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Integrating Patient-reported Outcomes Into Orthopaedic Clinical Practice: Proof of Concept From FORCE-TJR

  • Symposium: ABJS Carl T. Brighton Workshop on Outcome Measures
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Good orthopaedic care requires a knowledge of the patient’s history of musculoskeletal pain and associated limitations in daily function. Standardized measures of patient-reported outcomes (PROs) can provide this information. Integrating PROs into routine orthopaedic patient visits can provide key information to monitor changes in symptom severity over time, support shared clinical care decisions, and assess treatment effectiveness for quality initiatives and value-based reimbursement.

Where Are We Now?

Although standardized, validated PRO surveys are routinely used in clinical and comparative effectiveness research, they are not consistently or efficiently collected in clinical practice.

Where Do We Need to Go?

Ideally, PROs need to be collected directly from patients before their surgeon visit so the data are readily available to the surgeon and patient at the time of the office visit. In addition, PROs should be integrated in the electronic health record to monitor patient status over time.

How Do We Get There?

PRO integration in clinical practice requires minor modifications to the office flow, some additional staff to facilitate collection, and the technical infrastructure to score, process, and store the responses. We document successful office procedures for collecting PROs in one busy orthopaedic clinic and some suggested methods to extend this model to the Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement (FORCE-TJR) consortium of 121 surgeons where the process is centralized and staff obtained consent to send the PRO directly to the patient’s home. Both methods are options for the broader adoption of office-based PROs.

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Acknowledgments

The authors acknowledge the contributions of UMass Memorial Health Care and its information systems staff and Janel Milner BS for their support of the PRO system development and its ongoing operations. We also acknowledge Sylvie Puig PhD for her editorial contributions.

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Authors and Affiliations

  1. Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA

    David C. Ayers MD, Hua Zheng PhD & Patricia D. Franklin MD, MBA, MPH

Authors
  1. David C. Ayers MD
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  2. Hua Zheng PhD
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  3. Patricia D. Franklin MD, MBA, MPH
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Corresponding author

Correspondence to David C. Ayers MD.

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Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

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Ayers, D.C., Zheng, H. & Franklin, P.D. Integrating Patient-reported Outcomes Into Orthopaedic Clinical Practice: Proof of Concept From FORCE-TJR. Clin Orthop Relat Res 471, 3419–3425 (2013). https://doi.org/10.1007/s11999-013-3143-z

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  • DOI: https://doi.org/10.1007/s11999-013-3143-z

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