E-mail reminders improve completion rates of patient-reported outcome measures.

BACKGROUND: Patient-reported outcome measures (PROMs) have become increasingly important in assessing clinical outcomes. However, acquisition of data at routine time intervals can be challenging. The ability of e-mail reminders to save follow-up intervals when office visits are missed is unknown. MATERIALS AND METHODS: A retrospective review of a consecutive series of 186 shoulder surgical patients who underwent surgery between October 2, 2012, and July 2, 2013, was conducted. Simple Shoulder Test and 12-Item Short Form Health Survey scores were completed at preoperative visits using office-based tablet surveys. Patients were observed for completeness of PROMs at expected routine follow-up of 1 year and 2 years. When office visits were missed, e-mail reminders with links to online surveys were sent to patients without further incentives. Improvement in data acquisition achieved using e-mail reminders when patient follow-up was missed was assessed. The influence of the procedure performed was further analyzed to determine whether patients treated with different surgical procedures would be more compliant with PROM completion. RESULTS: Use of e-mail reminders significantly increased the number of patients for whom complete follow-up data were obtained. Compared with tablet surveys completed during office visits alone, the addition of e-mail reminders increased the collection of complete PROM data (both 1- and 2-year follow-up) by 25.8% (P < .001). Similar findings were observed for total shoulder arthroplasty and arthroscopic rotator cuff repair patients (increased by 25.7% and 34.4%, respectively; P < .001). CONCLUSION: E-mail reminders serve as a mechanism to increase the completeness of follow-up data in the absence of in-office patient evaluation.

In-hospital Mortality Risk for Femoral Neck Fractures Among Patients Receiving Medicare.

Increased risk of mortality with time has been established in association with femoral neck fractures. However, little is known about the in-hospital mortality risk associated with femoral neck fractures in the US population. This study was conducted to determine the in-hospital mortality rate associated with femoral neck fractures and to identify independent demographic features associated with an increased risk of this primary outcome. The authors queried the PearlDiver database (PearlDiver Technologies, Inc, West Conshohocken, Pennsylvania) of Medicare patients from 2005 to 2010 for International Classification of Diseases, 9th Revision (ICD-9), diagnostic codes for femoral neck fractures and related conditions. Stratified sampling was conducted by creating a group within the data set that included patients with a death discharge using ICD-9-D-820.0 through ICD-9-D-820.13. Age, sex, and year of injury were analyzed as specific demographic variables related to mortality. A total of 751,232 femoral neck fractures occurred during the index study period. There were 11,420 deaths during the initial hospital stay, for an overall mortality rate of 1.52%. The mortality rate in patients older than 84 years was 2.06%. Of all deaths, 89% occurred in patients who were 75 years and older. The mortality rate for femoral neck fractures was 1.22% in women and 2.32% in men (odds ratio, 0.5; 95% confidence interval, 0.25-1.04). The overall mortality rate for patients in the Medicare population who were treated at an inpatient center for femoral neck fractures from 2005 to 2010 was 1.5%. Men had a mortality rate almost twice that of women. Patients older than 84 years were the most likely to die soon after sustaining a femoral neck fracture.

Trends in the Management of Achilles Tendon Ruptures in the United States Medicare Population, 2005-2011.

BACKGROUND: Achilles tendon ruptures are one of the most commonly treated injuries by orthopaedic surgeons and general practitioners. Achilles tendon ruptures have classically been thought to affect the middle-aged "weekend warrior" participating in basketball, volleyball, soccer, or any other ground sport that requires speed and agility; however, with a more active elderly population, these tears are becoming more common in older patients. PURPOSE: To report trends in nonoperative and operative treatment of Achilles tendon tears in the United States from 2005 to 2011 in patients registered with a large Medicare database. STUDY DESIGN: Descriptive epidemiological study. METHODS: Patients who underwent nonoperative and operative treatment of Achilles tendon ruptures by either primary repair or primary repair with graft (International Classification of Diseases 9 [ICD-9] diagnosis code 727.67, Current Procedural Terminology [CPT] codes 27650 and 27652) for the years 2005 to 2011 were identified using the PearlDiver Medicare Database. Demographic and utilization data available within the database were extracted for patients who underwent nonoperative as well as operative treatment for Achilles tendon ruptures. Statistical analysis involved Student t tests, chi-square tests, and linear regression analyses, with statistical significance set at P < .05. RESULTS: From 2005 to 2011, there were a total of 14,127 Achilles tendon ruptures. Of these, 9814 were managed nonoperatively, 3531 were treated with primary repair, and 782 were treated with primary repair with graft. The incidence of Achilles tendon increased from 0.67 per 10,000 in 2005 to 1.08 per 10,000 in 2011 (P < .01). There was no significant difference in the number of Achilles ruptures between males (6636) and females (7582) (P > .05). There was an increase in the overall number of Achilles tendon ruptures over time (1689 in 2005 compared with 2788 in 2011; P < .001) but no difference in the percentage of Achilles ruptures treated operatively (P > .05). Older patients were more likely to be treated nonoperatively (P < .05). No differences in operative versus nonoperative treatment were seen between yearly quarter (P > .05), sex (P > .05), or region (P > .05). CONCLUSION: The incidence of Achilles tendon ruptures is increasing with time, but the trend in operative and nonoperative treatment has not changed between 2005 and 2011. Older patients, especially those older than 85 years, are more likely to be treated nonoperatively. No differences in treatment patterns were seen based on sex, region, or yearly quarter.