Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Aug 4;7(3):e22.00026.
doi: 10.2106/JBJS.OA.22.00026. eCollection 2022 Jul-Sep.

Sociodemographic Factors Are Associated with Patient-Reported Outcome Measure Completion in Orthopaedic Surgery: An Analysis of Completion Rates and Determinants Among New Patients

David N Bernstein  1   2 , Aditya V Karhade  1   2 , Christopher M Bono  1 , Joseph H Schwab  1 , Mitchel B Harris  1 , Daniel G Tobert  1
Affiliations

Sociodemographic Factors Are Associated with Patient-Reported Outcome Measure Completion in Orthopaedic Surgery: An Analysis of Completion Rates and Determinants Among New Patients

David N Bernstein et al. JB JS Open Access. .

Erratum in

Abstract

Patient-reported outcome measures (PROMs) and, specifically, the Patient-Reported Outcomes Measurement Information System (PROMIS), are increasingly utilized for clinical research, clinical care, and health-care policy. However, completion of these outcome measures can be inconsistent and challenging. We hypothesized that sociodemographic variables are associated with the completion of PROM questionnaires. The purposes of the present study were to calculate the completion rate of assigned PROM forms and to identify sociodemographic and other variables associated with completion to help guide improved collection efforts.

Methods: All new orthopaedic patients at a single academic medical center were identified from 2016 to 2020. On the basis of subspecialty and presenting condition, patients were assigned certain PROMIS forms and legacy PROMs. Demographic and clinical information was abstracted from the electronic medical record. Bivariate analyses were performed to compare characteristics among those who completed assigned PROMs and those who did not. A multivariable logistic regression model was created to determine which variables were associated with successful completion of assigned PROMs.

Results: Of the 219,891 new patients, 88,052 (40%) completed all assigned PROMs. Patients who did not activate their internet-based patient portal had a 62% increased likelihood of not completing assigned PROMs (odds ratio [OR], 1.62; 95% confidence interval [CI], 1.58 to 1.66; p < 0.001). Non-English-speaking patients had a 90% (OR, 1.90; 95% CI, 1.82 to 2.00; p < 0.001) increased likelihood of not completing assigned PROMs at presentation. Older patients (≥65 years of age) and patients of Black race had a 23% (OR, 1.23; 95% CI, 1.19 to 1.27; p < 0.001) and 24% (OR, 1.24; 95% CI, 1.19 to 1.30; p < 0.001) increased likelihood of not completing assigned PROMs, respectively.

Conclusions: The rate of completion of PROMs varies according to sociodemographic variables. This variability could bias clinical outcomes research in orthopaedic surgery. The present study highlights the need to uniformly increase completion rates so that outcomes research incorporates truly representative cohorts of patients treated. Furthermore, the use of these PROMs to guide health-care policy decisions necessitates a representative patient distribution to avoid bias in the health-care system.

Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

PubMed Disclaimer

References

    1. Baumhauer JF. Patient-Reported Outcomes - Are They Living Up to Their Potential? N Engl J Med. 2017. Jul 6;377(1):6-9. - PubMed
    1. Cella D, Yount S, Rothrock N, Gershon R, Cook K, Reeve B, Ader D, Fries JF, Bruce B, Rose M; PROMIS Cooperative Group. The Patient-Reported Outcomes Measurement Information System (PROMIS): progress of an NIH Roadmap cooperative group during its first two years. Med Care. 2007. May;45(5)(Suppl 1):S3-11. - PMC - PubMed
    1. Bernstein DN, St John M, Rubery PT, Mesfin A. PROMIS Pain Interference Is Superior to the Likert Pain Scale for Pain Assessment in Spine Patients. Spine (Phila Pa 1976). 2019. Jul 15;44(14):E852-6. - PubMed
    1. Stekas ND, Johnson B, Jevotovsky D, Moses MJ, Segreto F, Fischer C, Buckland AJ, Errico TJ, Protopsaltis TS. PROMIS is superior to established outcome measures in capturing disability resulting from sagittal malalignment in patients with back pain. Spine Deform. 2020. Jun;8(3):499-505. - PubMed
    1. Cheung EC, Moore LK, Flores SE, Lansdown DA, Feeley BT, Zhang AL. Correlation of PROMIS with Orthopaedic Patient-Reported Outcome Measures. JBJS Rev. 2019. Aug;7(8):e9. - PubMed