1
|
Florentino SA, Baumhauer JF. Letter to the Editor: What Do Orthopaedists Believe is Needed for Incorporating Patient-reported Outcome Measures into Clinical Care? A Qualitative Study. Clin Orthop Relat Res 2024; 482:1094-1095. [PMID: 38578029 PMCID: PMC11124702 DOI: 10.1097/corr.0000000000003063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 03/05/2024] [Indexed: 04/06/2024]
Affiliation(s)
| | - Judith F. Baumhauer
- University of Rochester Department of Orthopaedic Surgery, Rochester, NY, USA
| |
Collapse
|
2
|
Witkin LR, Kasubhai A, Jiang SY, Gotian R. Understanding providers' perspectives using patient-reported outcomes in a pain management setting: a pilot study. Pain Manag 2024; 14:163-172. [PMID: 38573070 PMCID: PMC11229384 DOI: 10.2217/pmt-2023-0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 03/19/2024] [Indexed: 04/05/2024] Open
Abstract
Aim: This pilot study evaluated an electronic patient-reported outcomes collection system in pain management to understand providers' experiences using the data, and how it affects their patient interaction and guides their clinical decision-making. Materials & methods: Using stratified convenience sampling, nine semi-structured interviews were conducted with consented pain physicians. The transcribed, de-identified interviews were coded and analyzed. Results: Although most physicians utilized patient reported outcomes (PROs), one-third reported no significant change in their practice since implementation and 56% stated it does not influence their treatment recommendations. Conclusion: Despite the importance of measuring the impact of chronic pain on quality of life, there are significant limitations to the real-world use of PRO that may limit the patient's assessment and care.
Collapse
Affiliation(s)
- Lisa R Witkin
- Department of Anesthesiology, Weill Cornell Medicine, NY 10065, USA
| | - Abha Kasubhai
- Department of Anesthesiology, Weill Cornell Medicine, NY 10065, USA
| | - Silis Y Jiang
- Department of Anesthesiology, Weill Cornell Medicine, NY 10065, USA
| | - Ruth Gotian
- Department of Anesthesiology, Weill Cornell Medicine, NY 10065, USA
| |
Collapse
|
3
|
Shapiro LM, Katz P, Stern BZ, Kamal RN. Equitable Integration of Patient-Reported Outcomes Into Clinical Practice-Opportunities, Challenges, and a Roadmap for Implementation. J Am Acad Orthop Surg 2024; 32:187-195. [PMID: 38194644 DOI: 10.5435/jaaos-d-23-00798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/08/2023] [Indexed: 01/11/2024] Open
Abstract
Patient-reported outcome measures (PROMs) provide a standardized assessment from the patient about their own health status. Although originally developed as research tools, PROMs can be used in clinical care to complement objective functional measures (eg, range of motion) and are increasingly integrated to guide treatment decisions and predict outcomes. In some situations, when PROMs are used during clinical care they can improve patient mortality, outcomes, engagement, well-being, and patient-physician communication. Guidance on how PROMs should be communicated with patients continued to be developed. However, PROM use may have unintended consequences, such as when used implemented without accounting for confounding factors (eg, psychological and social health) or in perpetuating healthcare disparities when used imprecisely (eg, lack of linguistic or cultural validation). In this review, we describe the current state of PROM use in orthopaedic surgery, highlight opportunities and challenges of PROM use in clinical care, and provide a roadmap to support orthopaedic surgery practices in incorporating PROMs into routine care to equitably improve patient health.
