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

2020 ◽  
Vol 38 (7) ◽  
pp. 1414-1422 ◽  
Author(s):  
Prakash Jayakumar ◽  
Kevin J. Bozic
Keyword(s):  
Decision Making ◽  
Outcome Measures ◽  
Joint Replacement ◽  
Total Joint Replacement ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Patient Reported

scholarly journals Implementation of Patient-Reported Outcome Measures in U.S. Total Joint Replacement Registries

2014 ◽  
Vol 96 (suppl 1) ◽  
pp. 104-109 ◽  
Author(s):  
Patricia D. Franklin ◽  
David Lewallen ◽  
Kevin Bozic ◽  
Brian Hallstrom ◽  
William Jiranek ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Joint Replacement ◽  
Total Joint Replacement ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Patient Reported

scholarly journals THE USE OF PATIENT REPORTED OUTCOME MEASURES BY PHYSICAL THERAPISTS IN THE PEDIATRIC SPORTS POPULATION

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0003
Author(s):  
Jamila N. Aberdeen ◽  
Heather F. Stewart ◽  
Rebecca K. Frank Burnett ◽  
Elliot Greenberg
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Outcome Measures ◽  
Response Rate ◽  
Physical Therapists ◽  
Clinical Care ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Patient Reported ◽  
Knee Disorders

Purpose: Patient reported outcome measures (PROs) allow physical therapists (PTs) the ability to objectively understand a patients’ perception of their symptoms, functional status, and health related quality of life. Although professional organizations have issued recommendations for PRO use, many of these measures were developed and validated within the adult population which may limit their application to pediatric orthopedics. It is currently unknown which measures are being used within this population, and thus the purpose of this study is to evaluate the current use of PROs among pediatric sports PT and determine how PRO information is used in clinical care. Methods: An online survey, developed in REDCap™, was administered via email to members of the Sports Section Youth Athlete Special Interest Group (YASIG) and the Pediatric Research in Sports Medicine Society (PRiSM), over the course of 8 weeks. The survey was developed and pilot tested by 4 physical therapists and 3 orthopedic surgeons and consisted of 24 possible questions, taking 3-5 minutes to complete. Descriptive statistics and frequency tallies were utilized to analyze the data. Results: There was a total of 70 respondents (response rate YASIG 17%; response rate PRiSM 90%) who completed the questionnaire in its entirety. There was a wide range of clinical experience with 31% reporting 0-5 years, 23%, 6-10 years, 16%, 11-15 years, and 30% >16 years. The majority (54%) reported working in a hospital based outpatient setting or private practice (24%). Ninety four percent (n=66) of respondents reported using PROs, with 100% (n=66) of these subjects issuing them at the initial visit, 94% (n=62) at discharge, and 91% (n=60) monthly. The Neck Disability Index (76%, n=50), Oswestry (76%, n=50), and QuickDASH (68%, n=45) were most frequently used for neck, back and shoulder disorders, respectively. The Lower Extremity Functional Scale (LEFS) was the most widely utilized measure for multiple body regions including 74% (n=49) for either hip or knee dysfunction, and 26% (n=16) for ankle. In general, knee disorders demonstrated the highest degree of variability in scale selection with 52% (n=34) using the IKDC, 35% (n=23) using the Pedi-IKDC and 20% (n=13) (using the KOOS). The information obtained from PROs was used to demonstrate effectiveness of treatment (80%, n=53), inform clinical decisions (77%, n=51), satisfy insurance requirements (59%, n=39), used for goal writing (60%, n=40), and research (36%, n=24). Only 6% (n=4) of PTs indicated that PROs did not impact clinical reasoning within their plan of care. When asked how the information from PROs is used within clinical practice, it was noted that 71% (n=47) of PTs would ‘revise physical therapy goals’ if scores were either higher or lower than expected and 38% (n=25) would ‘refer patient back to the physician’ if PRO results showed lack of progress or regression. In addition, 20% (n=13) of PTs noted they utilize the results from PROs to help inform discharge decision making. When asked regarding barriers to using PROs, PTs reported inadequate time (42%, n=28), difficultly remembering to administer (38%, n=25) and uncertainty regarding which PRO to use (21%, n=14) as the main impediments in using PROs. Conclusions: Our results indicate that the majority of pediatric sports PTs are using PROs to establish efficacy of treatment, inform clinical decision making and set goals. Inadequate time and indecision with regards to which scale to use, were identified as barriers to use. Knee disorders demonstrated the largest variability in scale use. Interestingly, the LEFS was reported at high frequencies for the hip, knee and ankle joints despite the availability of other joint specific measures available. The Oswestry and NDI are also used by 76% of respondents despite neither tool being validated in pediatrics. This finding may be due to the absence of any pediatric specific alternative measures. Clinical Relevance: The Center for Medicare and Medicaid implemented value based purchasing program per the mandate of the Affordable Care Act. The Act established a performance based approach to payment with a goal of ensuring better clinical outcomes and improved patient experience. As a result, there is an increased emphasis on using PROs to demonstrate efficacy and functional improvement. It is reassuring that many PTs are using PROs and using the obtained data to drive clinical care. However, the high variability in scale choice makes comparative outcomes research difficult. In addition, the majority of the PROs used are not validated within the pediatric population and thus may not be appropriate tools for assessing these patients perception of care delivered or even represent their functional/athletic limitations. Given the high prevalence of use and importance to clinical practice, the need for psychometric testing and/or scale development specifically for pediatric sports population is imperative.

