Patient-Reported Outcomes in Orthopaedics

Christensen, Daniel; Dickens, Jonathan; Freedman, Brett A.; Mauntel, Timothy C.; Owens, Brett D.; Potter, Benjamin K.; Provencher, Matthew; Tokish, John M.; Waterman, Brian R.; Antosh, Ivan J.; Bellamy, Jaime L.; Cameron, Kenneth L.; Cook, Karon F.; Eckel, Tobin T.; Eichinger, Josef K.; Garcia, E’Stephan J.; Helgeson, Melvin D.; Joyner, Patrick W.; Kang, Daniel G.; Kilcoyne, Kelly G.; Krueger, Chad A.; LeClere, Lance E.; Li, Xinning; Martin, Kevin D.; McCallum, Jeremy R.; McDonald, Lucas S.; Ortiz, Dionisio; Pallis, Mark; Parada, Stephen A.; Patzkowski, Jeanne C.; Posner, Matthew; Rivera, Jessica C.; Robins, R. Judd; Rothrock, Nan; Schmitz, Matthew R.; Slabaugh, Mark A.; Song, Daniel J.; Stinner, Daniel J.; Tintle, Scott M.; Tucker, Christopher; Waltz, Robert A.; Wilson, Kevin C.

doi:10.2106/jbjs.17.00608

Cited by 73 publications

(34 citation statements)

References 92 publications

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“…Patient-reported outcomes (PROs) are increasingly collected for both research and clinical practice as a gold standard of outcomes measurement 11 , 12 : The American Board of Orthopaedic Surgery (ABOS) now collects PROs for Part II board certification, and The Centers for Medicare & Medicaid Services (CMS) encourage reporting of PRO data for joint replacement. 13 PRO data will continue to be central to improving outcomes as we shift toward a value-based healthcare system. However, identifying the cost of care delivery across healthcare organizations has proved a significant challenge.…”

Section: Introductionmentioning

confidence: 99%

Time-Driven Activity-Based Costing: A Better Way to Understand the Cost of Caring for Hip Fractures

Blaschke

Parikh

Vang

et al. 2020

Geriatr Orthop Surg Rehabil

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Geriatric hip fractures are a common and costly injury. They are expected to surge in incidence and economic burden as the population ages. With an increasing financial strain on the healthcare system, payors and providers are looking toward alternative, value-based models to contain costs. Value in healthcare is the ratio of outcomes achieved over costs incurred, and can be improved by reducing cost while maintaining or improving outcomes, or by improving outcomes while maintaining or reducing costs. Therefore, an understanding of cost, the denominator of the value equation, is essential to value-based healthcare. Because traditional hospital accounting methods do not link costs to conditions, there has been little research to date on the costs of treating geriatric hip fractures over the entire cycle of care. The aim of this article is to summarize existing costing methodologies, and in particular, to review the strengths and limitations of Time-Driven Activity-Based Costing (TDABC) in orthopaedic trauma, especially as it pertains to the needs and challenges unique to hip fracture care. TDABC determines costs at the patient-level over the entire care cycle, allowing for population variability, while simultaneously identifying cost drivers that might inform risk-stratification for future alternative payment models. Through process mapping, TDABC also reveals areas of variation or inefficiency that can be targeted for optimization, and empowers physicians by focusing on costs in the control of the provider. Although barriers remain, TDABC is well-positioned to provide transparent costing and targets to improve the value of hip fracture care

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Section: Introductionmentioning

confidence: 99%

Time-Driven Activity-Based Costing: A Better Way to Understand the Cost of Caring for Hip Fractures

Blaschke

Parikh

Vang

et al. 2020

Geriatr Orthop Surg Rehabil

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“…In order to examine and compare the effects of different treatments on disability, it is necessary to use patient-reported outcome measures (PROMs). Currently, PROMs are considered a necessary aspect of medical treatment evaluation,8 9 and are used in national and international registries 10. Furthermore, PROMs are frequently used and recommended to support clinical decision-making, health policies and reimbursement processes 11.…”

Section: Introductionmentioning

confidence: 99%

“…Lack of validity or suboptimal measurement properties of PROMs might bias (positively or negatively) the effects of randomised controlled trials 12. The respondent and patient burden of the selected PROMs must also be considered for successful implementation in research and clinical practice 9. Given the importance of using appropriate PROMs, internationally recognised guidelines such as the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) were developed (https://www.cosmin.nl/).…”