Collapse
Affiliation(s)
- Lauren M Shapiro
- From the Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, CA (Shapiro), the Department of Medicine, University of California-San Francisco, San Francisco CA (Katz), the Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine, New York, NY (Stern), the VOICES Health Policy Research Center, and Department of Orthopaedic Surgery, Stanford University, Redwood City, CA (Kamal)
| | | | | | | |
Collapse
|
4
|
Solberg LI, Ziegenfuss JY, Rivard RL, Norton CK, Whitebird RR, Elwyn G, Swiontkowski M. Is There Room for Individual Patient-Specified Preferences in the Patient-Reported Outcome Measurement Revolution? J Patient Cent Res Rev 2023; 10:210-218. [PMID: 38046995 PMCID: PMC10688914 DOI: 10.17294/2330-0698.2017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
Purpose The study aim was to test the feasibility of collecting qualitative patient-preferred outcomes or goals and the degree of their attainment as an addition to a standardized process for collecting quantitative composite patient-reported outcome measures (PROMs) from patients undergoing knee joint replacement. Methods Patients of a large Midwestern medical group scheduled to have total replacement of their knee joint have been asked to complete a PROMs survey preoperatively and at 3 and 12 months after surgery since 2014. In March 2020, an open-ended question about their most important preferred outcome was added to the existing questionnaire. The responses for all 3 time periods from the first 6 months of this addition were summarized quantitatively and analyzed by 2 reviewers. Results During that 6-month period, 1481 people completed the main survey while 1463 (98.8%) also completed the open-ended question. At baseline, 90.8% of the 590 baseline respondents identified a preferred outcome. If multiple-choice categories had been used, 82.7% of the responses would have lost some or a large amount of their preferred goals' meaning. Of the 144 who completed surveys at both baseline and 3 months, 86.1% reported another outcome in addition to pain relief, while 54.2% reported "Complete or Mostly" achieving their self-identified preferred outcome. Conclusions Most people who have joint replacement surgery and respond to a quantitative PROMs survey are willing to report on their other preferred outcomes as well. Adding an open-ended question to PROMs surveys may increase clinician focus on addressing outcomes important to each patient.
Collapse
|
5
|
Dyrek N, Pulik Ł, Piwowarczyk A, Skała W, Grabowska-Mycko N, Łęgosz P. Cross-Cultural Adaptation, Reliability, and Validity of the Polish Version of the Neck Outcome Score. Clin Pract 2023; 13:1352-1359. [PMID: 37987422 PMCID: PMC10660527 DOI: 10.3390/clinpract13060121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 10/18/2023] [Accepted: 10/26/2023] [Indexed: 11/22/2023] Open
Abstract
This study aimed to translate and psychometrically validate the Neck Outcome Score (NOOS) in the Polish population according to the recommendations of the American Academy of Orthopedic Surgeons Participants completed online version of the NOOS, Neck Disability Index (NDI), and Visual Analogue Scale (VAS) for pain assessment (23 November 2021-9 April 2022). The questionnaires were completed by 57 women and 32 men with cervical spine ailments. A retest was performed after 48 h. The analysis confirmed the high internal consistency (Cronbach's alpha of 0.95) of the Polish NOOS. No floor/ceiling effects were observed. The Polish NOOS showed a significant Spearman's coefficient correlation with NDI (0.87; p < 0.001) and VAS (0.79; p < 0.001). The intraclass correlation coefficient (ICC) for the test-retest was found to be high (0.97). The Polish NOOS can be used for clinical and research purposes as an equivalent to the original version.
Collapse
Affiliation(s)
- Nicola Dyrek
- Student Scientific Association of Reconstructive and Oncology Orthopedics, Department of Orthopedics and Traumatology, Medical University of Warsaw, 02-005 Warsaw, Poland
| | - Łukasz Pulik
- Department of Orthopedics and Traumatology, Medical University of Warsaw, Lindley 4 Str., 02-005 Warsaw, Poland
| | - Aleksandra Piwowarczyk
- Student Scientific Association of Reconstructive and Oncology Orthopedics, Department of Orthopedics and Traumatology, Medical University of Warsaw, 02-005 Warsaw, Poland
| | - Wiktoria Skała
