“Ultimately, it’s the patient outcome that counts”

With support from the AO’s Innovation Funding, the International Consortium for Health Outcomes Measurement (ICHOM) has developed the world’s first standardized set of patient-centered outcome measures for major injury.

The now-completed 18-month project, funded by the Transport Accident Commission (Victoria, Australia), the AO Foundation, and the Dutch Stichting ZiektekostenVerzekering Krijgsmacht (Armed Forces Health Insurance Foundation) in tandem with the Ministry of Defence in the Netherlands, aims to drive groundbreaking improvements in how trauma outcomes are measured and evaluated, ultimately enhancing patient care globally. 

Michael Schütz, Chairperson of the AO Technology Transfer Board and director of the Jamieson Trauma Institute in Brisbane, Australia, led the project and was a member of the project’s Patient-Centered Outcomes Measures Working Group. In this interview, he emphasizes how standard outcome measurements can drive patient empowerment and cost efficiency and explains how the AO can help make a difference for patients and health care providers.

Why is international collaboration so important in trauma outcomes measurement?

Michael Schütz: I have been trained and worked in Switzerland, Germany, and Australia. When I compare these healthcare systems, there are subtle differences in how complex trauma is managed, based on historical and health economic aspects. And when you look at other jurisdictions worldwide, some of these regions lack structured trauma systems and are looking for guidance. What matters most is either preventing injuries or providing excellent care, so patients feel well managed and supported—leading to the best possible outcomes. Comparing outcomes, costs, and setups across countries helps us learn from each other and improve value-based patient care. That was the intention of this project—to make systems more comparable. The recommendations standardize outcome measures, making it possible to compare patient results and system costs across countries for similar injuries. This includes factors like education, training, pre-hospital care, and rehabilitation—but ultimately, it’s the patient outcome that counts.

What made the ICHOM the best possible partner for this project?

The benefit of developing these outcome measures with the ICHOM is that they've done it before. They know the processes quite well. The ICHOM has experience with outcome scores for about 60% of global diseases. Like the AO, the ICHOM has a strong global network. Nowadays, they're a partner at the World Economic Forum (WEF). There are obvious discussions to be had at the WEF, there's diabetes, there's obesity, there’s cardiovascular disease. And the ICHOM is always part of these discussions because it developed the outcome scores. It’s recognized as a global player. I met the ICHOM founder, Stefan Larsson, a long time ago, and from my own experience working in various systems, I thought: Actually, that's something we should do for major trauma. The ICHOM applies a very rigorous process to its projects. After conducting a thorough literature review, we formed a global working group and held regular virtual meetings—sometimes inconveniently timed, especially for our collaborators in New Zealand, who had to join the calls at 2 or 3am.

What are the next steps now that the project has been concluded?

Now that it's been published in the Lancet, we'll have to take it further.. This is a tool, not more, not less. On the one hand, we need to promote it and make it more well-known among stakeholders. But this is just one component. The other and even more crucial part is that we need to implement and use this tool, ideally in several jurisdictions worldwide. The tool is flexible regarding the injury severity score (ISS), and we hope to see it adopted for major injuries internationally. Implementation is always the hardest part. Doctors may see the survey as extra work, and another challenge is that surveys tend to attract only highly motivated patients. The real challenge is to engage the broader patient population, who may not be as motivated or able to complete surveys. I'm a very strong advocate of linking this tool in as many ways as possible. We also need to team up with health economists who give us a clear understanding of how the costs are calculated and what you can do in different jurisdictions.

How do you envision improving patient engagement?

An empathetic AI language tool could revolutionize data collection, interacting with patients to complete surveys and gather both objective and subjective information. It could also provide valuable feedback to patients about their recovery, improving doctor-patient communication. This is very important. I see a patient, and I know he had this injury. And if I have all this data, I can say to him: “You are doing better than 80% of the people who have a similar injury, particularly in terms of strength.” And then, as a physician, you’re in a situation where you not only get information but also give information back to the patient. Doctor-patient communication is not a one-way street. You have to give back.

Why is patient empowerment so important in trauma recovery?

Empowering patients with information helps them become active participants in their recovery. When patients understand their condition and set personal goals, it benefits not only them but also their families and communities. A very important question is how we can build up trust in patients. Nowadays, a lot of patients seek answers online. We need to be able to give them an outlook, a clear recovery timeline. We should be able to tell our patients: When you have this kind of injury, expect two years of recovery. It's not you, it's the injury and the combination of your injuries, and you need to accept it. Because if patients have false expectations, their mental health will deteriorate, and that can be a serious burden on the system. Recovery is not purely a surgical thing, and it's important to investigate what we can improve about it.

So basically, patient empowerment leads to better outcomes?

Yes. When a patient understands themselves as part of the team, the outcome will be better. Otherwise, they just sit around and don’t participate in their healing. We can't afford this, our systems can’t afford it. Especially in severe trauma, because recovery doesn't happen overnight. And if you understand the process as a patient, you can collaborate in your own healing.

How can the AO contribute to this process?

The AO’s original focus was on developing implants and training surgeons, but we’re now actively expanding into new technologies and patient-centered approaches. We’re striving to be a differentiator. Our global network is a significant asset, and by forging the right partnerships and collaborations, we can have an impact. Insurance companies are very interested in collaborating on such projects because they carry the financial burden and are looking for ways to reduce their costs. We need to look for partners with expertise that we don’t have, and at the same time offer our own expertise to become part of something bigger. The AO has been a collaborator in developing these outcome measures, and we should continue our participation by bringing a global group of like-minded people and organizations together who want to run studies.