Even when patient-reported outcome measures (PROMs) are successfully integrated into electronic health records (EHRs), such patient-centered data is rarely accessed by members of clinical care teams, a study suggests in the November/December issue of American Journal of Medical Quality (AJMQ), Official Journal of the American College of Medical Quality (ACMQ). The magazine is published in the Lippincott Portfolio by Wolters Kluwer.
At one large orthopedic clinic, care teams had access to data for PROMs for less than 1% of visits for patients who had total knee or hip replacement surgery, reports Janet Y. They wrote, “Making PROMs available for care team review in electronic health records … is not sufficient to encourage the incorporation of PROMs into clinical patient care.”
Why data for PROMs are important in patient care
A major focus of efforts to measure health care quality, PROMs are designed to collect data about outcomes important from a patient’s perspective – eg, daily functioning, quality of life, and experience of care. Data from PROMs was used primarily for general reporting of system-wide results or quality improvement initiatives. Few studies have evaluated whether and how PROMs are used to inform daily patient care.
As part of a larger project at a health network in the Midwest, the Osteopathic Department has invested in the study to integrate PROMs into electronic health records (EHRs). