Speaker details how to get started collecting patient-reported outcome measures
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Global health, physical function, pain intensity, pain interference and depression are patient-reported outcome measures that should be integrated into clinical decision-making, according to a foot and ankle surgeon.
Daniel Guss, MD, MBA, an assistant professor at Harvard Medical School and foot and ankle surgeon at Massachusetts General Hospital, presented his advice for collecting patient-reported outcome measures (PROMs) at the American Orthopaedic Foot & Ankle Society Annual Meeting. The meeting was held virtually.
“The goal of this talk specifically is to just help those who are starting out,” Guss said in his presentation. He said PROM domains include physical, social and mental components. Within each of these global domains are several Patient-Reported Outcomes Measurement Information System questionnaires physicians can use. “It is a hard landscape to navigate,” he said.
Guss said the beauty of PROMs is that expert recommendations already exist and can be followed.
“Ultimately, when we here in Boston decided which to collect, we went with the recommendations of others,” he said. “These are the five that we collect: global health, physical function, pain intensity, pain interference and then also depression. And so, you are covering all those domains.”
Once health care professionals decide which PROMs to collect, there are “key components” to put in place, Guss said.
“One is the software. What am I going to use as an actual software platform in order to collect these PROMs? [Electronic medical record] EMR is an option, but it is not the only option. The key thing is, no matter what platform you use, it is important that it includes the computer-adapted testing, because it remarkably shortens the requirement of what patients have to fill out and prevents questionnaire fatigue,” he said. “The other component is the hardware. The easiest way that a lot of places are doing is a tablet, though you can go online. Then the other component that we think about is also the Wi-Fi. We had our own struggles which when we suddenly loaded all these tablets onto the Wi-Fi network, it started crashing, and the hospital had to build a dedicated Wi-Fi network.”
Guss suggested using third-party software such as that from the American Academy of Orthopaedic Surgeons AAOS, which is a registry effort. He also noted there are open-source platforms, like Redcap, but these require a knowledgeable and dedicated IT team. There are also cost-affordable private companies, like Surgical Outcomes Systems, which is owned by Arthrex, Guss said. However, he noted questions of data ownership could arise.
After deciding on a platform, the next step is to operationalize it, Guss said.
“How am I going to create a workflow that collects PROMs? What I mean by that is, a patient walks up to the front desk. Now what?” he said. “Is it going to be the front desk person or is it going to be the medical assistant that then helps them access it? When do they fill out the PROMs? Do they do it in the waiting room? Do they do it when they are going to radiology? Do they do it in the exam room as they are waiting to meet with you?”
The COVID-19 pandemic caused some to collect PROMs at home, Guss said. The process had no impact on response rate, so it is another collection technique to consider, he said.
“No matter where you decide to [collect PROMs], and technology has enabled a lot of filling it at home, you probably want to avoid seeing the patient until they are filled out because what we have found is that when you see the patient, the iPad is put aside when the visit is over and if they are not filled out, they are not going to get filled out,” he said.
Lastly, Guss addressed the “critical question” of what to do with the PROMs. He said PROMs can help health care professionals meet CMS requirements and can also be useful as research measures. Guss said surgeons must prove the utility of PROMs to patients and make them aware that the measures are beneficial to patients.
“Realize that this probably has to replace some of the paperwork you may be using now, especially in follow-up visits, and learn how to integrate these scores in clinical decision-making, which is arguably the most important,” Guss concluded.
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Guss D, et al. Getting started with clinical outcome collection. Presented at: American Orthopaedic Foot & Ankle Society Annual Meeting; Sept. 10-12, 2020 (virtual meeting).
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