How Should We Use Patient-Reported Outcome Measures at the Point of Care in Hand Surgery?

Abstract

Purpose: Despite the importance of collecting patient-reported outcome measures (PROMs), there are few process guidelines for physicians on how to collect and communicate individualized PROMs in patients at the point of care. The purpose of this study was to develop process guidelines on how to routinely collect and communicate individualized PROMs at the point of care in hand surgery.

Methods: A consortium of 9 fellowship-trained hand or upper limb surgeons and experts in quality measure development evaluated the importance, feasibility, usability, and scientific acceptability of 12 candidate process guidelines regarding the collection and use of individualized PROMs at the point of care using a modified RAND/University of California Los Angeles Delphi appropriateness method. The panelists evaluated each candidate process guideline in 2 blinded voting rounds with an intervening face-to-face discussion. Predetermined criteria were used to determine panelist agreement or disagreement.

Results: The consortium did not reach a consensus on the validity of any of the 12 candidate process guidelines on the routine collection and communication of individualized PROMs at the point of care in hand surgery. The domains of importance and feasibility had greater median scores than those of usability and evidence.

Conclusions: To effectively collect and use PROMs to improve care for individual patients, process guidelines for when and how PROM scores should be collected and communicated with patients are needed. The expert consortium was unable to reach an agreement on any of the candidate process guidelines, often because of limitations in evidence supporting the use of PROMs at the point of care.

Clinical relevance: Patient-reported outcome measures continue to guide outcome assessments that reflect patient perspective. Although PROM scores are currently aggregated and used to draw broad conclusions about populations, they can also be used as communication tools or to trigger management decisions (eg, use of therapy) that improve care for individual patients. Process guidelines on how to use PROM scores at the point of care are needed.

Keywords: Hand surgery; patient-centered care; patient-reported outcome measures; point of care; shared decision making.