Section: Introductionmentioning

confidence: 99%

Patient-reported outcome measures for hip-related pain: a review of the available evidence and a consensus statement from the International Hip-related Pain Research Network, Zurich 2018

et al. 2020

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Hip-related pain is a well-recognised complaint among active young and middle-aged active adults. People experiencing hip-related disorders commonly report pain and reduced functional capacity, including difficulties in executing activities of daily living. Patient-reported outcome measures (PROMs) are essential to accurately examine and compare the effects of different treatments on disability in those with hip pain. In November 2018, 38 researchers and clinicians working in the field of hip-related pain met in Zurich, Switzerland for the first International Hip-related Pain Research Network meeting. Prior to the meeting, evidence summaries were developed relating to four prioritised themes. This paper discusses the available evidence and consensus process from which recommendations were made regarding the appropriate use of PROMs to assess disability in young and middle-aged active adults with hip-related pain. Our process to gain consensus had five steps: (1) systematic review of systematic reviews; (2) preliminary discussion within the working group; (3) update of the more recent high-quality systematic review and examination of the psychometric properties of PROMs according to established guidelines; (4) formulation of the recommendations considering the limitations of the PROMs derived from the examination of their quality; and (5) voting and consensus. Out of 102 articles retrieved, 6 systematic reviews were selected and assessed for quality according to AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews). Two showed moderate quality. We then updated the most recent review. The updated literature search resulted in 10 additional studies that were included in the qualitative synthesis. The recommendations based on evidence summary and PROMs limitations were presented at the consensus meeting. The group makes the following recommendations: (1) the Hip and Groin Outcome Score (HAGOS) and the International Hip Outcome Tool (iHOT) instruments (long and reduced versions) are the most appropriate PROMs to use in young and middle-aged active adults with hip-related pain; (2) more research is needed into the utility of the HAGOS and the iHOT instruments in a non-surgical treatment context; and (3) generic quality of life measures such as the EuroQoL-5 Dimension Questionnaire and the Short Form Health Survey-36 may add value for researchers and clinicians in this field. We conclude that as none of the instruments shows acceptable quality across various psychometric properties, more methods studies are needed to further evaluate the validity of these PROMS—the HAGOS and iHOT—as well as the other (currently not recommended) PROMS.

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“…Shifting the spotlight away from clinical assessment toward patient's factors in deciding when surgery is and is not appropriate, and incorporating subjective perceptions of health in the decision‐making process, surgeons are increasingly adopting patient‐focused tools, such as patient‐reported outcome measures (PROMs), and concepts, such as shared decision‐making (SDM) 15–18 . PROMs capture physical, emotional, and social aspects of health and wellbeing from the patient's perspective 19 .…”

Section: Introductionmentioning

confidence: 99%

Advanced decision‐making using patient‐reported outcome measures in total joint replacement

Jayakumar

Bozic

2020

Journal Orthopaedic Research

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Up to one‐third of total joint replacement (TJR) procedures may be performed inappropriately in a subset of patients who remain dissatisfied with their outcomes, stressing the importance of shared decision‐making. Patient‐reported outcome measures capture physical, emotional, and social aspects of health and wellbeing from the patient's perspective. Powerful computer systems capable of performing highly sophisticated analysis using different types of data, including patient‐derived data, such as patient‐reported outcomes, may eliminate guess work, generating impactful metrics to better inform the decision‐making process. We have created a shared decision‐making tool which generates personalized predictions of risks and benefits from TJR based on patient‐reported outcomes as well as clinical and demographic data. We present the protocol for a randomized controlled trial designed to assess the impact of this tool on decision quality, level of shared decision‐making, and patient and process outcomes. We also discuss current concepts in this field and highlight opportunities leveraging patient‐reported data and artificial intelligence for decision support across the care continuum.

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Patient-Reported Outcomes in Orthopaedics

Cited by 73 publications

References 92 publications

Time-Driven Activity-Based Costing: A Better Way to Understand the Cost of Caring for Hip Fractures

Time-Driven Activity-Based Costing: A Better Way to Understand the Cost of Caring for Hip Fractures

Patient-reported outcome measures for hip-related pain: a review of the available evidence and a consensus statement from the International Hip-related Pain Research Network, Zurich 2018

Advanced decision‐making using patient‐reported outcome measures in total joint replacement

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