Hasani Swindell, MD, has treated professional athletes whose livelihoods depend on getting back on the field. Now, he practices in Brooklyn, N.Y., where many of his patients have a different reason they cannot afford to stay sidelined: Their livelihoods depend on getting back to work.
To Dr. Swindell, the distinction is smaller than it might seem.
Whether the goal is returning to professional sports, getting back to a physically demanding job or playing basketball on the weekend, orthopedic care ultimately has to answer the same question: Did the treatment actually get the patient back to what matters to them?
Dr. Swindell, an orthopedic sports medicine surgeon and assistant professor of orthopedic surgery at New York City-based Columbia University and NewYork-Presbyterian Brooklyn Methodist Hospital, is helping Columbia build an infrastructure designed to answer that question with greater precision.
The orthopedic surgery department is implementing PatientIQ, an outcomes platform that allows physicians to systematically collect and analyze patient-reported outcomes. As orthopedic care faces greater scrutiny over outcomes and reimbursement, Dr. Swindell sees something larger at stake: who gets to define whether orthopedic care is working.
“If we don’t think of a way to measure how well we’re doing, somebody else is,” Dr. Swindell told Becker’s.
Beyond ‘in my experience’
Orthopedics has been measuring outcomes for decades. What has changed, Dr. Swindell said, is the precision expected from those measurements.
Early research often classified results broadly as satisfactory, good or excellent. The field later moved toward validated measures and, increasingly, standardized patient-reported outcomes that allow surgeons to track recovery across procedures and patient populations.
That matters because broad conclusions about whether a procedure works can obscure important differences among patients.
“We kind of overgeneralize,” Dr. Swindell said. As surgeons narrow their focus to particular procedures and patient populations, “the quality of our outcomes have to be better.”
PatientIQ allows practices to collect those outcomes over time and query them by factors such as procedure, patient characteristics and recovery milestones.
Instead of simply telling a patient with an anterior cruciate ligament injury that recovery takes a certain number of months, for example, a surgeon could point to how similar patients actually progressed.
Success isn’t the same for every patient
For a professional running back, recovery might mean regaining the speed and confidence required to cut on the field. For someone who plays basketball recreationally, success might mean being able to play three-on-three again.
Patient-reported outcomes can capture some of those differences, but Dr. Swindell said measurement still begins with a straightforward conversation.
“It starts with asking the patient, ‘What are your goals?’” he said.
He returns to those goals during follow-up visits, tracking whether the patient is getting closer to the activity that matters to them.
“It’s really about setting goals, tracking progress and figuring out how to get from point A to point B,” he said.
That philosophy has followed Dr. Swindell from Chicago to Brooklyn.
He completed a sports medicine fellowship at Chicago-based Midwest Orthopaedics at Rush, where he served as a team physician for professional and collegiate athletes. He is now Columbia’s first extension of sports medicine into another New York City borough.
The populations are different, but Dr. Swindell has found an important parallel. Many of his Brooklyn patients are manual laborers or union workers whose ability to earn a living also depends on their bodies. For them, months away from work can carry serious consequences.
“When we think of professional athletes, we think about doing everything we can to get them back to a physically demanding profession where their physical abilities are their livelihood,” he said. “For many of the patients I’m treating now, it’s the same idea.”
Return to play and return to work, he said, can be remarkably similar measures.
The data could humble surgeons
Better outcomes data will not necessarily tell surgeons what they want to hear. Dr. Swindell expects it to be “humbling in some ways.”
Without meaningful benchmarks, physicians can end up improving things that may have little bearing on whether patients actually get better. A surgeon might become faster at performing an ACL procedure, for example, but Dr. Swindell questions the value of that improvement if it does not change the patient’s outcome.
Better data can instead establish what he described as the “goalpost.” It could also put evidence behind one of medicine’s most familiar phrases: In my experience.
“I was always taught not to say, ‘In my experience,’ because what does that really mean?” he said. “Now you can actually measure how your patients do.”
The transparency can extend across a practice. If one physician’s patients consistently report stronger outcomes, colleagues can ask what that physician is doing differently.
“Everybody wins at the end,” Dr. Swindell said.
If surgeons don’t define success, someone else will
For Dr. Swindell, the stakes extend beyond individual surgeons.
Standardized outcomes across large numbers of patients could give orthopedics stronger evidence about which procedures work, for whom and by how much, evidence he sees becoming increasingly important as insurers scrutinize reimbursement.
But there is another reason he believes physicians should take the lead.
“If we do it now, we have the power to decide what we’re measuring because we’re the ones in the field,” he said.
Otherwise, he worries outside stakeholders could establish measures that fail to capture what matters clinically and use them to make broader decisions about care and resources.
“It’s twofold,” Dr. Swindell said. “It’s for the patients, but it’s also about keeping our practices and hospitals and allowing us to continue providing care with the freedoms we have now.”
Automating outcomes collection can also leave physicians with less administrative work competing for their attention.
“If I can think less about those things and just pay attention to who’s in front of me because everything else is already taken care of, then I can focus on what I’m trying to do and what I’m good at,” he said.
Taking the guesswork out
Dr. Swindell expects the data being collected today to eventually help surgeons make more individualized treatment decisions.
He pointed to efforts to use patient characteristics to estimate outcomes with different ACL grafts as an example. Applied more broadly, similar models could help surgeons assess a patient’s likelihood of success, potential complications and factors to consider before recommending treatment.
There will always be variables a model cannot neatly capture, from a patient’s occupation to the resources available during recovery. That, Dr. Swindell said, remains part of the art of medicine.
But better data could remove some of the uncertainty around everything else.
“We use good data to predict who’s going to do well after a procedure,” he said. “That’s the pinnacle of what we can ask for. It takes the guessing out of it.”
That is the larger promise Dr. Swindell sees in outcomes measurement: better evidence about what works, without losing sight of the individual patient it is supposed to work for.
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