- Student Scientific Association of Reconstructive and Oncology Orthopedics, Department of Orthopedics and Traumatology, Medical University of Warsaw, 02-005 Warsaw, Poland
| | - Nina Grabowska-Mycko
- Department of Orthopedics and Traumatology, Medical University of Warsaw, Lindley 4 Str., 02-005 Warsaw, Poland
| | - Paweł Łęgosz
- Department of Orthopedics and Traumatology, Medical University of Warsaw, Lindley 4 Str., 02-005 Warsaw, Poland
| |
Collapse
|
6
|
Shapiro LM, Koh J, Jones C, Seiden RF, Spindler K. Introducing the Patient-Reported Outcome Measures Workgroup and How It Is Helping Patients and Physicians Harness the Benefits. J Am Acad Orthop Surg 2023; 31:1057-1058. [PMID: 37580049 DOI: 10.5435/jaaos-d-23-00599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Affiliation(s)
- Lauren M Shapiro
- From the Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, CA (Shapiro), Department of Orthopaedic Surgery, NorthShore University Health System, Skokie, IL (Koh), Orthopaedic Surgery Department, Dignity Health Arizona, Phoenix, AZ (Jones), American Academy of Orthopaedic Surgeons (Seiden), Department of Orthopaedic Surgery, Cleveland Clinic Florida, Coral Springs, FL (Spindler)
| | | | | | | | | |
Collapse
|
7
|
Arshad Z, Haq II. Letter to the Editor: What Do Orthopaedists Believe is Needed for Incorporating Patient-reported Outcome Measures into Clinical Care? A Qualitative Study. Clin Orthop Relat Res 2023; 481:1650-1651. [PMID: 37326518 PMCID: PMC10344580 DOI: 10.1097/corr.0000000000002740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 05/23/2023] [Indexed: 06/17/2023]
Affiliation(s)
- Zaki Arshad
- Foundation Doctor/House Officer PGY-1, University Hospitals Leicester NHS Trust, Leicester, UK
| | - Ibrahim Inzarul Haq
- Senior House Officer PGY-3, University Hospitals Leicester NHS Trust, Leicester, UK
| |
Collapse
|
8
|
Riddle DL. KOOS score maps were externally validated to inform knee arthroplasty shared decision making. Knee Surg Sports Traumatol Arthrosc 2023; 31:1491-1499. [PMID: 36622418 PMCID: PMC10065897 DOI: 10.1007/s00167-023-07315-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/04/2023] [Indexed: 01/10/2023]
Abstract
PURPOSE The Knee injury and Osteoarthritis Outcome Survey (KOOS) profile of outcome measures are among the most commonly used outcome measures in knee arthroplasty (KA). The purpose was to develop and externally validate "score maps" (one-page figural depictions of most likely scores) for KOOS Pain and Function subscales to facilitate a variety of clinical decisions related to shared decision making prior to KA. METHODS Presurgical KA data collected within 1 year of surgery and obtained in two independent studies were used in this cross-sectional study. Score maps were designed to be easily understandable, single-page graphical depictions of predicted KOOS Pain, and KOOS Function, daily activity subscales. To create the score maps, individual item scores from one dataset were used to determine the most probable responses for each item for the entire range of possible scores. Predicted KOOS score maps were derived from Osteoarthritis Initiative (OAI) data and externally validated using an independent single site KA cohort study. Score map predicted scores from OAI were compared to actual presurgical KOOS subscale scores using Weighted Kappa (Κw) agreement coefficients and actual versus predicted differences in scores. RESULTS The score maps derived from OAI and applied to actual scores in the validation sample demonstrated moderate to substantial chance-corrected agreement for both KOOS Pain and KOOS Function, daily activity subscale items. For example, KOOS Pain score map scores applied to the external validation dataset showed chance-corrected agreement with Κw ranging from 0.43 to 0.73. Score maps predicted actual item scores within ± 1 point at least 94% of the time. Findings for the KOOS Function, daily activity subscale items were similar. CONCLUSIONS Score maps derived from OAI data agreed with actual KOOS scores obtained on an independent dataset at an acceptable degree of precision. Easy-to-use KOOS Pain and Function, daily activity score maps have potential to facilitate a variety of important clinical decisions during discussions between patients and surgeons prior to KA. LEVEL OF EVIDENCE Level III prognostic study.
Collapse
Affiliation(s)
- Daniel L Riddle
- Departments of Physical Therapy, Orthopaedic Surgery and Rheumatology, Virginia Commonwealth University, 900 East Leigh Street, Fourth Floor, Room 100, Richmond, VA, USA.
