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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.
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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)
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Pila S, Stern BZ, Rothrock NE, Franklin PD. Evaluating a web-based personalized decision report for total knee or hip replacement: Lessons learned from patients. J Eval Clin Pract 2023; 29:844-853. [PMID: 37316454 PMCID: PMC11210323 DOI: 10.1111/jep.13887] [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: 02/22/2023] [Revised: 05/31/2023] [Accepted: 06/02/2023] [Indexed: 06/16/2023]
Abstract
RATIONALE Patient-reported outcomes (PROs) are increasingly used in the context of clinical care, but evaluation of patients' perspectives of PRO-based applications in routine care remains limited. AIMS AND OBJECTIVES This paper investigates patients' acceptability of a personalized web-based decision report for total knee or hip replacement and identifies opportunities to refine the report. METHOD This qualitative evaluation was embedded in a pragmatic cluster randomized trial of the report. We interviewed 25 patients with knee and hip osteoarthritis about their experiences using the personalized decision report in the context of a surgical consultation. The web-based report contained current descriptive PRO scores of pain, function and general physical health; tailored predicted postoperative PRO scores (i.e., personalized likely outcomes based on actual knee or hip replacement outcomes of similar patients in a national registry); and information about alternative nonoperative treatments. Two trained researchers analysed the interview data qualitatively using a combination of inductive and deductive coding. RESULTS We identified three major categories for evaluation: content of report, presentation of data in report and engagement with report. Patients generally liked the report overall but specifically valued different pages of the report based on where they were in the surgical decision-making process. Patients identified areas of confusion in data presentation related to graph orientation, terminology and interpretation of T-scores. Patients also highlighted support needs to meaningfully engage with the information in the report. CONCLUSION Our findings highlight areas of opportunity to further refine this personalized web-based decision report and similar patient-facing PRO applications for routine clinical care. Specific examples include additional tailoring of reports via filterable web-based dashboards and scalable educational supports to facilitate more independent patient understanding and use.
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Affiliation(s)
- Sarah Pila
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Brocha Z Stern
- Center for Education in Health Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Nan E Rothrock
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Patricia D Franklin
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Müller A, Gruhn S, Sawicki OA, Glushan A, Witte C, Klaaßen-Mielke R, Lembeck B, Beyer M, Gerlach FM, Greiner W, Karimova K. Collaborative Ambulatory Orthopaedic Care in Patients with Hip and Knee Osteoarthritis: A Retrospective Comparative Cohort Study on Health Utilisation and Economic Outcomes. Int J Integr Care 2023; 23:22. [PMID: 37275630 PMCID: PMC10237241 DOI: 10.5334/ijic.6442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 05/09/2023] [Indexed: 06/07/2023] Open
Abstract
Objective To evaluate a novel healthcare programme for the treatment of patients with hip and knee osteoarthritis in southern Germany in terms of clinical and health economic outcomes. The study is based on claims data from 2014 to 2017. Methods We conducted a retrospective comparative cohort study of 9768 patients with hip and knee osteoarthritis, of whom 9231 were enrolled in a collaborative ambulatory orthopaedic care programme (intervention group), and 537 patients received usual orthopaedic care (control group). Key features of the programme are coordinated care, morbidity-adapted reimbursement and extended consultation times. Multivariable analysis was performed to determine effects on health utilisation outcomes. The economic analysis considered annual costs per patient from a healthcare payer perspective, stratified by healthcare service sector. Besides multivariable regression analyses, bootstrapping was used to estimate confidence intervals for predicted mean costs by group. Results Musculoskeletal-disease-related hospitalisation was much less likely among intervention group patients than control group patients [odds ratio (OR): 0.079; 95% CI: 0.062-0.099]. The number of physiotherapy prescriptions per patient was significantly lower in the intervention group (RR: 0.814; 95% CI: 0.721-0.919), while the likelihood of participation in exercise programmes over one year was significantly higher (OR: 3.126; 95% CI: 1.604-6.094). Enrolment in the programme was associated with significantly higher ambulatory costs (€1048 vs. €925), but costs for inpatient care, including hospital stays, were significantly lower (€1003 vs. €1497 and €928 vs. €1300 respectively). Overall annual cost-savings were €195 per patient. Conclusions Collaborative ambulatory orthopaedic care was associated with reduced hospitalisation in patients with hip and knee osteoarthritis. Health costs for programme participants were lower overall, despite higher costs for ambulatory care.
