Disconnected: Electronic Patient-Reported Outcome Measure Collection In Orthopaedic Patients at an Urban Safety-Net Hospital

Nicholas J Tucker; Ananya Shah; Cyril Mauffrey; Mark Hammerberg; Joshua A Parry

doi:10.5435/JAAOS-D-23-00132

Disconnected: Electronic Patient-Reported Outcome Measure Collection In Orthopaedic Patients at an Urban Safety-Net Hospital

J Am Acad Orthop Surg. 2023 Nov 1;31(21):1136-1142. doi: 10.5435/JAAOS-D-23-00132. Epub 2023 Jul 10.

Authors

Nicholas J Tucker¹, Ananya Shah, Cyril Mauffrey, Mark Hammerberg, Joshua A Parry

Affiliation

¹ From the Department of Orthopaedics (Dr. Tucker, Dr. Mauffrey, Dr. Hammerberg, Dr. Parry), Denver Health Medical Center, St. Denver, CO (Tucker, Mauffrey, Hammerberg, and Parry), and the University of Colorado School of Medicine, Denver, Colorado (Tucker, Shah, Mauffrey, Hammerberg, and Parry), Aurora, CO.

PMID: 37432990
DOI: 10.5435/JAAOS-D-23-00132

Abstract

Introduction: Collection of patient-reported outcome measures (PROMs) in orthopaedic patients at safety-net hospitals is challenging. The purpose of this study was to evaluate the success of electronic PROM (E-PROM) collection in this setting.

Methods: A retrospective review identified 207 consecutive orthopaedic patients undergoing 77 elective arthroplasty procedures and 130 trauma procedures. E-PROMs were collected through automated e-mails from an online patient engagement platform (PatientIQ) at 2 weeks, 6 weeks, and 3 months postoperatively. Patients with trauma received the percentage of normal Single Assessment Numerical Evaluation (SANE) and Patient-Reported Outcomes Measurement Information System-Physical Function (PROMIS-PF). Arthroplasty patients received the Hip/Knee SANE, Hip/Knee Disability and Osteoarthritis Outcome Score-Joint Replacement (HOOS Jr/KOOS Jr), PROMIS Global Physical Health (PROMIS-G-PH), and Veterans RAND 12-Item (VR-12) Health Survey.

Results: Compared with patients with trauma, arthroplasty patients were older (median difference 18.0 years; 95% confidence interval [CI] 12.0-22.0; P < 0.0001), more likely to be Hispanic/Black (proportional difference 16.9%; CI 2.8-30.3%; P = 0.02), more likely to have noncommercial or no insurance (proportional difference 34.0%; CI 23.2-43.0%; P < 0.001), and did not differ in Area Deprivation Index or E-PROM completion at each time point. E-PROMs were completed at 2 weeks, 6 weeks, and 3 months by 25.1% (52 of 207), 24.6% (51 of 207), and 21.7% (45 of 207) of all patients, respectively. Trauma and arthroplasty patients had a similar rate of partial E-PROM completion. Patients who completed 3-month E-PROMs were less likely to be Hispanic/Black (PD -16.4%; CI -31.0 to -0.2%; P < 0.04); less likely to have noncommercial/no insurance (PD -20.0%; CI -35.5 to -4.5%; P = 0.01); and did not differ in age, sex, Area Deprivation Index, or procedure type.

Discussion: The low collection rate of E-PROMs from orthopaedic patients at safety-net hospitals should be weighed against their costs. E-PROM collection may exacerbate disparities in PROM collection among certain patient populations.

Level of evidence: Diagnostic Level III.