| |
Collapse
|
9
|
Pronk Y, van der Weegen W, Schreurs BW, Pilot P. Quality of total hip arthroplasty health care based on four years of patient-reported outcomes in the Netherlands. Health Qual Life Outcomes 2023; 21:24. [PMID: 36918879 PMCID: PMC10011788 DOI: 10.1186/s12955-023-02104-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 02/21/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Joint arthroplasty registries have incorporated patient-reported outcomes (PROs) to evaluate outcomes from a patients' perspective to improve total hip arthroplasty (THA). To draw valid conclusions on PROs, a minimum response rate (RR) of 60% is advised. This study investigated (1) if the quality of THA health care based on PROs improved over the years in the Netherlands, (2) if RRs improved over the years, and (3) difference in PROs over the years in hospitals with RR ≥ 60% compared to RR < 60%. METHODS Longitudinal study with publicly available datasets from 2016 to 2019. Primary outcome was increase/decrease in PRO change scores including 95%CI ranges over the years between preoperatively and 3 months postoperatively (pre-3 m), and 12 months postoperatively (pre-12 m). Improved quality of health care was arbitrary defined as when ≥ 3 of 4 included scores or ranges were statistically significant improved. Secondary outcome was increase/decrease in RRs over the years. Subgroups RR ≥ 60% and RR < 60% were compared. RESULTS Hospitals (%) collecting THA PROs increased from 78 to 92%. EQ VAS change score increased over the years, and 95%CI ranges of EQ VAS, EQ-5D descriptive system and NRS pain during activity decreased over the years at pre-3 m (p < 0.05). All THA pre-12 m PRO change scores and 95%CI ranges remained equal (p > 0.05). Pre-3 m RR remained equal (around 43%, p = 0.107) and pre-12 m RR decreased 9% (49% to 40%, p = 0.008). Pre-3 m subgroup RR ≥ 60% was too small to analyse (5%). No difference was found between pre-12 m subgroups (RR ≥ 60% = 16%), p > 0.05). CONCLUSIONS Quality of THA health care based on PROs seems equal in the Netherlands between 2016 and 2019. Although more hospitals participated in PRO collection, low RRs with large IQRs are observed and only 16% of the hospitals achieved the advised RR ≥ 60%. Multiple recommendations are provided to improve PRO collection and use.
Collapse
Affiliation(s)
- Yvette Pronk
- Research Department, Kliniek ViaSana, Hoogveldseweg 1, 5451 AA, Mill, The Netherlands
| | - Walter van der Weegen
- Department of Orthopaedic Surgery, Sports & Orthopaedics Research Centre, Sint Anna Ziekenhuis, Bogardeind 2, 5664 EH, Geldrop, The Netherlands.
| | - Berend Willem Schreurs
- Department of Orthopaedic Surgery, Radboudumc, Geert Grooteplein Zuid 10, 6562 GA, Nijmegen, The Netherlands.,Landelijke Registratie Orthopedische Implantaten (LROI), Bruistensingel 230, 5232 AD, 's-Hertogenbosch, The Netherlands
| | - Peter Pilot
- IMUKA, Kanaalstraat 10, 6116 AD, Roosteren, The Netherlands
| |
Collapse
|
10
|
Paul S, Barik S, Raj V, Raj M, Kalia RB, Goyal T, Arora M, Nazeer M. A cross sectional survey exploring the awareness and familiarity regarding patient reported outcome measures (PROMs) among joint reconstruction surgeons in India. J Orthop 2023; 37:59-63. [PMID: 36974097 PMCID: PMC10039111 DOI: 10.1016/j.jor.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/07/2023] [Accepted: 02/16/2023] [Indexed: 03/29/2023] Open
Abstract
Background The aim of this study is to describe the usage of PROM, its use or lack of use, barriers in using it and its future prospect among the arthroplasty surgeons from a developing country like India. Methods An online survey was conducted by emailing an anonymous questionnaire to orthopaedic surgeons working in three tertiary care academic institutions and two tertiary care private hospitals. All orthopaedic surgeons or residents who have been performing or assisting in arthroplasty and arthroscopy were included in the study. The study was cross-sectional in design based on a single response from all surgeons. Results The mean age of the 87 surgeons participating in this study was 38.6 ± 4.7 years. 62.1% of surgeons had used PROMs for both clinical as well as research purposes at some point. 25.9% of surgeons had an adequate understanding of the function, benefits, and drawbacks of PROMs. Among the barriers against using PROMs, time constraint was agreed upon by most of the surgeons (59.5%). 64.3% of surgeons were willing to incorporate the PROMs into their daily practice if the barriers are overcome. Conclusion The limitations of use of PROM should also be borne in mind before embarking on its widespread implementation. Involvement of regulatory and professional societies as well as substantial investment in manpower, money and time is required for making the use of PROMs regular.
