Optimizing PROM Implementation in Orthopedic Clinics for Longitudinal Outcome Monitoring: Lessons from a Multisite Study

Abstract

Background: Systematic patient-reported outcome measure (PROM) collection is challenging for clinics, particularly when patients are not in the office. The Arthritis care through Shared Knowledge (ASK) study deployed multimodal approaches to collect PROMs using a clinical microsystem framework.

Conceptual model: Informed by the clinical microsystem model, the authors coached 12 orthopedic practices to implement shared processes to support best practices for PROM collection and use. Orthopedic sites collected PROMs from new patients before the first office visit; patients completed the PROM from home via an online assessment in a personalized e-mail. Site staff placed follow-up phone reminders. At 6 and 12 months after the visit, PROMs were collected from home, prompted by an e-mail or phone call.

Performance outcomes: Of the 25,043 new patients identified by clinical sites during the study enrollment, approximately 60% completed a pre-visit PROM-36.6% completed the online PROM after receiving a single automated e-mail, and an additional 31.1% completed the PROM after receiving a text, an e-mail, or a phone call from the staff. The remaining 32.2% of PROMs were collected on arrival at the office. Of patients completing PROMs, 11,140 were eligible to participate in longitudinal collection, and 51.3% consented. Of these, approximately 84% completed a 6-month survey, more than 83% completed a 12-month survey, and more than 91% completed either a 6-month PROM, a 12-month PROM, or both.

Learning: This study illustrates that a multimodal approach to PROM collection using a clinical microsystem approach sustainably supports PROM completion rates. Further efforts are needed to define strategies to engage all patients in understanding and reporting PROMs to inform their care.