and physical exam. 9 All data were collected in REDCap (Research Electronic Data Capture; Vanderbilt University, Nashville, TN), an electronic data-capture platform designed for academic clinical and translational database development. 10 Patient demographic characteristics, nasal history, nasal exam, and preoperative NOSE scores were recorded through REDCap in a Health Insurance Portability and Accountability Act-compliant manner.…”

“…The nasal exam worksheet focused on external nasal anatomy and the NAW on intranasal anatomy. 9 On the NAW, deviation of the septum and nasal valve narrowing and collapse were analyzed by unique categories: left superior septal deviation, right superior septal deviation, left inferior septal deviation, and right inferior septal deviation on a 4-point Likert scale (rated 0 if not present, 1 for mild, 2 for moderate, 3 for severe), and left IVN at rest, right IVN at rest, left external valve narrowing (EVN) at rest, right EVN at rest, left internal valve collapse (IVC) with inspiration, right IVC with inspiration, left external valve collapse (EVC) with inspiration, and right EVC with inspiration on a 3-point Likert scale (rated 1 for absent/mild, 2 for moderate, 3 for severe). Each item was scored individually.…”

Preoperative characteristics of over 1,300 functional septorhinoplasty patients

“…Some were referred for surgical intervention, whereas others wanted to discuss medical and surgical options. The subjects completed a preoperative NOSE questionnaire in the clinic on paper or electronically and underwent a standardized nasal history and physical exam . All data were collected utilizing REDCap (Research Electronic Data CaptureJ) (Vanderbilt University, Nashville, TN), an electronic data‐capture platform designed for academic clinical and translational database development .…”

“…Physical exam findings were documented on a nasal exam and nasal anatomic worksheet in REDCap (Vanderbilt University). The nasal exam worksheet focused on external nasal anatomy and the nasal anatomic worksheet (NAW) on intranasal anatomy . On the NAW, deviation of the septum and nasal valve narrowing and collapse were analyzed by unique categories: left superior septal deviation (rated 0 if not present, 1 for mild, 2 for moderate, 3 for severe), right superior septal deviation (0–3), left inferior septal deviation (0–3), right inferior septal deviation (0–3), left internal valve narrowing at rest (rated 1 for absent/mild, 2 for moderate, 3 for severe), right internal valve narrowing at rest (1–3), left external valve narrowing at rest (1–3), right external valve narrowing at rest (1–3), left internal valve collapse with inspiration (1–3), right internal valve collapse with inspiration (1–3), left external valve collapse with inspiration (1–3), and right external valve collapse with inspiration (1–3).…”