Background:Challenges exist in routinely collecting patient-reported outcomes (PROs) from patients at a busy ambulatory clinic. A number of validated Patient-Reported Outcomes Measurement Information System (PROMIS) subdomains allow for efficient PRO administration.Purpose:To determine the time to completion (TTC) of 3 PROMIS computer adaptive test (CAT) scores. CAT questionnaires were administered at the ambulatory clinic with the following PROMIS subdomains: Pain Interference (PI), Depression, and Physical Function for lower extremity (PF) or for upper extremity (UE). The secondary purpose was to determine the influence of patient demographic factors on TTC.Study Design:Cross-sectional study; Level of evidence, 3.Methods:Patients were recruited from 3 fellowship-trained upper extremity and sports medicine orthopaedic surgery clinics. PROMIS CAT questionnaires were administered to consecutive patients during the study period (July 2017–September 2017). The start and completion times of each CAT were recorded. The primary outcome of interest was TTC of the questionnaires. Patients were stratified into age quartiles to determine the impact of age on TTC. Patient demographic information, such as sex, race, and ethnicity, was determined retroactively.Results:A total of 1178 questionnaire sets consisting of 3658 individual PROMIS forms were analyzed. The mean TTC was 3.29 minutes for all 4 forms in aggregate, with PROMIS PI, PF, UE, and Depression taking on average 1.05, 0.74, 0.96, and 0.57 minutes to complete, respectively. Patients from the oldest age quartile (mean ± SD, 70.3 ± 7.5 years) had a statistically significant longer TTC as compared with the second quartile (41.2 ± 4.7 years) (3.70 vs 2.87 minutes; P < .05). Asian patients had the longest PROMIS PF TTC, while white patients completed PF with the shortest TTC (1.28 vs 0.68 minutes; P < .05). Patients of unstated ethnicity had a longer TTC for PF as compared with their Hispanic/Latino and non-Hispanic/Latino counterparts (0.91 vs 0.30 and 0.70 minutes; P < .05).Conclusion:PROMIS CAT forms are efficient tools for collecting patient-reported outcomes in the ambulatory orthopaedic surgery clinic. Older patients, Asian patients, and patients of unstated ethnicity took longer to complete the forms.

In this simulated game analysis, pitchers experienced increased fatigue after each successive inning. While the average pitch velocity declined with each successive inning, the torque on the medial elbow increased after inning 3. These findings signify a possible relationship between fatigue and injury risk.

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Background:Pay-for-performance reimbursement models are becoming increasingly popular, but the implementation of a routine patient-reported outcome (PRO) collection system places additional burden on both the patient and the provider. The Patient-Reported Outcomes Measurement Information System (PROMIS) was developed in an effort to make PRO collection more practical and efficient, but providers may be reluctant to embrace a transition to a PROMIS-based clinical outcome registry.Hypothesis:PROMIS can be successfully incorporated into daily clinical practice, with an overall patient compliance rate of 80%.Study Design:Cross-sectional study; Level of evidence, 3.Methods:As part of routine practice, all patients presenting to a single surgeon’s sports medicine clinic for an appointment were asked to complete a series of PROMIS computerized adaptive tests (CATs), including PROMIS Physical Function, Physical Function–Upper Extremity, Pain Interference, and Depression subscales. Overall compliance was calculated by dividing the number of survey sets completed by the number of eligible clinic visits. Compliance rates were further assessed by patient age, type of clinic visit, and location of injury. Costs associated with this system of routine PRO collection were categorized as start-up or maintenance costs.Results:From August 7, 2017, to December 8, 2017, there were 581 patients (1109 clinic encounters) who met inclusion criteria for the study. Of the 1109 clinic encounters, there was an overall compliance rate of 91.3% (1013/1109 visits during which the patient completed the entire PROMIS survey set). Overall, the full survey set consisted of a mean 15.3 questions and took a mean of 2.6 minutes to complete. Patients who were aged ≥62 years had a significantly lower compliance rate (81.8%; P < .0001) than each of the younger patient quartiles. When analyzing patients by the most common locations of injury (elbow, shoulder, hip, knee), the compliance rate for completing PROMIS was significantly higher for the hip than for the shoulder (95.1% vs 88.9%, respectively; P = .02). The cost of establishing a PROMIS-based registry using our project design and workflow was estimated at $2045, whereas the monthly maintenance cost was $1000.Conclusion:The routine electronic collection of PROMIS scores in the ambulatory orthopaedic clinic resulted in a compliance rate of over 90%, although older patients were generally less compliant than younger patients. Our system of data collection is practical and efficient in a high-volume orthopaedic clinic and places minimal financial burden on the provider.

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