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Affiliation(s)
- Angelina Müller
- Institute of General Practice, Goethe University, Theodor-Stern-Kai 7, Frankfurt, 60590, DE
| | - Sebastian Gruhn
- Health Economics and Health Care Management, Bielefeld University, P.O. Box 10 01 31, 33501, Bielefeld, DE
| | - Olga A. Sawicki
- Institute of General Practice, Goethe University, Theodor-Stern-Kai 7, Frankfurt, 60590, DE
| | - Anastasiya Glushan
- Institute of General Practice, Goethe University, Theodor-Stern-Kai 7, Frankfurt, 60590, DE
| | - Claudia Witte
- aQua, Institute for Applied Quality Improvement and Research in Health Care, 37073 Goettingen, DE
| | - Renate Klaaßen-Mielke
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr-University Bochum, DE
| | - Burkhard Lembeck
- Joint Practice for Orthopaedic and Trauma Dr. Lembeck und Dr. Pampel, Hindenburgstr. 7/1, 73760, Ostfildern-Nellingen, DE
| | - Martin Beyer
- Institute of General Practice, Goethe University, Theodor-Stern-Kai 7, Frankfurt, 60590, DE
| | - Ferdinand M. Gerlach
- Institute of General Practice, Goethe University, Theodor-Stern-Kai 7, Frankfurt, 60590, DE
| | - Wolfgang Greiner
- Health Economics and Health Care Management, Bielefeld University, P.O. Box 10 01 31, 33501, Bielefeld, DE
| | - Kateryna Karimova
- Institute of General Practice, Goethe University, Theodor-Stern-Kai 7, Frankfurt, 60590, DE
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Gupta L, Najm A, Kabir K, De Cock D. Digital health in musculoskeletal care: where are we heading? BMC Musculoskelet Disord 2023; 24:192. [PMID: 36918856 PMCID: PMC10012296 DOI: 10.1186/s12891-023-06309-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 03/10/2023] [Indexed: 03/16/2023] Open
Abstract
BMC Musculoskeletal Disorders launched a Collection on digital health to get a sense of where the wind is blowing, and what impact these technologies are and will have on musculoskeletal medicine. This editorial summarizes findings and focuses on some key topics, which are valuable as digital health establishes itself in patient care. Elements discussed are digital tools for the diagnosis, prognosis and evaluation of rheumatic and musculoskeletal diseases, coupled together with advances in methodologies to analyse health records and imaging. Moreover, the acceptability and validity of these digital advances is discussed. In sum, this editorial and the papers presented in this article collection on Digital health in musculoskeletal care will give the interested reader both a glance towards which future we are heading, and which new challenges these advances bring.
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Affiliation(s)
- Latika Gupta
- Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK.,City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.,Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, The University of Manchester, Manchester, UK
| | - Aurélie Najm
- Institute of Infection, Immunity and Inflammation, College of Medical Veterinary and Life Sciences, University of Glasgow, Sir Graeme Davies Building Level 4, Glasgow, UK.,NHS Royal Alexandra Hospital, Glasgow, UK
| | - Koroush Kabir
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Diederik De Cock
- Biostatistics and Medical Informatics Research Group, Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium.
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Stern BZ, Franklin PD, Shapiro LM, Chaudhary SB, Kamal RN, Poeran J. Equity-Driven Implementation of Patient-Reported Outcome Measures in Musculoskeletal Care: Advancing Value for All. J Bone Joint Surg Am 2023; 105:726-735. [PMID: 36728450 DOI: 10.2106/jbjs.22.01016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
ABSTRACT The clinical use of patient-reported outcome measures (PROMs) in musculoskeletal care is expanding, encompassing both individual patient management and population-level applications. However, without thoughtful implementation, we risk introducing or exacerbating disparities in care processes or outcomes. We outline examples of opportunities, challenges, and priorities throughout PROM implementation to equitably advance value-based care at both the patient and population level. Balancing standardization with tailored strategies can enable the large-scale implementation of PROMs while optimizing care processes and outcomes for all patients.
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Affiliation(s)
- Brocha Z Stern
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY.,Department of Population Health Science & Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Patricia D Franklin
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lauren M Shapiro
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California
| | - Saad B Chaudhary
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Robin N Kamal
- Department of Orthopaedic Surgery, VOICES Health Policy Research Center, Stanford University, Redwood City, California
| | - Jashvant Poeran
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY.,Department of Population Health Science & Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY
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