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Adolescent Idiopathic Scoliosis DSS A Guide for Residents

Adolescent Idiopathic Scoliosis DSS A Guide for Residents. Tanaz Dutia Debby Keller Emily Zajano Healthcare Information Systems Project 2 May 3, 2000. What Is the Problem?. What is the problem: Inefficiencies & errors in the clinical surgical realm Why is it a problem:

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Adolescent Idiopathic Scoliosis DSS A Guide for Residents

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  1. Adolescent Idiopathic Scoliosis DSS A Guide for Residents Tanaz Dutia Debby Keller Emily Zajano Healthcare Information Systems Project 2 May 3, 2000

  2. What Is the Problem? • What is the problem: • Inefficiencies & errors in the clinical surgical realm • Why is it a problem: • Escalating hc costs, time costs, lack of integration between sites, surgical implications • Whose problem is it? • Surgeons, patients, policymakers • What is the value of a DSS? • Easier access to information • Sort relevant information • Increased ability to process information

  3. Our Specific Problem • A DSS for adolescent idiopathic scoliosis • Attacked single piece of problem; Which treatment option should be used for patient’s curve angle • Tool for residents/teaching • Actual component DSS: rules for curvature and treatment options for the data input by surgeon • Makes the decisions: given this right thoracic curve angle, which treatment should be used? • Secondary DSS: pre-and post-operative checklists • Other tools: • Integrate scheduling (between departments), research and hyperlinks, cost considerations, treatment risks

  4. Technical Architecture • Presentation system: GUI, forms in MS access • Language system:Visual basic, SQL • Problem processing system: Visual basic • Knowledge system: built in MS access, Scoliosis Research Society, AAOS Homepage, Lovell and Winter’s Guide to Pediatric Orthopedics Presentation Problem Processing Knowledge Language

  5. Background on Scoliosis • Of every 1,000 children, 4 develop spinal curves that are considered large enough to need treatment. • Adolescent idiopathic scoliosis (unknown cause) is the most common type and occurs after the age of 10. It is more common in females by a 2:1 ratio. • When curves in excess of 30 degrees are evaluated, females are more frequently affected by a ration of approximately 8-10:1.

  6. Treatment 1: Observation • Doctors follow patients without treatment and re-examine them every 4 to 6 months. • The patient must be skeletally immature. • An idiopathic right thoracic curve of less than 25 degrees. • No added costs. • Risk of curve progressing.

  7. Treatment 2: Bracing • Purpose is to stop a curve from progressing when the patient is still growing* and has an idiopathic curve: • Between 20 and 39 degrees. • As a child nears the end of growth, the indications for bracing will depend on how the curve affects the child's appearance, whether the curve is getting worse, and the size of the curve. • Recommended brace: TLSO, Charleston (night only). *If female, has not had her first menstrual period.

  8. Treatment 3: Surgery • Advise patients to have surgery to correct a curve or stop it from worsening when: • To prevent further progression of the curve. • To control the curve when brace treatment has failed. • To improve an undesired cosmetic appearance. • For reasons of discomfort or postural fatigue. • Recommended surgery: posterior spinal fusion.

  9. Process- Before Entering DSS • Detect scoliosis • Location: school checks, PCP visits, other • A curve of 10 degrees or more • Uneven shoulders and waist • Prominent shoulder blade or shoulder blades • Elevated hips • Leaning to one side • Is diagnosis correct? • Tumor, asymmetric abdomen • Refer to orthopedic surgeon • Use only right thoracic curve for DSS

  10. Process in DSS Doctor reviews standards for AIS Enter measurement into Patient Form -Standard Measurement Form -Hyperlinks -DSS: Treatment option for curve angle *If within surgical parameters, provides buttons linking to next step -Option to override treatment decision by DSS -Review Cost/Risk Considerations from form Surgical Aspect Follow-up Checks -DSS: Pre-operative and post-operative checklists -Access surgical schedule -Check status of all patients using DSS on follow-up visits

  11. Case Scenarios • #1:Anne Smith, age 11 • Treatment option-brace • Dr. Zajano • #2:Timothy Way, age 14 • Treatment option- surgery • Dr. Dutia

  12. Moving Ahead • Expanding DSS to include left lumbar and right thoracic curves for consideration • Security measures

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