What Do Orthopaedists Believe is Needed for Incorporating Patient-reported Outcome Measures into Clinical Care? A Qualitative Study

Abstract

BackgroundPatient-reported outcome measures (PROMs) are increasingly promoted for use in routine orthopaedic care with the expectation that if they are made available during encounters, they will be incorporated into clinical practice. We investigated an initiative in which PROMs were systematically collected and provided via the electronic health record but were infrequently used.Questions/purposesIn a qualitative study, we asked: (1) Why are PROM results not being used in clinical care when they are available to surgeons? (2) What aspects of PROMs are seen as useful for clinical care? (3) How are PROMs generally perceived by surgeons and orthopaedic leaders?MethodsA cross-sectional qualitative study was conducted in a single health system in an urban setting using semistructured interviews with a purposive sample of orthopaedic surgeons and leaders who would have substantial knowledge of and experience with the organization’s PROM system, which was embedded in the electronic health record and developed for use in clinical care but was not being used. We included surgeons whose practices consisted of at least 90% patients with osteoarthritis, including surgical and nonsurgical management, and thus their patients would be completing PROMs surveys, or surgeons who were leaders in one of the three orthopaedic divisions in the health plan. The senior research manager for orthopaedics identified 14 potential participants meeting these criteria, 11 of whom agreed to study participation. Participants included nine surgeons and two orthopaedic leaders; the majority were men, with a median of 13 years of clinical practice. Study interviews were conducted by an experienced interviewer not known to participants, in private conference rooms in the healthcare setting, and a median (range) of 27 minutes (16 to 40) in length. A content analysis approach was employed for data analysis, with thematic inductive saturation reached in the analysis and attention to trustworthiness and rigor during the analytic process.ResultsInterviewees reported that PROM scores are not being used in patient clinical care because of logistical barriers, such as access and display issues and the time required, and perceptual barriers, such as concerns about patient understanding and the validity and reliability of measures. Surgeons preferred talking with patients about the personal outcomes patients had identified as important; most patients preferred to assess progress toward their own goals than PROMs scores for other people. Surgeons also identified changes that could facilitate PROM use and reduce barriers in clinical care, including pushing PROM scores to physicians’ inboxes, developing inserts for physician notes, using easy-to-understand graphical displays, and engaging patients about PROMs earlier in the care process. Participants all agreed that PROMs in aggregate use are valuable for the organization, department, and individual surgeons, but individual patient scores are not.ConclusionDespite the availability of PROMs, there are im...

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“…Some participants described hypothetical versus actual benefits of PROM feedback for communication because they perceived limited use of the PROM feedback by surgeons compared to other clinical data. While orthopaedic surgeons have expressed concerns about using PROMs for individual patient management [ 47 ], participating surgeons were advocates for use per voluntary involvement in the trial. Our findings may reflect challenges with patient recall or misalignment between patients’ and clinicians’ perspectives on how PROM feedback should be used in the clinic, with surgeons using the report in ways unrecognized by patients.…”

Quality of total hip arthroplasty health care based on four years of patient-reported outcomes in the Netherlands

“…They prefer to talk with patients about personal outcomes. However, they mention that using PROs on an aggregated level is valuable for hospitals and individual surgeons [33]. Secondly, support stakeholders to evaluate THA outcomes from a patients' perspective using the already existing multiple examples and recommendations how to use the PROs [34,35].…”

Emerging innovations and advancements in the field of musculoskeletal oncology

“…4,5 With the creation of specific population databases and institutional collaborations, we are now able to research the subjective impact of our treatment and management of patients with musculoskeletal tumors. [5][6][7][8][9][10][11] Cizik, Blank and associates provide a description of the pertinent advances in this specific research area as it relates to orthopaedic oncology patients. The importance of PROMs to orthopedic oncology care is complemented by the recent increased focus on socioeconomic considerations in the management of these complex patients.…”

“…Patient reported outcome measures (PROMs) have shifted the clinical focus from the objective assessment of providers to the subjective perspective of the patient 4,5 . With the creation of specific population databases and institutional collaborations, we are now able to research the subjective impact of our treatment and management of patients with musculoskeletal tumors 5–11 . Cizik, Blank and associates provide a description of the pertinent advances in this specific research area as it relates to orthopaedic oncology patients.…”