Rationale

Over the past five years, Dr. Shane Burch, a UCSF spine surgeon, has developed a relational Filemaker Pro database solution (SID) for tracking all patients treated at the UCSF Spine Center.  The system tracks patient reported outcomes at clinical visits for both surgical and non-surgical patients over time, using hundreds of variables to enable both prospective and retrospective research projects. In 2011 over 25,000 patient reported outcome surveys were collected and SID is currently being used in an ongoing double blind prospective randomized FDA trial being run at the spine center. To our knowledge this represents one of the best data collection tools with the highest collection rates on campus. The database solution also offers integration of administrative data (cost) to be linked to patient reported outcomes allowing for economic analyses to be performed like cost minimization. This tool has greatly reduced our outcomes error rate and has helped us increase our outcomes collection rate to ~98% of eligible patients.

While the database is already proving to be very useful, there is still a significant amount of development work required to make the database integrate efficiently into a clinic setting with minimal research support.  We propose to hire a FileMakerPro specialist to help us complete the development of this database which will allow for additional functionality and the expansion of the spine database to other UC campuses. 

While the structure we've developed is specifically for the collection of spine surgery outcomes, this model could easily be adapted to other disciplines.  The true value of this model is in the ability to tie together diagnoses, procedures, and outcomes and produce very simple queries that are easily understandable to lay personnel.   

Plan

Identify and hire a FileMakerPro consultant/developer to complete the following functions:

1. Develop and improve screen layouts for the use of SID on both stationary and mobile devices to expand the collection of patient reported outcomes.
2. Develop an import function to merge outcome data collected via REDCap.
3. Develop additional reporting and export functions to meet departmental needs such as cost analysis reporting, quality assurance reporting and accurate readmission rate reporting.
4. Integration of data from a less versatile database such that the data from as far back as 2002 can be utilized through SID.
5. Functional improvement of tracking patients for prospective studies through expansion of the “prospective study” feature:
   1. Patient preferences for completing outcomes (e.g., email, iPad, paper)
   2. Notifications to research staff triggering patient follow-up (collecting outcomes on patients who don’t return to clinic) to reduce the ‘lost to follow up’ error rate 
   3. Improve the reporting of complications to meet FDA or other societal requirements
6. Roll out to other UC spine groups.
7. Roll out to other UC non-spine groups.

Criteria and Metrics for Success

1. Completion of all plans by 12/31/13 to include a single database containing all surgical and outcomes data from prior databases.
2. Effortless “push of a button” function to import data from REDCap and queries to produce data reports for: outcomes by diagnoses, outcomes by procedure, cost, complication and follow up reporting.
3. Distribution of SID as a turnkey solution for other spine clinics throughout the UC system.

Approximate Cost and Very Brief Justification

Total Budget: $49,500

We estimate that this project can be finished by a developer in 300 hours at a rate of $165/hour.

Collaborators

Dr. Shane Burch – Assistant Professor in Residence, UCSF Department of Orthopaedic Surgery, is an orthopedic surgeon who specializes in the treatment of spinal deformity, degenerative spine conditions and cancer involving the spine.

Linda Racine – Staff Research Associate II, UCSF Department of Orthopaedic Surgery, oversees the collection of outcomes and the management of multiple departmental databases.