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Practice Innovation Unit

It is no secret that healthcare is in crisis: high and rising costs, opaque and inconsistent quality, and widespread provider burnout. Musculoskeletal conditions and care delivery contribute substantially to the local and national burden on patients, providers, and health systems. In response, the Practice Innovation Unit was established in Fall 2016 in the Duke Department of Orthopaedic Surgery. 

The PIU’s mission is to fundamentally transform the way that orthopaedic care is delivered, experienced, and financed. Its approach is to develop, implement, and disseminate effective care models and practice approaches to achieve its vision of high-value patient care and improved provider satisfaction.

PIU Leadership


Espousing a Bias Toward Action, the PIU is quickly and relentlessly enacting its strategy. Whereas many attempts at healthcare solutions tackle one isolated dimension of healthcare (e.g. technology, policy, care delivery), the PIU pursues an integrated strategy: it recognizes the power of architecting the very infrastructure and crafting the very policy that enables transformative care models in which clinicians enjoy practicing, which in turn feed back iteratively to inform smart infrastructure investments and focused, pragmatic policies.

We are delivering results on our strategy:

Care model

Joint Health Program. Launched October 2017, this care model addresses the sizable gaps and opportunities in the non-operative care of hip and knee osteoarthritis through longitudinal, adaptive, personalized lifestyle and behavioral health management delivered and coordinated by a psychologically-informed physical therapist.


Healthcare payment reform. Recognizing the crucial need for new ways to pay for new care models, the PIU is deepening its productive working relationship with the Duke-Margolis Center for Health Policy in engaging stakeholders and publishing literature in condition-based (as opposed to episode-based) payment model design and implementation.

Payers. The PIU is engaged in and is furthering discussions with government and commercial health insurers to move toward productive data sharing and care model pilots to improve the musculoskeletal health of affected populations.

Duke Department of Physical and Occupational Therapy. It has been a joy to act upon the deep collaboration and teamwork fostered between Orthopaedic Surgeons and Physical Therapists to launch the Joint Health Program care model. To effectively care for patients with chronic musculoskeletal conditions, it takes a team of appropriately-skilled multidisciplinary providers delivering the right care at the appropriate times in the right settings.


Ortho data universe. The PIU is core to a larger team building a department-wide data universe to collect patient-reported outcomes, store among other medical record data, and liberate for clinical care, research, and quality improvement purposes.

E-communications. Pilot test of core telehealth EHR technology that enables providers to appropriately screen and schedule patients with the right provider at the right time.

Time-driven activity-based costing. Pilot test of real-time location system tracking of patients, providers, and staff in clinic environment to evaluate costs and effectiveness of care delivery as they relate to healthcare value.

Research and publications. Defining the problems and opportunities in non-operative osteoarthritis management, conceptually how to address them, and practically how to evaluate and implement solutions.

Actionable data science. Building visualizations for the Joint Health Program team to act upon in real-time to care for an individual patient and for the entire population. Data input includes the remote submission of patient-reported symptoms and outcomes.


To get in touch with the Practice Innovation Unit, please contact Jonathan O’Donnell.