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New PROM system aims to improve reporting of clinical care of patients
Integration of PROMIS in orthopedics relies on system familiarity among orthopedists, surgeons, hospital systems.
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In 2004, a group of scientists, statisticians and psychometricians from across the United States established the Patient-Reported Outcomes Measurement Information System as part of the Roadmap for Medical Research to develop a new system of patient-reported outcome measures for use in clinical care and medical research. Funded by the NIH, the Patient-Reported Outcomes Measurement Information System, or PROMIS, aims to improve the reporting of patient symptoms, function and health-related quality of life in an efficient and precise manner.
“[PROMIS is] meant to be the next wave or the future modes by which we capture patient outcomes or collect information on patients in terms of how they are doing from the musculoskeletal standpoint,” Alpesh A. Patel, MD, professor of orthopedic surgery at Northwestern Feinberg School of Medicine in Chicago, told Orthopedics Today.
PROMIS
According to Darrel S. Brodke, MD, professor and senior vice chair in the Department of Orthopedics at the University of Utah in Salt Lake City, outcome scores have been thought of as a research tool for surgeons to compare patient-reported outcome scores between two treatments to identify which treatment is more beneficial to patients. However, Brodke noted patient-reported outcome measures have been recently used as a clinical care tool, with PROMIS measuring physical health, mental health and social health in patients compared with other outcome measure tools that measured disease-specific patterns alone.
“The PROMIS system, when we look at it for specific orthopedic conditions — whether that is things like foot and ankle problems, hip and knee arthritis, spine problems in the neck or the lower back — we find the results are valuable and reliable, meaning we can get a good and accurate measure on our patients as good, if not better, than the historical measures and again with a lot more efficiency,” Patel said.
Patel added, where historic measures did not pick up patients who were high or low functioning, “PROMIS is meant to capture the entire spectrum with more accuracy and reliability.”
PROMIS also uses computerized adaptive testing, which can shorten the test by asking questions pertinent to the specific patient, while increasing accuracy, according to Brodke.
“These [questions] were developed in such a way that we could use a computer to help deliver the questions,” Brodke told Orthopedics Today. “It is called computerized adaptive testing and in doing that [orthopedists] can decrease the burden on the office and patients, since they do not have to answer as many questions. They can come into the clinic and, in a minute or two, they can answer their outcome measures rather than having to spend 5 [minutes] to 10 minutes, or more, answering questions prior to being seen by the doctor.”
PROMIS integration
Developed with the goal to provide a more accurate form of information through better questions, better accuracy and better efficacy in orthopedics, as well as across all medical fields, PROMIS needs to be integrated into clinics and hospitals, which can be done by way of an access portal developed by the PROMIS group.
“The PROMIS group has developed an access portal [to] their algorithm that runs their measures, and you need to then develop a program or application that can utilize that access portal allowing your patients to interface with it,” Brodke said. “There are a number available for people to buy, and there are a lot of places trying to integrate it within the electronic medical record or IT system, whether it is a university or a private practice.”
However, to be able to successfully integrate PROMIS into practices, Patel said surgeons, orthopedists and hospital systems need to be familiar with the system and understand it.
“They need to understand what [PROMIS] is, and they need to understand what the suggested improvements are over legacy measures,” Patel said. “Those then need to be incorporated into the quality metrics that individual practices and hospitals are currently performing, and that is still a big lead forward into unlocking all of the potential benefits of PROMIS.”
He continued, “This is just getting it to scale; getting people to understand what it is, to understand the value of it and then getting it out to scale in a bigger format other than a few centers around the country.” – by Casey Tingle
- Reference:
- Brodke DJ, et al. J Am Acad Orthop Surg. 2016;doi:10.5435/JAAOS-D-15-00404.
- Brodke DJ, et al. J Am Acad Orthop Surg. 2016;doi:10.5435/JAAOS-D-15-00420.
- Patel AA. J Am Acad Orthop Surg. 2016;doi:10.5435/JAAOS-D-16-00436.
- For more information:
- Darrel S. Brodke, MD, can be reached at University of Utah, 590 Wakara Way, Salt Lake City, UT 84108; email: ip@aaos.org.
- Alpesh A. Patel, MD, can be reached at Northwestern Feinberg School of Medicine, 259 East Erie, 13th Fl., Chicago, IL 60611; email: ip@aaos.org.
Disclosures: Patel is deputy editor of Spine for the Journal of the American Academy of Orthopaedic Surgeons. Brodke reports no relevant financial disclosures.