Published 3/11/2024
Jeffery D. Angel, MD, MFin, FAAOS

Unlocking the Power of Patient-Reported Outcomes: Essential Advantages for Orthopaedic Surgeons

Editor’s note: This article is part of the “PROMs in Practice” series presented by the AAOS Patient-Reported Outcome Measures (PROMs) Workgroup. Each month, a workgroup member will address the impact of PROMs on their subspecialty, patient care, the future of musculoskeletal healthcare, and more.

Patient-reported outcomes (PROs) are reports of a patient’s health condition that come directly from the patient, without interpretation by a clinician. In orthopaedic surgery, there is a growing impetus for the collection of PROs with validated tools such as PROMs. The implementation of PROMs has become a pressing issue for the specialty, as the Centers for Medicare & Medicaid Services will soon start penalizing hospitals based on their rate of PROM collection. This policy is presently enforceable for inpatient hip and knee arthroplasty, and it will likely soon apply to outpatient hip and knee arthroplasty cases as well.

This article explores the advantages PROMs can provide to surgeons. To fully comprehend the advantages of PROMs, it is essential to consider the driving forces behind the jobs of orthopaedic surgeons. The principles of such forces are outlined in Daniel Pink’s book Drive as “purpose,” “mastery,” and “autonomy.” The purpose of orthopaedic surgeons’ work is understood as the commitment to improving patients’ lives, which is exemplified by the difference (delta) between preoperative and postoperative PROMs.

Mastery in orthopaedic surgery can be enhanced when a surgeon compares the PROMs of his or her patients to established benchmarks. Additionally, mastery can be further gained from the adoption of evidence-based practices driven by the use of PROMs in research and registries.

Autonomy is nurtured when surgeons use PROM data garnered from the patients in their own practices to guide their efforts in quality improvement. Surgeons can analyze data, implement process enhancements, and even encourage patient compliance with reporting. The ability to govern oneself is far more appealing than relying solely on payers’ claims data and other proxies for outcome report cards.

Additionally, PROMs offer advantages for patients and the public, aligning with the triple aim of enhancing patient experience, improving population health, and reducing costs, as first described by the Institute for Healthcare Improvement.

Improved patient engagement
PROMs empower patients to actively participate in their own care. The increased engagement and satisfaction result in stronger relationships between surgeons and patients. The use of PROMs in practice will ideally result in improved compliance and patient activation, leading to better outcomes. A randomized clinical trial from Jayakumar et al, published in JAMA Network Open, evaluated the efficacy of a patient decision aid that included personalized outcome estimations with PROMs. The study found that use of the tool led to better decision quality as compared with decisions by patients undergoing routine clinical care.

Personalized patient care
Incorporating PROMs allows orthopaedic surgeons to deliver more personalized and tailored care. Multiple studies have demonstrated that patients desire a shared decision-making approach to their care, which can be guided by PROM scores. Collecting and analyzing these measures offer surgeons valuable insights into the patient’s individual experiences, concerns, and goals. This information enables surgeons to develop treatment plans that align with each patient’s unique needs, resulting in improved treatment outcomes and patient satisfaction.

Streamlined workflows
Incorporating PROMs into practice may help orthopaedic surgeons streamline their workflow. Surgeons can gather essential information directly from patients, reducing the need for lengthy interviews. Shared decision making can then be done in real time to increase efficiency. An example would be the use of technology to record and visually graph functional and pain scores before a patient’s visit. The surgeon could quickly review results and show the patient the expected, average, and usual postoperative score gain. Baseline PROM scores have also been proposed as a possible automatic measure that would allow for an approved precertification of surgical procedures.

Enhanced communication
Actively involving patients in their own care through the incorporation of PROMs can improve communication between orthopaedic surgeons and their patients. Surgeons can use these tools to better understand patients’ expectations, address any concerns, and ensure a shared decision-making process. This collaborative approach strengthens the patient-physician relationship and leads to a more personalized and tailored approach to care.

Assessment of treatment efficacy
PROMs offer a method to evaluate the effectiveness of orthopaedic treatments and the patient’s perspective of care received. These tools allow surgeons to regularly measure and monitor outcomes, then assess the success of interventions, identify areas for improvement, and optimize treatment plans for each patient.

This data-driven approach enhances the quality of care and contributes to evidence-based medicine. As an example, a study form Bernstein et al, published in Musculoskeletal Care, evaluated the effects of PROM use on patient experience. The authors demonstrated that when PROMs were utilized (as compared with a cohort of patients with whom PROMs were not utilized), patients were more likely to rate the clinician higher and recommend the clinician to another patient.

Quality improvement
In addition to the benefits in clinical practice, the use of PROMs allows orthopaedic surgeons to contribute to quality-improvement initiatives and research efforts. Collection of PROMs helps surgeons identify trends and benchmark their practice outcomes. AAOS has robust registries that accept PROM data for research and tracking purposes, which also helps satisfy the third part of the triple aim: improving population health. Finally, demonstration of efficacy and quality through improved postoperative PROMs can help guide policymakers to write and incorporate laws and policies that are evidence-based and improve care for our patients.

Results from PROMs also can help identify cost-effective treatment options by offering insights on interventions that provide the greatest benefit to patients. Using these data, surgeons can align treatment plans with patient goals and preferences, optimize resource allocation, and minimize unnecessary healthcare expenditures.

Furthermore, PROMs may help orthopaedic surgeons demonstrate value for the care they provide. Lee et al demonstrated that PROMs can be used in spine surgery to calculate quality-adjusted life years, which can be used to demonstrate the value of health outcomes.

Professional development
These tools also play a role in the professional development of orthopaedic surgeons. Surgeons can refine their skills by actively seeking patient feedback and measuring outcomes. Thus, they can enhance their reputation and gain recognition for providing high-quality care. This commitment to continuous improvement and patient-centered care can distinguish surgeons, which may manifest with the possible requirement of PROM submission and reporting for Centers of Excellence.

To summarize, PROMs offer numerous advantages for orthopaedic surgeons. By embracing PROMs, surgeons can enhance their practice, improve patient outcomes, and contribute to the overall success of the triple aim. Personalized patient care, enhanced communication, objective assessment of treatment efficacy, quality improvement, increased patient satisfaction, cost-effectiveness, and professional development are key benefits that PROMs bring to orthopaedic surgery.

Resources developed by the PROMs Workgroup will be announced to AAOS membership as they are released and can be found via aaos.org/proms. For more information or to get involved, email proms@aaos.org. 

Jeffery D. Angel, MD, MFin, FAAOS, is a general orthopaedic surgeon in private practice for 30 years at White River Health in Batesville, Arkansas. Dr. Angel is a member of the AAOS PROMs Workgroup.


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