Adolescent Idiopathic Scoliosis DSS A Guide for Residents

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Adolescent Idiopathic Scoliosis DSS A Guide for
Residents

• Tanaz Dutia
• Debby Keller
• Emily Zajano
• Healthcare Information Systems Project 2
• May 3, 2000

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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

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Our Specific Problem

• A DSS for adolescent idiopathic scoliosis
• Attacked single piece of problem Which treatment
  option should be used for patients 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

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Technical Architecture
Presentation
Problem Processing
Knowledge
Language

• Presentation system GUI, forms in MS access
• Language systemVisual basic, SQL
• Problem processing system Visual basic
• Knowledge system built in MS access, Scoliosis
  Research Society, AAOS Homepage, Lovell and
  Winters Guide to Pediatric Orthopedics

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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 21
  ratio.
• When curves in excess of 30 degrees are
  evaluated, females are more frequently affected
  by a ration of approximately 8-101.

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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.

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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.

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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.

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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

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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
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Case Scenarios

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

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Moving Ahead

• Expanding DSS to include left lumbar and right
  thoracic curves for consideration
• Security measures