scholarly journals Are responders to patient health surveys representative of those invited to participate? An analysis of the Patient-Reported Outcome Measures Pilot from the Australian Orthopaedic Association National Joint Replacement Registry

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254196
Author(s):  
Ian A. Harris ◽  
Kara Cashman ◽  
Michelle Lorimer ◽  
Yi Peng ◽  
Ilana Ackerman ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Joint Replacement ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Telephone Call ◽  
Joint Replacement Registry ◽  
Asa Score ◽  
Significant Difference ◽  
Patient Reported

Background Patient-reported outcome measures (PROMs) are commonly used to evaluate surgical outcome in patients undergoing joint replacement surgery, however routine collection from the target population is often incomplete. Representative samples are required to allow inference from the sample to the population. Although higher capture rates are desired, the extent to which this improves the representativeness of the sample is not known. We aimed to measure the representativeness of data collected using an electronic PROMs capture system with or without telephone call follow up, and any differences in PROMS reporting between electronic and telephone call follow up. Methods Data from a pilot PROMs program within a large national joint replacement registry were examined. Telephone call follow up was used for people that failed to respond electronically. Data were collected pre-operatively and at 6 months post-operatively. Responding groups (either electronic only or electronic plus telephone call follow up) were compared to non-responders based on patient characteristics (joint replaced, bilaterality, age, sex, American Society of Anesthesiologist (ASA) score and Body Mass Index (BMI)) using chi squared test or ANOVA, and PROMs for the two responder groups were compared using generalised linear models adjusted for age and sex. The analysis was restricted to those undergoing primary elective hip, knee or shoulder replacement for osteoarthritis. Results Pre-operatively, 73.2% of patients responded electronically and telephone follow-up of non-responders increased this to 91.4%. Pre-operatively, patients responding electronically, compared to all others, were on average younger, more likely to be female, and healthier (lower ASA score). Similar differences were found when telephone follow up was included in the responding group. There were little (if any) differences in the post-operative comparisons, where electronic responders were on average one year younger and were more likely to have a lower ASA score compared to those not responding electronically, but there was no significant difference in sex or BMI. PROMs were similar between those reporting electronically and those reporting by telephone. Conclusion Patients undergoing total joint replacement who provide direct electronic PROMs data are younger, healthier and more likely to be female than non-responders, but these differences are small, particularly for post-operative data collection. The addition of telephone call follow up to electronic contact does not provide a more representative sample. Electronic-only follow up of patients undergoing joint replacement provides a satisfactory representation of the population invited to participate.

scholarly journals Revision Surgery in Total Joint Replacement Is Cost-Intensive

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Markus Weber ◽  
Tobias Renkawitz ◽  
Florian Voellner ◽  
Benjamin Craiovan ◽  
Felix Greimel ◽  
...  
Keyword(s):  
Infection Rate ◽  
Joint Replacement ◽  
Total Joint Replacement ◽  
Revision Arthroplasty ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Complication Rates ◽  
Joint Replacements ◽  
Patient Reported ◽  
One Year

Revisions after total joint replacement increase constantly. In the current study, we analyzed clinical outcome, complication rates, and cost-effectiveness of revision arthroplasty. In a retrospective analysis of 162 revision hip and knee arthroplasties from our institutional joint registry responder rate, patient-reported outcome measures (EQ-5D, WOMAC), complication rates, and patient-individual charges in relation to reimbursement were compared with a matched control group of primary total joint replacements. Positive responder rate one year postoperatively was lower for revision arthroplasties with 72.9% than for primary arthroplasties with 90.1% (OR=0.30, 95%CI=0.18–0.59, p=0.001). Correspondingly, improvement in patient-reported outcome measures one year after surgery was lower in revision than in primary joint arthroplasty with EQ-5D 0.19±0.25 to 0.30±0.24 (p<0.001) and WOMAC 24.3±30.3 to 41.2±21.3 (p<0.001). Infection rate was higher in revision (6.8%) compared to primary replacements (0%, p=0.001). Mean charges in revision arthroplasty were 76.0% higher than in matched primary joint replacements (7110.8±2249.4$ to 4041.1±975.7$, p<0.001), whereas reimbursement was only 23.6% higher (9243.3±2258.4$ in revision and 7477.9±703.1$ in primary arthroplasty, p<0.001). Revision arthroplasty is associated with lower outcome and higher infection rate compared to primary replacements. The high financial expense of revision arthroplasty is only partly covered by a higher reimbursement.

