Two surgeons can have similarly low complication rates while their patients report different recoveries. That difference is worth investigating—and could reveal opportunities to improve care.
A patient’s knee replacement goes according to plan. There is no infection, revision, or readmission. But the patient reported difficulty with stairs before surgery and reports little improvement at follow-up.
An isolated response about persistent difficulty with stairs may not warrant a physician review. The same finding across a group of patients is different: it gives peers a reason to examine whether patient selection, treatment decisions, or recovery support could explain the pattern.
For orthopedic groups already collecting patient-reported outcomes (PROs) for reporting or benchmarking, peer review offers another use for the data: identifying recovery patterns worth examining with physicians. First, physicians need to trust what the data show.
What could PROs add to orthopedic Peer Review and OPPE?
Peer review may be punitive or non-punitive as a concerning case. Ongoing Professional Practice Evaluation (OPPE) looks for trends across a physician’s practice. Depending on the organization, reviewers may draw on chart findings, complications, infection rates, readmission rates, LOS, complication rates, readmissions, revisions, and other relevant measures. The Medical Executive Committee determines which criteria belong in its OPPE process and how the findings are reviewed.
A review can establish that a procedure was appropriate and uneventful while leaving another question unanswered: Did the patient improve? PROs collected before treatment and at follow-up can show changes in pain, function, mobility, and quality of life across patients, including those whose care never prompted a case review. If limited improvement appears repeatedly, peers have a reason to examine the patients and their care.
Would a surgeon trust the comparison?
Surgeons have good reason to ask that question.
In a study of ACL reconstruction, researchers compared 40 surgeons using five subscales of the Knee injury and Osteoarthritis Outcome Score (KOOS), a patient-reported outcome measure. Thirty changed performance quartiles depending on whether the comparison focused on pain, symptoms, daily activities, sports function, or knee-related quality of life – even after adjustment for available patient factors. The study did not test PROs in peer review. It demonstrated how much the choice of outcome can affect a surgeon comparison.
A physician asked to defend a ranking like that would reasonably want to know what was measured and why. They would also want to know which patients are represented. Were baseline and follow-up responses collected consistently? Are patients with difficult recoveries missing from the results? Are there differences in preoperative function or case mix that the comparison does not fully account for?
Having PRO data is one thing. Having data physicians can use confidently in peer review is another. That takes an appropriate measure, consistent collection over time, sufficient follow-up, and enough clinical context to interpret an apparent difference.
This is where the work behind a PRO program matters. CODE manages patient eligibility, outreach, follow-up, recovery of missed responses, and data validation – work that affects whether a pattern can be seen and trusted. The medical staff can then decide how to consider the findings within its review process.
How could a PRO finding lead to better care?
Imagine two hip replacement surgeons whose patients report different gains in function. Once peers establish that the comparison is credible, they can look at where the difference occurs. Is it concentrated among patients who began with particularly limited function? Are patients receiving the same recovery support?
The answers could lead to different decisions. One finding might prompt a closer look at patient selection and expectations before surgery. Another might reveal a rehabilitation barrier affecting patients across the group. Physicians could make a change, then follow the same patient – reported measure to see whether subsequent patients do better.
The discussion can start with a strong result, too. If comparable patients consistently report greater gains in function, peers can examine what might be contributing – from patient selection to recovery support – and consider whether those practices could help the wider group.
This is where PROs can contribute to both patient care and practice-based learning. Physicians can identify a pattern, examine the care behind it, make a change, and follow the same outcome measure to see whether subsequent patients do better. For groups already collecting longitudinal PRO data, that is a reason to bring recovery trends into peer review alongside complications and case reviews.
Bringing the data into the room is only the first step. In studies of comparative PROM feedback to hip and knee surgeons, reports and discussions did not consistently improve the patient outcomes measured. Those studies did not test formal peer review, but they underscore the need to investigate a finding, decide whether care should change, and check subsequent results—not simply circulate a report.
Where should an orthopedic group start?
Start with one procedure and one question the current review process does not answer well. For example: Among patients with uncomplicated knee replacements, how many still report difficulty with daily activities at follow-up?
Then assess whether the existing PRO data can answer it. Look at the measure and follow-up interval, the number of eligible patients, and how many have usable responses before and after treatment. If the data support a credible pattern, bring it to physicians alongside the clinical information they already review. Investigate the cause, decide whether care should change, and keep measuring.
Are your PRO data ready to inform a physician discussion?
