No full-text available
To read the full-text of this research,
you can request a copy directly from the author.
Building a Patient Reported Outcome Metric (PROM) Database: One Hospital’s Experience
Abstract
Background:
A number of provisions exist within the Patient Protection and Affordable Care Act that focus on improving the delivery of health care in the United States, including quality of care. From a total joint arthroplasty perspective, the issue of quality increasingly refers to quantifying patient-reported outcome metrics (PROMs). This article describes one hospital's experience in building and maintaining an electronic PROM database for a practice of 6 board-certified orthopedic surgeons.
Methods:
The surgeons advocated to and worked with the hospital to contract with a joint registry database company and hire a research assistant. They implemented a standardized process for all surgical patients to fill out patient-reported outcome questionnaires at designated intervals.
Results:
To date, the group has collected patient-reported outcome metric data for >4500 cases. The data are frequently used in different venues at the hospital including orthopedic quality metric and research meetings. In addition, the results were used to develop an annual outcome report. The annual report is given to patients and primary care providers, and portions of it are being used in discussions with insurance carriers.
Conclusion:
Building an electronic database to collect PROMs is a group undertaking and requires a physician champion. A considerable amount of work needs to be done up front to make its introduction a success. Once established, a PROM database can provide a significant amount of information and data that can be effectively used in multiple capacities.
... Breckenridge et al 24 presented a summary of expert recommendations for PROs collection within renal registries in Europe. Rolfson et al, 25 Franklin et al 26 There were six individual registry studies on PROs collection: three from the US, [27][28][29] two from the UK, 30,31 and one from Australia. 32 There were two studies on cancer registries, 30,32 a study on PROs in the management of chronic spinal pain, 31 three studies on surgery registries: spine surgery, 27 joint arthroplasty, 29 and an unselected surgical patients registry. ...
... Rolfson et al, 25 Franklin et al 26 There were six individual registry studies on PROs collection: three from the US, [27][28][29] two from the UK, 30,31 and one from Australia. 32 There were two studies on cancer registries, 30,32 a study on PROs in the management of chronic spinal pain, 31 three studies on surgery registries: spine surgery, 27 joint arthroplasty, 29 and an unselected surgical patients registry. 28 ...
... The purposes of PROs collection focused on their value in tracking the patient recovery process to improve services and to develop interventions in particular clinical domains, such as surgery, 27,28 spinal osteopathy services, 31 cancer, 30,32 and total joint arthroplasty. 29 ...
Purpose
Patient-centred and value-based health-care organisations are increasingly recognising the importance of the patient perspective in the measurement and evaluation of health outcomes. This has been primarily implemented using patient-reported outcome measures (PROMs). Clinical quality registries (CQRs) are specifically designed to improve direct clinical care, benchmark health-care provision and inform health service planning and policy. Despite CQRs having incorporated the patient perspective to support the evaluation of health-care provision, no evidence-based guidelines for inclusion of PROMs in CQRs exist. This has led to substantial heterogeneity in capturing and reporting PROMs within this setting. This publication is the first in a series describing the development of evidence-informed guidelines for PROMs inclusion within CQRs in Australia.
Methods
This study consisted of three components: 1) a literature review of existing evidence of guidelines, enablers, barriers, and lessons learnt of PROMs use within the CQRs setting; 2) a survey of Australian CQRs to determine current practices for PROMs use and reporting; and 3) development of a preliminary conceptual framework for PROMs inclusion in CQRs.
Results
Content analysis of the literature review and survey of 66 Australian registries elicited eight categories for the conceptual framework. The framework covers eight components: rationale, setting, ethics, selection of PROMs, administration, data management, statistical methods, feedback, and reporting.
Conclusion
We developed a preliminary conceptual framework, which classified findings, from both the literature and the survey, into broad categories ranging from initial development to outcome dissemination providing the structure for development of guidelines in the next phase of this project, engaging national and international leaders in health-related quality of life research, clinicians, researchers, patient advocates and consumers.
... The search yielded six relevant articles for screening. 5,9,[14][15][16][17] References from the retrieved papers were reviewed for additional papers not identified in the search. The directory from the International Society of Arthroplasty Registries website was consulted to identify member registries. ...
... 9,13,46 A 2016 paper by Rana 17 outlines the implementation of a PROMs database for a group of six arthroplasty surgeons in Maine, United States and the unexpected difficulties which were encountered. 17 Scepticism regarding the use of PROMs may be an issue. 6 For example, a Cochrane review regarding the use of PROMs to improve treatment for adult mental health disorders found that providers felt pressured to use PROMs in practice, leading to scepticism and irritation. ...