PP054 The All Wales Patient Reported Outcome Measures (PROMs), Patient Reported Experience Measures (PREMs) and Effectiveness Program

2017 ◽  
Vol 33 (S1) ◽  
pp. 97-98
Author(s):  
Kathleen Withers ◽  
Robert Palmer ◽  
Grace Carolan-Rees
Keyword(s):  
Decision Making ◽  
Outcome Measures ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Smoking History ◽  
Health Board ◽  
National Guidelines ◽  
Patient Reported ◽  
Oxford Hip Score ◽  
Inform Decision Making

INTRODUCTION:Prudent health care aims to do the minimum needed to achieve the greatest patient benefit. This aim relies on the availability of evidence on the safety and efficacy of interventions to support decision making. The principles of prudent healthcare support co-production, whereby service users contribute to service provision. Collection of patient reported data is becoming more widespread, however use of this data to inform decision making is limited.METHODS:A national patient reported outcome measures (PROMs) program has been formed supported by the Welsh Government, Welsh Health Boards and the NHS Wales Informatics Service. An electronic platform has been developed to facilitate collection of PROMs and patient reported experience measures (PREMs) from patients treated in secondary care. We collected baseline PROMs where possible and invited patients to submit PROMs and PREMs post-treatment. Data collected included EuroQuol five dimensions questionnaire (EQ5D), co-morbidities, body mass index (BMI), smoking history and alcohol intake. Disease specific tools were used where available and responses linked to clinical data. Individual level data will be available during clinic consultations, and collated data analyzed on national and health board levels to assess clinical effectiveness. The platform is currently being piloted in several sites across Wales.RESULTS:Initial baseline pilot data from hip replacement patients found that over 55 percent of responders were classed as overweight or obese, with over 80 percent carrying out less than the national guidelines for exercise.The baseline scores for hip patients were; EQ-5D Index (Mean .29, median .29, range (-.59 -1)), EuroQol-visual analogue scales (EQ-VAS) (Mean 57.8, median 60, range (0:100)), and Oxford Hip Score (Mean 14.9, median 14, range (0:48)).When compared to baseline scores collected by NHS England in 2015/16 (1), the average EQ5D Index and Oxford Hip Score collected in Wales was lower than that in England (p< .05).CONCLUSIONS:The program will provide a large dataset from patients across all of Wales with data on numerous chronic and acute conditions. The data collected will facilitate service improvements and will inform decision making as part of the prudent healthcare agenda.

National Implementation of an Electronic Patient Reported Outcome Measures Program for Joint Replacement Surgery (Preprint)

2021 ◽  
Author(s):  
Emma L. Heath ◽  
Ilana I. Ackerman ◽  
Michelle F. Lorimer ◽  
Sophia Rainbird ◽  
Grace O’Donohue ◽  
...  
Keyword(s):  
Data Collection ◽  
Outcome Measures ◽  
Joint Replacement ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Successful Implementation ◽  
Replacement Surgery ◽  
Patient Registration ◽  
National Implementation ◽  
Patient Reported

BACKGROUND There is a global emphasis on expanding data collection for joint replacement procedures beyond implant attributes and progression to revision surgery. Patient reported outcome measures (PROMs) are increasingly considered as an important measure of surgical outcomes from a patient’s perspective. However, a major limitation preventing wider use of PROMs data in national data collection has been the inability to systematically collect and share electronic information with relevant stakeholders in a comprehensive and financially sustainable manner. OBJECTIVE We aim to report on the development of an electronic data capture and reporting system by a national registry for the collection of PROMs and the processes used to identify and overcome barriers to implementation and uptake. We also aim to provide a cost breakdown of establishing and maintaining a nationwide electronic PROMs program. METHODS Between 2018 and 2020 three governance and advisory committees were established to develop and implement a PROMs pilot program nested within a nationwide joint replacement registry. The program involved electronic collection of pre- and 6-month post-operative data for hip, knee or shoulder replacement surgery from 44 Australian hospitals. Resource requirements for the program included a Project Manager, Software Developers, Data Manager and Statistician. An online platform was tested, refined, and implemented for electronic PROMs collection with scalability considered for future expansion to all Australian hospitals and additional data fields. Technical capabilities included different access for multiple user types, patient registration, automatic reminders via SMS and email, online consent and patient outcome real-time dashboards accessible for different user groups (surgeons, patients, hospitals and project stakeholders). RESULTS During the PROMs pilot period, there were 14,890 procedures registered in the electronic system. This equated to 60% of people who had a joint replacement at participating hospitals during this period. Patient registration and data collection were efficient (20-30 seconds and 10-12 minutes, respectively). Engagement with the reporting dashboards (proportion of those who viewed their dashboard) varied by user group: 197 (71.1%) hospital administrators, 68 (52.7%) project stakeholders, 177 (45.3%) surgeons and 1138 (12.9%). Cost analysis determined an overall cost per patient of AUD7 - AUD15 (approximately USD5 - USD12) for two PROMs collections per joint replacement procedure once the program was established. CONCLUSIONS Successful implementation of an orthopaedic PROMs program with planned scalability for a broader national rollout requires significant funding and staffing resources. However, this expenditure can be considered worthwhile, given that collection and reporting of PROMs can drive healthcare improvement processes. Further consideration of strategies to improve stakeholder engagement with electronic reporting dashboards (particularly for patients and surgeons) will be critical to the ongoing success of a national PROMs program.

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