Integrating patient-reported outcomes into orthopaedic clinical practice: proof of concept from FORCE-TJR

Abstract

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.

Fig. 1A–B

Two examples of SF-36 physical and mental component summary score trends over time are shown. (A) Physical function shows a decline before THA and significant improvement to the national norm by 10 months after surgery. Emotional health remains strong throughout. (B) Physical function declines before TKA and improves significantly by the 4-month postoperative visit. Emotional health declined with preoperative pain but is at the national norm after surgery. PCS = physical component summary; MCS = mental component summary.

Fig. 2

A diagram illustrates the data collection process in the office.