Total joint arthroplasty is performed to decreased pain, restore function and productivity and improve quality of life. One-year implant survivorship following surgery is nearly 100%; however, self-reported satisfaction is 80% after total knee arthroplasty and 90% after total hip arthroplasty. Patient-reported outcomes (PROs) are produced by patients reporting on their own health status directly without interpretation from a surgeon or other medical professional; a PRO measure (PROM) is a tool, often a questionnaire, that measures different aspects of patient-related outcomes. Generic PROs are related to a patient’s general health and quality of life, whereas a specific PRO is focused on a particular disease, symptom or anatomical region. While revision surgery is the traditional endpoint of registries, it is blunt and likely insufficient as a measure of success; PROMs address this shortcoming by expanding beyond survival and measuring outcomes that are relevant to patients – relief of pain, restoration of function and improvement in quality of life. PROMs are increasing in use in many national and regional orthopaedic arthroplasty registries. PROMs data can provide important information on value-based care, support quality assurance and improvement initiatives, help refine surgical indications and may improve shared decision-making and surgical timing. There are several practical considerations that need to be considered when implementing PROMs collection, as the undertaking itself may be expensive, a burden to the patient, as well as being time and labour intensive.
Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180080
... Broderick et al., outlined how software such as 'EPIC' notifies patients via email prior to 'healthcare events' such as operations or clinic dates and allows retrieval of collected data in graphical or tabular form [18]. Malhotra et al. outlined how the use of a customised software package and trained personnel resulted in an over 85% response rate [46]. Multiple other papers have demonstrated the role of tablet and smartphone use in improving elective PROM data collection, but our paper has demonstrated the success yet dearth of this implementation in the trauma setting [26,31,[47][48][49][50]. ...
Aims:
The aim of this study was to provide a scoping review to the role of digital technology in the collection of orthopaedic trauma related patient reported outcome measures (PROMs) METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews and Arksey and O'Malley frameworks were followed. A search strategy identified relevant literature, with the identified criteria screened for acceptability for inclusion. Data was extracted to form a descriptive analysis.
Results:
Six studies met the criteria for inclusion. All were quantitative, the majority were published in the United States of America and the use of iPads was the commonest form of digital technology used. Heterogeneity existed in the type of outcomes collected between studies. All studies aimed to compare traditional methods of PROMs collection to digital methods, with an overall thematic summary suggestive of the positive impact of electronic methods of collecting patient reported outcomes.
Conclusion:
This paper has demonstrated the dearth of ePROM implementation in the orthopaedic trauma setting, however its use has proved successful and therefore further evidence is needed to demonstrate its effectiveness. Furthermore, the types of PROMs in orthopaedic trauma varies significantly, and efforts to standardise the type of digital trauma PROMs used are recommended.
... 11 Successful incorporation PROM have been reported by institutes in the Western world and this would require apart from the apparent stakeholders, involvement of regulatory agencies and professional societies like Indian Orthopedic Association (IOA), state chapters of IOA, Indian Society of Hip and Knee Surgeons and Indian Arthroplasty Association. 12 Similarly, before embarking on a widespread use, the limitations of use of PROM should also be borne in mind. Choosing the correct tool which is validated for the specific population is crucial. ...
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.
... Su aplicación ha demostrado que no siempre el procedimiento más tradicional (en este caso, el reemplazo total de rodilla) está relacionado con una mejoría en la calidad de vida del paciente, aún cuando se ofrece un resultado "ortopédicamente correcto." 11 Esas discrepancias encontradas dejan en evidencia la necesidad de continuar investigando en esa área para poder llegar a conclusiones relevantes 12,13 ; especialmente debido al incremento en el rol que tienen los PROM en la toma de decisiones de organizaciones nacionales de salud y como herramienta para evaluar la eficacia de procedimientos e intervenciones. 14 En pacientes que cumplen con los criterios para un RPR, elegir esta alternativa puede ofrecer beneficios en comparación al reemplazo total de rodilla (RTR), siendo las más evidentes: la conservación de una mayor porción de la anatomía normal de la rodilla, y el menor daño a los tejidos del paciente. ...
Introduction Knee osteoarthritis is one of the most prevalent musculoskeletal pathologies in the world and the surgical treatment is until today the only definitive therapy. NAVIO™ system is one of the most recently available robotic devices for partial knee arthroplasty. It offers great precision in the process of alignment, bone remodeling and soft tissue balancing without exposing the patient to the radiation or the costs of the CT scan usually performed before the arthroplasty with the current robotic systems.
