Following the opening of the Research & Outcomes Centre at the London Sports Orthopaedic practice, Ian McDermott discusses the importance of clinical research and data gathering in today’s modern practice
Most people would tend to associate research with labs and with universities. However, research underpins the very essence of modern evidence-based clinical practice, and a thorough knowledge and understanding of research is essential for maintaining the most modern and up-to-date patient care with the latest technologies.
To-date, it has always been particularly difficult to set up and run clinical research projects within the independent healthcare sector, and even robust clinical audit and outcomes data has proved hard to obtain. The advent of PHIN (the Private Healthcare Information Network) is a meaningful and positive outcome from the CMA’s attempt at improving competition and ‘customer care’ within the private sector. For years, people have talked about how difficult it is to gather outcomes data and to make a meaningful assessment of ‘quality’ within healthcare. However, with PHIN now being legally mandated to gather data from the independent healthcare sector, there is finally a much-needed incentive that is now forcing people to take data collection far more seriously.
While we fully support PHIN’s endeavours, what has become very clear to all involved is that the task that PHIN took on far exceeds what it initially appeared prepared for. After a period of what appeared to be some resistance from some professional organisations and registries with respect to the sharing of confidential data, it now looks as if PHIN are slowly gaining ground and momentum. However, the scope of its remit and the extent of the dataset being gathered is, inevitably, somewhat limited, and whether PHIN will actually be able to provide meaningful data that truly differentiates between the quality of care provided by different centres or by different individual consultants, or how long it might take to achieve this, remains to be seen.
What is clear, however, is that the culture of data gathering and of data sharing, when it comes to clinical outcomes, is now established, and this is something that those consultants with a clear sense for improvement will want to embrace and engage with, rather than remaining passive and just relying on faceless nameless clerks to provide unvalidated data that could potentially impact upon each consultant’s reputation and practice.
Within the London Sports Orthoapedics (LSO), we are taking our data collection very seriously, and we consider the basic PHIN dataset as just a rudimentary starting point. Our new Research & Outcomes Centre is equipped with a brand new top-of-the-range Biodex Isokinometer, for accurately measuring strength, power and speed for multiple movements of multiple different body parts. Our Research Centre is also the first in the UK to be able to offer the latest in 3D video gait analysis, with the Emovi KneeKG. In addition, we now have a dedicated Research Office, staffed by a full-time clinical nurse specialist, a dedicated research physio and a dedicated research nurse, all working with LSO in conjunction with London Bridge Hospital. Our centre now allows us to gather extensive datasets of patients’ pre-op and post-op objective and subjective performance and outcomes scores, with PROMs (Patient Reported Outcomes Measures) being taken directly from patients, face-to-face, and recorded and stored with dedicated software developed in conjunction with Optimum Contact, who provide outcomes data for several NHS Trusts.
Our aim is very specific: to gather detailed, accurate, robust patient data so that we can demonstrate clinical outcomes, with a view to us sharing our data and publishing our outcomes widely. We believe that within our practice we offer first-class patient care of the highest possible calibre, and we intend to prove that and quantify that, rather than just relying on ‘soft data’ from patient and referrer feedback.
However, the PROMs data is just a basic starting point. The LSO Research & Outcomes Centre has also been set up specifically to support multiple clinical audits and clinical research projects, with several projects already underway, including:
A retrospective audit of 60 meniscal allograft transplantation cases, evaluating the different potential definitions of success.
A retrospective comparative cohort audit of 120 patients investigating the effects of Vivostat PRF biological glue in reducing pain, swelling and bleeding after total knee replacement surgery.
A review of 50 patients following internal bracing of Achilles tendon repairs with FibreTape.
A prospective study investigating the role of patellar taping in patients with patellar maltracking, using a patellofemoral calliper and 3T MRI at 30 degrees knee flexion.
Since opening the Research Centre we have already received several submissions from local physiotherapy colleagues for further collaborative clinical projects.
It is our firm intention to generate significant volumes of papers and presentations, providing further insight into the latest and best clinical treatments, to ensure that the private sector starts to contribute actively to academia.
To support our endeavours, the consultants at LSO have helped establish the Sports Orthopaedics Research Foundation (SORF). SORF (www.sorf.org.uk) is an independent entity with its own Board of Trustees, and it has been set up as a tool to generate funding to support clinical audit, research, medical training and education. It has recently succeeded in its registration with the Charities Commission to be registered as a formal charity, and the foundation has already managed to accrue funds, with a formal grants application policy and a grants committee made up of individuals with proven academic records.
We are determined to persevere with our mission to bring clinical audit and research firmly into the private sector. With each project that we set up, the overall process for designing studies and for going through the formal application processes (with hospital approval and with formal Research & Ethics Committee submissions) becomes that much easier, with a positive feedback loop and a snowball effect. The task that PHIN has been handed is huge and daunting, but it is incumbent on all consultants to seize this moment as a pivotal point, and to engage with clinical outcomes deeply and enthusiastically.
We’re all aware of how poor quality data can be when it is gathered by relatively disinterested and sub-optimally informed individuals with no vested interest in the data’s accuracy: the only way to counter the potential negatives is for consultants to lead on their own data capture and for this data to be shared openly.
The private healthcare sector offers some of the newest techniques with some of the latest technologies from some of the best consultants in the world in some of the best hospitals in the world. With time and effort, with a bit of commitment and appropriate investment, and with the right manpower and the right tools, we really ought to be able to corroborate statements that currently sound like just marketing spiel, and back them up with genuine hard facts and figures.
Patient care in the private sector in the UK is truly world class, particularly in the top London private hospitals, where investment has been huge. Let’s all work together properly to actually prove it.
For more information, visit: www.sportsortho.co.uk