Optimizing the Value of Patient-Reported Outcome Measures in Improving Care Delivery through Health Information Technology

Using patient-reported outcomes measures (PROMs) in the individual care of a patient and using aggregated data for research and quality improvement holds great promise; however, few organizations make use of them, and response rates are low. In addition, there is limited evidence of impact on outcomes, with results being mixed. To date, PROMs have largely been developed without patient input, and many have focused only on the quantitative measurement of specific symptoms and bodily functions.

This research worked with orthopedic surgeons and patients to learn what outcomes are most important to patients, to identify ways to increase response rates, and to evaluate the impact of providing surgeons aggregate information on PROMs and patient-preferred outcomes (PPOs).

The specific aims of the research were as follows:

• Identify PPOs and patient contextual information (PCI) useful in care planning.
• Test the impact on PROM survey and item response rates from adding other PPOs and PCI to surveys and from using health information technology-enhanced patient outreach.
• Compare the impact on outcomes and experience from making individual PROM and PPO scores available via the electronic health record (EHR) during patient care and via mobile devices versus that for other procedures whose scores are available only to physicians in aggregate.
• Test the impact of providing surgeons with aggregate information from health information technology claims, accounting systems, and the EHR on PROM and PPO scores and costs over time.

Patients were interviewed to determine what outcomes were important to them, as well as what PCI would be helpful to their clinicians in care planning. A patient survey was administered to a stratified random sample of adult orthopedic patients who were scheduled or who had had a hip or knee replacement or spinal surgery. A followup survey was designed to determine if patients choose the same surgical outcome most important to them that they chose pre-operatively and to determine the ability of patients to report improvement in pain and other outcomes. Orthopedic surgeons and leaders were interviewed about why PROMs were not being used in patient care, what aspects of PROMs are useful, how they are viewed, what care processes they see as being of low value, and which care process were under the control of surgeons.

The researchers found that patients preferred an outcome specific to them rather than a multi-item generic score. Using text reminders resulted in a five percent increase in response rate. Surgeons indicated they perceived aggregate PROMs to be valuable for departments, organizations, and individual clinicians. Quarterly performance comparison reports did not show improved outcomes over five quarters; however, it was felt this might be too short of an evaluation period. These reports will continue to be produced to evaluate the impact over the long term.