Objective To evaluate the outcomes measured by the patients before and after the arthroplasty using NAVIO™ and the STRIDE™ prosthesis.
Materials and Methods Application of the Knee Injury Osteoarthritis Outcome Score (KOOS) questionnaire in the preoperative and 12 months after the surgical procedure of the first 47 patients operated using NAVIO™ at Cornerstone Regional Hospital, Edinburg, Texas.
Results There was an improvement of the normalized samples in all the categories with p < 0.05.
Commentary Recent studies have suggested that in Chile the presentation of osteoarthritis is associated with a lower degree of severity compared with the rest of Latin American countries. This makes relevant the application of more conservative surgical therapies, which could offer the patient symptomatic relief and allow them to reestablish their daily activities causing the minimum impact possible. These advantages were observed in patients undergoing this surgical procedure.
Conclusions Unicompartmental knee replacement using NAVIO ™ surgical system and STRIDE™ prosthesis demonstrated a substantial improvement in patient's quality of life, reducing pain and improving their function during sports and recreational activities.
... A considerable amount of work is required making routine PRO measurement a success [48]. Our data show the feasibility of routine collection of PRO data in a hospital setting, and the data will be used for the Dutch national registry in joint replacement [49]. ...
Background
Patient-Reported Outcome (PRO) measurement is a method for measuring perceptions of patients on their health and quality of life. The aim of this paper is to present the results of PRO measurements in total hip and knee replacement as routinely collected during 20 years of surgery in a university hospital setting. Methods
Data of consecutive patients between 1993 and 2014 were collected. Health outcomes were measured pre-surgery and at 3, 6, and 12 months post-surgery. Outcomes for hip replacement were measured with the Harris Hip Score (HHS) and Oxford Hip Score (OHS). Outcomes for knee replacement were measured with the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and the Knee Society Score (KSS). A Visual Analog Scale (VAS) for pain was used. Absolute and relative Minimal Clinically Important Differences (MCID) were estimated. Generalized estimating equation analysis was used for estimating mean outcomes. Trends over time were analyzed. ResultsThe database contained 2,089 patients with hip replacement, and 704 patients with knee replacement. Mean HHS and OHS scores in primary hip replacement at 12 months post-surgery were 86.7 (SD: 14.5) and 41.1 (SD: 7.5) respectively. Improvements on the HHS based on absolute MCID was lower for revisions compared to primary hip replacements, with 72.4% and 87.0% respectively. Mean WOMAC and KSS scores in knee replacement at 12 months post-surgery were 21.5 (SD: 18.2) and 67.0 (SD: 26.4) respectively. Improvements based on absolute MCID were lowest for the KSS (62.6%) and highest for VAS pain (85.6%). Trend analysis showed a difference in 1 out of 24 comparisons in hip replacement and in 2 out of 9 comparisons in knee replacement. Conclusions
The functional status of a large cohort of patients significantly improved after hip and knee replacement based on routine data collection. Our study shows the feasibility of the routine collection of PRO data in patients with total hip and knee replacement. The use of PRO data provides opportunities for continuous quality improvement.
Background:
Detailed in-house databases are a staple of surgical research and a crucial source of data for many studies from which clinical guidelines are built. Despite the importance of generating a clear and thorough developmental design, the literature on database creation and management is limited. Here we present our stepwise single institution process of developing a clinical facial fracture database.
Methods:
We outline the process of development of a large single-institution clinical pediatric facial fracture database. We highlight critical steps from conception, regulatory approval, data safety/integrity, human resource allocation, data collection, quality assurance, and error remediation. We recorded patient characteristics, comorbidities, details of the sustained fracture, associated injuries, hospitalization information, treatments, outcomes, and follow-up information on REDCap (Research Electronic Data Capture). Protocols were created to ensure data quality assurance and control. Error identification analysis was subsequently performed on the database to evaluate the completeness and accuracy of the data.
Results:
A total of 4451 records from 3334 patients between 2006 and 2021 were identified and evaluated to generate a clinical database. Overall, there were 259 incorrect entries out of 120,177 total entries, yielding a 99.8% completion rate and a 0.216% error rate.
Conclusion:
The quality of clinical research is intrinsically linked to the quality and accuracy of the data collection. Close attention must be paid to quality control at every stage of a database setup. More studies outlining the process of database design are needed to promote transparent, accurate, and replicable research practices.
