SynopsisMethods for measuring outcomes after hand and upper extremity surgery continue to evolve, yet remain inconsistent in quality. In this article we review the use of patient-reported outcomes measures in upper extremity surgery patients, and provides a practical guide to questionnaire selection, assessment, and utilization. We also present the future direction of health services research, and how it will drive changes in measuring outcomes in hand surgery.
KeywordsPatient-reported outcomes; hand surgery outcomes; patient-reported measures of hand function; COSMIN; CAT; PROMIS; Health services research
OVERVIEWThe upper extremity is a highly specialized functional, sensory, and aesthetic unit. The upper extremity can also suffer a unique range of insults. In 2010, the United States Bureau of Labor Statistics reported the annual incidence rate of hand injuries at 25.1 per 10,000 workers, and the most frequently injured population were young, active workers.(1) When the costs of medical care, rehabilitation, and productivity loss are computed, for this younger population of trauma patients as well as the often-older population with arthritis, neuropathies, and other sources of pain and functional loss, the burden of hand pathology is massive.(2) How we as providers evaluate and manage hand pathology is critical to individuals and society as a whole.On the national level, as health care delivery and reimbursement in the United States undergoes rapid and substantial change, the focus on quality and value of care continues to increase. A shift towards value-based insurance models has begun.(3, 4) These programs aim to reduce patient costs and increase access and utilization of high-value treatments, while discouraging low-value treatments. "Choosing Wisely" and other similar campaigns © 2012 Elsevier Inc. All rights reserved.Corresponding Author: Kevin C. Chung, MD, MS, Section of Plastic Surgery, University of Michigan Health System, 2130 Taubman Center, SPC 5340, 1500 E. Medical Center Drive, Ann Arbor, MI, kecchung@umich.edu,. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. are also emphasizing appropriate and evidence-based surgical interventions.(5) Fee for service reimbursement is changing, and quality of care will play an increasing role in provider compensation.(6, 7) This all has resulted in a renewed focus on the need for highquality evidence to support provider decision-making and delivery of care.In the US, Canada, the UK, and many other nations, health services research has been a substantial area of focus for over 15 years.(8, 9) This field analyzes how pati...