Electronic capture of patient-reported and clinician-reported outcome measures in an elective orthopaedic setting: a retrospective cohort analysis

Abstract

ObjectivesTo determine whether an entirely electronic system can be used to capture both patient-reported outcomes (electronic Patient-Reported Outcome Measures, ePROMs) as well as clinician-validated diagnostic and complexity data in an elective surgical orthopaedic outpatient setting. To examine patients' experience of this system and factors impacting their experience.DesignRetrospective analysis of prospectively collected data.SettingSingle centre series. Outpatient clinics at an elective foot and ankle unit in the UK.ParticipantsAll new adult patients attending elective orthopaedic outpatient clinics over a 32-month period.InterventionsAll patients were invited to complete ePROMs prior to attending their outpatient appointment. At their appointment, those patients who had not completed ePROMs were offered the opportunity to complete it on a tablet device with technical support. Matched diagnostic and complexity data were captured by the treating consultant during the appointment.Outcome measuresCapture rates of patient-reported and clinician-reported data. All information and technology (IT) failures, language and disability barriers were captured. Patients were asked to rate their experience of using ePROMs. The scoring systems used included EQ-5D-5L, the Manchester-Oxford Foot Questionnaire (MOxFQ) and the Visual Analogue Scale (VAS) pain score.ResultsOut of 2534 new patients, 2176 (85.9%) completed ePROMs, of whom 1090 (50.09%) completed ePROMs at home/work prior to their appointment. 31.5% used a mobile (smartphone/tablet) device. Clinician-reported data were captured on 2491 patients (98.3%). The mean patient experience score of using Patient-Reported Outcome Measures (PROMs) was 8.55±1.85 out of 10 and 666 patients (30.61%) left comments. Of patients leaving comments, 214 (32.13%) felt ePROMs did not adequately capture their symptoms and these patients had significantly lower patient experience scores (p<0.001).ConclusionsThis study demonstrates the successful implementation of technology into a service improvement programme. Excellent capture rates of ePROMs and clinician-validated diagnostic data can be achieved within a National Health Service setting.

The facilitators and barriers to implementing patient reported outcome measures in organisations delivering health related services: a systematic review of reviews

“…As other studies have found, there is a need for organisations to invest in electronic systems [ 44 ]. However, this may not always be feasible, for example due to budget constraints or a lack of prioritisation by the organisation.…”

A pilot study of patient reported outcomes evaluating treatment related symptoms and quality of life for men receiving high dose rate brachytherapy combined with hypo-fractionated radiotherapy or hypo-fractionated radiotherapy alone for the treatment of localised prostate cancer

“…the National Health Service England PROMs programme costs £825 000 annually [48]. Malhotra et al demonstrated electronic PROMs (ePROMs) can be successfully implemented into a service and innovative data collection methods improve the ease of administration, data capture rates and lower costs [49]. The implementation of ePROMs is now a realistic goal as the majority of patients now have access to smart-phones, tablet devices and internet access; alongside developments in electronic databases, which enable real-time collection of data.…”

Standardising the collection of patient-reported experience measures to facilitate benchmarking and drive service improvement

“…Deprivation and increased age are known to be associated with lower use of the internet, and a 2013 study finding indicated that younger, more affluent patients were more likely to use an electronic PROMs system (Ashley et al). Despite this, electronic collection of patient reported data has been carried out successfully in the UK (Malhotra et al 2016). Electronic data capture is less costly than traditional paper based methods and removes the need for data entry.…”