How do I start a Patient-reported Outcomes Program at my Institution

Developing a PRO program may be an involved process for your institution. It may take months to design and implement, therefore taking time to discuss each category below will hopefully streamline the process and guide you to a successful program.

Define PRO team

Most likely, within your institution a core group of colleagues (i.e., orthopaedic group, quality department, or hospital administration) has decided that including PROs in your practice of care for total joint arthroplasty may provide important information to improve patient outcomes. Beyond this core group, you may need to bring in other disciplines to help drive this initiative and development. Below is a list of potential key stakeholders who may assist in developing and capturing PROMs for your institution:

• Orthopaedic Department
• Orthopaedic Practice Groups and Clinics (not only physicians and nurses, but front desk staff may need to be involved)
• Quality Department
• Information Technology
• Orthopaedic Service Line
• Research
• Rehabilitation
• Hospital Administration
• Patient Advocate/Patient Representative
• Institutional Review Board (guidance/review)

As you begin to design your protocol for data collection, the appropriate stakeholders will become apparent and engaging these groups will help build collaboration and buy-in on why a PRO program is beneficial and sustainable.

Define your institution’s goals for implementing a PRO program

If you are interested in a PRO program, you and your colleagues will need to determine the reasons you would like to launch a PRO program.

You may consider asking yourselves questions such as:

 Are we launching a research initiative with specific aims?
 Are we seeking comparative benchmarks to our peers?
 Are we wanting to quantify our outcomes from our patients’ perspective?
 Do we want to measure if patients have improved function or reduced pain?
 Are there other areas of self-reported health that are critical to assess?
 Do we want to screen for referrals for pain management?
 Do we want to screen for patients at risk for poor outcomes?
 Do we want to measure whether our patients’ overall health has improved?
 Are we wanting patient provided data to be utilized during the clinical encounter?
 Do we want to utilize PROs for evaluating quality improvement initiatives?
 Do we want to allow for analyses to compare procedures or surgical protocols?
 What are the requirements of the payer-specific program for which we are hoping to qualify?

Determine the appropriate PRO measure

Your reasons for implementing a PRO program will direct your team to a certain instrument(s) that will allow you to meet your objectives. For example, if your institution has decided to collect PROMs for research initiatives, you may choose an instrument that measures multiple domains, like the HOOS and KOOS. These instruments are joint-specific instruments that have five subscales measuring function, pain, hip/knee symptoms, sports and recreation (high level activities of daily living) and quality of life, which would provide a depth of data to address many research hypotheses. However, if you are focused on measuring patients’ outcomes as part of your clinical care, a shorter instrument focused on physical function or critical symptoms (e.g., pain) will suffice as long as it is able to detect change. Other factors to review when assessing PRO instruments are the levels of validity, reliability, and responsiveness of the PROM. Each PROM that is available through AJRR’s platform has been validated, however it will be up to your institution to determine which instrument(s) meets the standards or needs for your PRO program. You will also need to consider the cost to use a specific PROM. Your hospital and/or practice group will be responsible for any PROM licensing cost if you do not use AJRR’s PRO platform to collect a PROM that requires a license. However, only three forms (SF-12, EQ-5D, and WOMAC) require licenses.

For more information about PRO measures, visit here.

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