Patient-reported outcome measures (PROMs) and, specifically, the Patient-Reported Outcomes Measurement Information System (PROMIS), are increasingly utilized for clinical research, clinical care, and health-care policy. However, completion of these outcome measures can be inconsistent and challenging. We hypothesized that sociodemographic variables are associated with the completion of PROM questionnaires. The purposes of the present study were to calculate the completion rate of assigned PROM forms and to identify sociodemographic and other variables associated with completion to help guide improved collection efforts.
Methods:
All new orthopaedic patients at a single academic medical center were identified from 2016 to 2020. On the basis of subspecialty and presenting condition, patients were assigned certain PROMIS forms and legacy PROMs. Demographic and clinical information was abstracted from the electronic medical record. Bivariate analyses were performed to compare characteristics among those who completed assigned PROMs and those who did not. A multivariable logistic regression model was created to determine which variables were associated with successful completion of assigned PROMs.
Results:
Of the 219,891 new patients, 88,052 (40%) completed all assigned PROMs. Patients who did not activate their internet-based patient portal had a 62% increased likelihood of not completing assigned PROMs (odds ratio [OR], 1.62; 95% confidence interval [CI], 1.58 to 1.66; p < 0.001). Non-English-speaking patients had a 90% (OR, 1.90; 95% CI, 1.82 to 2.00; p < 0.001) increased likelihood of not completing assigned PROMs at presentation. Older patients (≥65 years of age) and patients of Black race had a 23% (OR, 1.23; 95% CI, 1.19 to 1.27; p < 0.001) and 24% (OR, 1.24; 95% CI, 1.19 to 1.30; p < 0.001) increased likelihood of not completing assigned PROMs, respectively.
Conclusions:
The rate of completion of PROMs varies according to sociodemographic variables. This variability could bias clinical outcomes research in orthopaedic surgery. The present study highlights the need to uniformly increase completion rates so that outcomes research incorporates truly representative cohorts of patients treated. Furthermore, the use of these PROMs to guide health-care policy decisions necessitates a representative patient distribution to avoid bias in the health-care system.
Level of evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Aims:
The aim of this study was to report our experience at 3.5 years with outpatient total hip arthroplasty (THA).
Methods:
In this prospective cohort study, we included all patients who were planned to receive primary THA through the anterior approach between 1 April 2014 and 1 October 2017. Patient-related data and surgical information were recorded. Patient reported outcome measures (PROMs) related to the hip and an anchor question were taken preoperatively, at six weeks, three months, and one year after surgery. All complications, readmissions, and reoperations were registered.
Results:
Of the 647 THA patients who had surgery in this period through the anterior approach, 257 patients (39.7%) met the inclusion criteria and were scheduled for THA in an outpatient setting. Of these, 40 patients (15.6%) were admitted to the hospital, mainly because of postoperative nausea and/or dizziness. All other 217 patients were able to go home on the day of surgery. All hip-related PROMs improved significantly up to 12 months after surgery, compared with the scores before surgery. There were three readmissions and two reoperations in the outpatient cohort. There were no complications related to the outpatient THA protocol.
Conclusion:
These study results confirm that outpatient THA can be performed safe and successfully in a selected group of patients, with satisfying results up to one year postoperatively, and without outpatient-related complications, readmissions, and reoperations. Cite this article: Bone Joint J 2020;102-B(1):82-89.
The Oxford hip and knee scores have been extensively used since they were first described in 1996 and 1998. During this time, they have been modified and used for many different purposes. This paper describes how they should be used and seeks to clarify areas of confusion.
Unlabelled:
We compared the metric properties of the University of California, Los Angeles (UCLA) activity scale, the Tegner score, and the Activity Rating Scale for assessment of activity levels in 105 patients undergoing THA (48 women; mean age, 63.4 years) and 100 patients undergoing TKA (61 women; mean age, 66.5 years). We assessed construct validity by correlating these scales with the International Physical Activity Questionnaire and different traditional patient self-reporting outcome measures. Test-retest reliability, feasibility, and floor and ceiling effects also were determined. The UCLA scale showed the strongest correlations with the other measures (r = -0.35 to 0.56 for THA; r = -0.55 to 0.23 for TKA) and was the only scale that discriminated between insufficiently and sufficiently active patients undergoing THA and TKA. The UCLA scale had the best reliability, provided the highest completion rate, and showed no floor effects. It seems to be the most appropriate scale for assessment of physical activity levels in patients undergoing total joint arthroplasty.
Level of evidence:
Level III, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.