Feasibility of PROMIS CAT Administration in the Ambulatory Sports Medicine Clinic With Respect to Cost and Patient Compliance: A Single-Surgeon Experience

Abstract

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.

Performance of PROMIS Physical Function, Pain Interference, and Depression Computer Adaptive Tests Instruments in Patients Undergoing Meniscal Surgery

“… 39 , 40 , 41 Additionally, multiple studies in the literature have emerged to support the use of the PIF CAT as an important augmentation to capturing physical function in patients with pain. 27 , 34 , 42 Kendall et al. 43 correlated the PIF CAT with the PF CAT in a population of patients presenting with spinal pain and concluded that the PIF CAT is a useful augmentation to physical function measures.…”

“… 21 , 23 , 24 , 25 , 26 As PROMIS measures continue to be introduced in new orthopedic disciplines, continued evaluation in specific patient populations before widespread adoption is essential. 27 , 28 , 29 , 30 Although the performance of the PROMIS PF CAT has previously been examined in meniscal surgery, 31 the comparative performance of the PF CAT relative to gold standard function PROMs has yet to be established. 31 Furthermore, the performance of PROMIS PIF and Depression has yet to be established in meniscal surgery.…”

Association of Preoperative PROMIS Scores With Short-term Postoperative Improvements in Physical Function After Minimally Invasive Transforaminal Lumbar Interbody Fusion

“…One recent study estimated the total cost of administration to be approximately $1,000 per month. 24 Fees and other implicit costs are important to acknowledge as these could be significant hurdles for researchers to overcome. While baseline and operative variables were assessed for statistical significance, only 3 variables were observed to have statistically significant differences among the 2 subgroups (e.g., sex, obesity, length of hospital stay).…”

“…However, other costs such as server fees, tablets to administer the surveys and research assistants to analyze the data add additional costs. One recent study estimated the total cost of administration to be approximately $1,000 per month [ 24 ]. Fees and other implicit costs are important to acknowledge as these could be significant hurdles for researchers to overcome.…”

Using a Web-Based Data Collection Platform to Implement an Effective Electronic Patient-Reported Outcome Registry

“…Previous studies have evaluated the feasibility and compliance of our system. On average, patients take 3.29 minutes to complete the entire survey set 5 and only have to answer 15.3 PROMIS questions in total 6 . Patient compliance for in-clinic survey administration is over 90%, 6 with remote e-mail compliance approaching 70% (unpublished data, P. Borowsky, November 2018).…”