Collapse
Affiliation(s)
- Souvik Paul
- Orthopedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Sitanshu Barik
- Orthopedics, All India Institute of Medical Sciences, Deoghar, India
| | - Vikash Raj
- Orthopedics, All India Institute of Medical Sciences, Deoghar, India
| | - Manish Raj
- Orthopedics, All India Institute of Medical Sciences, Deoghar, India
| | | | - Tarun Goyal
- Orthopedics, All India Institute of Medical Sciences, Bhatinda, India
| | - Manit Arora
- Orthopedics, Fortis Hospital, Mohali, Punjab, India
| | - Muhammed Nazeer
- Orthopedics, Kerala Institute of Medical Sciences, Thiruvananthapuram, India
| |
Collapse
|
11
|
Development of a score map to guide interpretation of WOMAC Pain scores prior to knee arthroplasty. Knee 2022; 39:153-160. [PMID: 36202019 DOI: 10.1016/j.knee.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/10/2022] [Accepted: 09/18/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Scores from patient reported outcome measures (PROMs) are challenging to interpret for both clinicians and patients. PROMs obtained prior to knee arthroplasty (KA) could be used to inform important decisions related to KA made by both patients and clinicians. The purpose of this study was to develop a "score map" to allow for efficient and meaningful use of PROMs scores for patients considering KA. METHODS Knee arthroplasty data obtained between one day and twelve months preoperatively from two multicenter studies were combined and used to develop and test the accuracy of a Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain Scale score map. To develop the score map, individual item scores were used to determine the most probable responses to items for the entire range of possible WOMAC Pain scores. Predicted WOMAC Pain scores, using the most probable response for each possible score on the score map, were compared to actual presurgical WOMAC Pain scores using Weighted Kappa (Κw) agreement coefficients. The score map is an easy-to-use graphical display of the entire range of WOMAC Pain scores from no pain to extreme pain for each item comprising the WOMAC Pain scale. RESULTS Data from 780 patients were used in the analyses. The score map predicted WOMAC Pain scores and showed substantial agreement with actual WOMAC Pain scores Κw = 0.68 (95 %CI = 0.58, 0.77) to Κw = 0.77 (95 % CI = 0.75, 0.79). Perfect prediction of actual scores occurred between 55.1 % and 62.5 % of the time for all WOMAC Pain items. CONCLUSION The WOMAC Pain score map has potential for facilitating a variety of important clinical decisions and discussions between patients and practitioners during healthcare encounters related to KA candidacy. For example, by comparing a patents' scores to literature-based estimates, patients may better understand how their WOMAC Pain scores compare to other persons who underwent KA, how much a score may change, on average, after surgery and whether this change might be acceptable to them.
Collapse
|
12
|
The smallest worthwhile effect is superior to the MCID for estimating acceptable benefits of knee arthroplasty. J Clin Epidemiol 2022; 152:201-208. [PMID: 36404574 DOI: 10.1016/j.jclinepi.2022.10.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/05/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVES Traditionally, the minimal clinically important difference (MCID) is used to judge the meaningfulness of outcomes in total knee arthroplasty (TKA). However, MCID estimates do not consider patient costs, potential side effects, and inconveniences. MCIDs vary substantially across TKA studies and have several conceptual and psychometric problems. A more scientifically sound alternative for estimating benefits patients expect TKA is the smallest worthwhile effect (SWE), measured with the benefit-harm trade-off method. METHODS We recruited 121 participants and followed them for 6 months after surgery. All participants completed Knee Injury and Osteoarthritis Score (KOOS) Pain and Function, and underwent an interview using the benefit-harm trade-off method. RESULTS The absolute SWE at the 50th percentile (approximating the average patient) was 31 points KOOS Pain improvement and 28 points for KOOS Function, daily living. Construct validity was supported with strong associations between meeting SWE (yes or no) and satisfaction with 6-month outcome (yes or no) using Pearson Chi Square (24.5, P < 0.001). CONCLUSION Current MCID-based methods for interpreting KOOS change scores have flaws while the SWE method is conceptually superior. We determined the SWE of TKA that would justify the costs, risks, and inconveniences of surgery. SWE estimates suggest that patients expect a substantially greater change in KOOS scores than would be expected using MCID estimates. Clinicians can use SWE estimates when discussing likely outcomes and potential TKA benefits and risks with their patients.
