Published 6/20/2024
Stuart J. Fischer, MD, FAAOS

AAOS Evidence-Based Quality and Value Committee Launches Evidence-Based Medicine Programs

The AAOS Evidence-Based Quality and Value (EBQV) Committee has put together a series of programs that explain the fundamentals of evidence-based medicine. This will be an invaluable resource for residents, fellows, and clinicians in practice who wish to learn more about how orthopaedic evidence is obtained and how studies are used to evaluate that evidence. The seven PowerPoint modules outline how clinical practice guidelines (CPGs) and performance measures are derived, along with the role that diagnostic, prognostic, and therapeutic studies play in developing evidence-based medicine. There is information about how to create PICO questions (Population, Intervention, Control, Outcome) that act as the framework of evidence-based studies. As both governmental and commercial payers look to evaluate the effectiveness of various orthopaedic treatments and the value they provide, a good understanding of the process for obtaining data is essential.

The EBQV curriculum consists of seven specific presentations that were initially posted in 2014. All have been reviewed and updated in 2024. They are presented by practicing surgeons who have been involved with the Academy’s evidence-based medicine programs and are members of the AAOS EBQV Committee. The learning modules are listed below.

Evidence-Based Orthopaedics: An Introduction
An introductory guide to how practitioners can use evidence-based medicine. This is the integration of best research evidence to determine patient treatment. The presentation outlines:

  1. how to perform a focused PubMed search
  2. how to assess levels of evidence of individual studies
  3. how to interpret the clinical significance versus statistical significance of review results
  4. how to interpret meta-analyses, test results, and forest plots

Evidence-Based Orthopaedics: Clinical Practice Guidelines
CPGs are educational tools to guide qualified physicians through treatment decisions. AAOS provides CPGs for common problems based on current and high-quality evidence. This module reviews the history of the evidence-based process, including a discussion of practice implications and limitations of guidelines. There is also a review of the CPG process and an explanation of the PICO format, levels of evidence, and how evidence is appraised. The presentation demonstrates CPG workgroups’ efforts to minimize bias during the development process.

Developing Evidence-Based Clinical Practice Guidelines
This module outlines the role of AAOS CPGs as well as their structures and the nine phases of the CPG development process. A CPG consists of procedure recommendations for a particular condition or disease topic that are supported by the best available literature evidence. CPGs are based on systematic literature reviews in which the quality of evidence is assessed and potential biases limited.

Evidence-Based Orthopaedics: Prognostic Studies
Prognostic studies are used to better understand the natural history of a disease and to help guide clinical decision making. This module includes a case-study presentation as an example of how to use prognostic studies as evidence when deciding on treatment. The module also discusses the types of primary studies used to assess prognosis and how to compare and assess the validity of the studies.

Evidence-Based Orthopaedics: Diagnostic Studies
This module provides a review of the key principles used in evaluating the strength of diagnostic studies as well as their precision and accuracy. It discusses specificity rule-in and sensitivity rule-out likelihood ratios and predictive values in case studies. The cases show how to apply these concepts to test performance.

Evidence-Based Orthopaedics: Evaluation of Therapeutic Studies
A therapeutic study involves the enrollment of patients and provides a specific treatment to the patients to study the impact on a disease. This module illustrates the inevitability of imperfections in trials, emphasizing that every study possesses limitations. Furthermore, it underscores the importance for practitioners to remain vigilant in discerning whether these limitations render a study’s conclusion invalid or if it remains valuable in informing treatment recommendations tailored to individual patients.

Clinical Practice Guidelines: Performance Measures
Performance measures are the key indicators of quality of care. This module discusses the methodology used in creating performance measures and their importance to clinicians. It explains how to properly frame PICO questions as part of measure development. It also reviews specific types of measures and their key components. In addition, there is guidance on interpreting CPT recommendations for measure development.

Individuals enrolled in these learning programs have the opportunity to earn one complimentary CME credit per module after completing a short quiz based on the presentation.

Each of the modules is narrated by current and past members of the AAOS EBQV Committee, including Antonia Chen, MD, MBA, FAAOS; Henry Bone Ellis Jr, MD, FAAOS; Aaron Chamberlain, MD, MSc, MBA, FAAOS; Paul Manner, MD, FAAOS; Matthew Schmitz, MD, FAAOS; and Stuart Fischer, MD, FAAOS. The seven evidence-based medicine modules are available on the Academy Learning Platform and can be accessed at learn.aaos.org.

Stuart J. Fischer, MD, FAAOS, is an orthopaedic surgeon in private practice in Watchung, New Jersey. He also serves on the AAOS Membership Council, Board of Councilors, and EBQV Committee.