Research & Benchmarking

Outcomes Data Collection Instruments and Protocols

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Diabetes
Asthma
Cataract Removal
Hip Replacement
Knee Replacement
Low Back Pain
Generic Forms

Diabetes Data Collection Protocol

Diabetes 2.1 – Patient Form
Diabetes 2.2 – Physician Baseline Form
Diabetes 2.3 – Physician Follow-up Form
Health Behaviors – Patient Form

GET ALL – self-extracting zip file contains all diabetes forms

Asthma Data Collection Protocol

Asthma 10.1 – Patient Form
Asthma 10.2 – Physician Form

GET ALL – self-extracting zip file contains all asthma forms

Cataract Removal Data Collection Protocol

Cataract 3.1 – Patient Preoperative Form
Cataract 3.2 – Physician Preoperative Form
Cataract 3.3 – Day of Surgery Form
Cataract 3.4 – Physician Postoperative Form
Cataract 3.5 – Patient Postoperative Form

GET ALL – self-extracting zip file contains all cataract forms

Total Hip Replacement Data Collection Protocol

Hip 13.1 – Patient Preoperative Form
Hip 13.2 – Physician Preoperative Form
Hip 13.3 – Patient Postoperative Form
Hip 13.4A – Day of Surgery Form
Hip 13.4B – Day of Discharge Form
Hip 13.4C – Physician Postoperative Form

GET ALL – self-extracting zip file contains all THR forms

Total Knee Replacement Data Collection Protocol

Knee 16.1 – Patient Preoperative Form
Knee 16.2 – Physician Preoperative Form
Knee 16.3 – Patient Postoperative Form
Knee 16.4A – Day of Surgery, Unilateral or First Knee
Knee 16.4B – Day of Surgery, Bilateral or Second Knee
Knee 16.4C – Implant Code Form
Knee 16.5 – Hospital Discharge Form
Knee 16.6 – Physician Postoperative Form
Knee 16.7 – Surgeon Information Form

GET ALL – self-extracting zip file contains all TKR forms

Low Back Pain Data Collection Protocol

Low Back 6.1 – Patient Baseline Questionnaire—Non-Surgical and Surgical
Low Back 6.2 – Physician Baseline Questionnaire—Non-Surgical and Surgical
Low Back 6.3 – Patient Post-Operative Questionnaire—Surgical Care
Low Back 6.4 – Physician Post-Operative Questionnaire—Surgical Care
Low Back 6.5 – Facility Discharge Form
Low Back 6.6 – Physician Characteristics Form
Low Back 6.7 – Patient Follow-Up Questionnaire—Non-Surgical Care
Low Back 6.8 – Physician Follow-Up Questionnaire—Non-Surgical Care
Low Back – Patient Employment History

GET ALL – self-extracting zip file contains all low back pain forms

Generic Forms

These forms are used in all of the above protocols

Personal Characteristics
Process Information
Health Status Questionnaire

GET ALL – self-extracting zip file contains all generic forms

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