Predictive analytics: Is this the wave of the future for orthopaedic surgery?

While transparency in healthcare delivery and reporting was a mainstream topic in 2015, Predictive Analytics looks to play a major role in orthopaedic practice protocols for years to come.

With the Accountable Care Act and payment reform, hospitals and surgeons are finding themselves placed at risk for the outcomes of patient care. Whether in a bundled payment or Accountable Care Organization Payment Model, the risk of poor patient outcomes either clinically or financially is a real concern.

Enter the world of Predictive Analytics! Predictive Analytics has been defined as "the branch of the advanced analytics which is used to make predictions about unknown future events1." While historically used in many business segments, the use of Predictive Analytics has taken hold in orthopaedic surgery as a means to quantitatively predict various outcomes of joint replacement patient care.

A risk for hospitals and surgeons in a bundled payment model is the discharge status of a patient to either a skilled nursing facility or to home. Data has shown that the clinical outcome of patients discharged home is equivocal to those who are sent to skilled nursing facilities2. Both the Risk Assessment and Prediction Tool (RAPT)3 and the AM-PAC 64 clicks tool developed at the Cleveland Clinic have been developed to assist surgeons in predicting the discharge of joint replacement patients to either a skilled nursing facility or home. With only 6 questions, the RAPT is simple and predictable in terms of probable discharge disposition for total joint replacement (TJR) patients.

With a move towards performing more traditionally inpatient joint replacement procedures as a short-stay or outpatient procedure, the ability to accurately predict whether a TJR patient could be discharged from a facility within 24 hours becomes very helpful information. Dr. Michael Meneghini and Dr. Pete Caccavallo in Indianapolis, Indiana have developed a tool they refer to as Outpatient Arthroplasty Risk Assessment5 (OARA). The OARA tool is a 60 question document that allows the pre-assessment provider (hospitalist/anesthesia) to place a percentage risk of time of discharge on potential TJR patients.

Recently, IBM has announced that they will be utilizing Watson to scan data and create outcome predictive analytics in the field of orthopedic surgery. Many other forms of predictive tools have been developed including the AJRR Risk Stratification tool6.

As healthcare continues to change so will the need for more Predictive Analytic tools to assist facilities and providers in crafting the most effective care plan for TJR patients with a predictable outcome.

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Richard Conn, MD
Medical Director, Stryker Performance Solutions

As a Medical Director for Stryker Performance Solutions, Dr. Conn provides support to our clients, as well as the overall orthopedic community, on such key subjects as healthcare and industry best practices, service line development, Health Care Reform initiatives, system alignment and engagement. Throughout his 28-year orthopedic practice, he focused on operating room efficiencies, innovative technologies, quality care pathways and patient-centric care.

Dr. Conn was the first in Mississippi in many ways: the first fully fellowship-trained Adult Reconstructive Surgeon, the first to offer comprehensive arthritis care, the first to perform outpatient partial knee arthroplasty in an ambulatory surgery setting and the first to envision and develop a comprehensive musculoskeletal complex including MOB, Imaging Center, ASC, PT, DME, Bone Densitometry and Orthopedic specialty hospital. With more than 11,000 joint replacements performed throughout his career, Dr. Conn now looks to share his experience, learn best practice techniques from others and leverage this knowledge to positively impact the lives of the patients we serve. He earned his Medical Doctor degree from the University of Mississippi Medical Center, Orthopedic Internship/Residency at the Greenville Hospital System in Greenville, South Carolina, and Fellowship in Adult Reconstructive Surgery at the Mayo Clinic in Rochester, Minnesota.

Mary Frances Delaune, MPH
Program Manager

Mary Frances applies her vast rehabilitation and service line optimization expertise while implementing Destination Centers of Superior Performance® for Joint Replacement, Spine and Fracture Care. Her 20 years of experience includes Staff Physical Therapist for the Department of Defense and Allied Services, Inc., Rehabilitation Team Coordinator for Maryland General Hospital, Manager of Rehabilitation Services for Anne Arundel Medical Center, Credentials Evaluator for the Foreign Credentialing Commission on Physical Therapists and Director, Department of Practice, for the American Physical Therapy Association.

Active in several professional organizations, Mary Frances is a frequent workshop and conference presenter, and has published numerous abstracts, Continuing Education Unit articles and non-peer-reviewed articles. She earned both Bachelor of Health Science and Master of Physical Therapy degrees from the University of the Sciences of Philadelphia, and studied for a Master of Public Health degree at George Washington University.

1 Downloaded from SAS at May 3,2016. AND Gandomi, A, Haider M. Beyond the hype: Big data concepts, methods, and analytics. Inter J Inform Mgmt. 2015 Apr; 35 (2):137–144.

2 Journal of Arthroplasty 2010 Sep;25(6):885-92. doi: 10.1016/j.arth.2009.06.022. Epub 2009 Sep 2. Predicting patient discharge disposition after total joint arthroplasty in the United States. Barsoum WK1, Murray TG, Klika AK, Green K, Miniaci SL, Wells BJ, Kattan MW.

3 Dauty M, Schmitt X, Menu P, Rousseau B, Dubois C. Using the Risk Assessment
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4Jette DU, Stilphen M, Ranganathan VK, Passek SD, Frost FS, Jette AM. AM-PAC
"6-Clicks" functional assessment scores predict acute care hospital discharge
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5 Meneghini RM, Ziemba-Davis M, Ishmael MK, Kuzma AL, Caccavallo PP. Safe Selection of Outpatient Joint Replacement Patients with Medical Risk Stratification: The "OARA Score". Paper presented at the 26th Annual Meeting of the American Association of Hip and Knee Surgeons (AAHKS), Nov 10-13, Dallas, TX.

6 American Joint Replacement Registry. Annual Report 2014. Published by the American Joint Replacement Registry, Rosemont. Retrieved May 6, 2016 from

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