Collapse
|
13
|
Ziegenfuss JY, Grossman ES, Solberg LI, Chrenka EA, Werner A, Asche SE, Norton CK, Nelson A, Reams M, Whitebird RR. Is the Promise of PROMs Being Realized? Implementation Experience in a Large Orthopedic Practice. Am J Med Qual 2022; 37:489-494. [PMID: 36314931 DOI: 10.1097/jmq.0000000000000079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Patient-reported outcome measures (PROMs), increasingly used for research and quality measurement, are lauded for their potential to improve patient-centered care, both through aggregate reporting and when integrated into clinical practice. However, there are few published studies of the resultant use of PROMs in clinical practice. This case study describes the implementation and use of PROMS in a Midwestern multispecialty medical group orthopedic practice among patients undergoing total knee and hip surgery. Specifically, rates of PROMs use by care teams are tracked over time once made available in the electronic health record. During this time, the orthopedics department achieved a patient PROMS survey response rate of 68% at baseline, 58% 3 months post-surgery, and 55% 12 months post-surgery. However, these data were only accessed by the care teams for fewer than 1% of associated clinical encounters. This suggests that making PROMs available for care team review in the electronic health record, even when coupled with relatively high response rates from patients and departmental leadership support is not enough to encourage integration of PROMs into clinical care for patients. Additional effort is required to identify barriers to PROMs use in clinical care and to test methods to enhance use.
Collapse
Affiliation(s)
| | | | | | | | - Ann Werner
- HealthPartners Institute, Minneapolis, MN
| | | | - Christine K Norton
- Patient Advocate and Independent Patient Research Consultant, Cottage Grove, MN
| | | | | | - Robin R Whitebird
- Morrison Family College of Health, School of Social Work, University of St. Thomas, St. Paul, MN
| |
Collapse
|
14
|
Patients' perspectives on the benefits of feedback on patient-reported outcome measures in a web-based personalized decision report for hip and knee osteoarthritis. BMC Musculoskelet Disord 2022; 23:806. [PMID: 35999585 PMCID: PMC9395772 DOI: 10.1186/s12891-022-05764-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 08/18/2022] [Indexed: 11/20/2022] Open
Abstract
Background Applications of patient-reported outcome measures (PROMs) for individual patient management are expanding with the support of digital tools. Providing PROM-based information to patients can potentially improve care experiences and outcomes through informing and activating patients. This study explored patients’ perspectives on the benefits of receiving feedback on PROMs in the context of a web-based personalized decision report to guide care for their hip or knee osteoarthritis. Methods This qualitative descriptive interview study was nested in a pragmatic clinical trial of a personalized report, which includes descriptive PROM scores and predicted postoperative PROM scores. Patients completed a semi-structured interview within 6 weeks of an office visit with an orthopaedic surgeon. Only patients who reported receiving the report and reviewing it with the surgeon and/or a health educator were included. Data were iteratively analyzed using a combination of deductive and inductive coding strategies. Results Twenty-five patients aged 49–82 years (60% female, 72% surgical treatment decision) participated and described three primary benefits of the PROM feedback within the report: 1. Gaining Information About My Health Status, including data teaching new information, confirming what was known, or providing a frame of reference; 2. Fostering Communication Between Patient and Surgeon, encompassing use of the data to set expectations, ask and answer questions, and facilitate shared understanding; and 3. Increasing My Confidence and Trust, relating to the treatment outcomes, treatment decision, and surgeon. Conclusions Patients identified actual and hypothetical benefits of receiving feedback on PROM scores in the context of a web-based decision report, including advantages for those who had already made a treatment decision before seeing the surgeon. Findings provide insight into patients’ perspectives on how digital PROM data can promote patient-centered care. Results should be considered in the context of the homogeneous sample and complex trial. While participants perceived value in this personalized report, questions remain regarding best practices in patient-facing data presentation and engagement. Trial registration ClinicalTrials.gov, NCT03102580. Registered on 5 April 2017. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05764-1.
Collapse
|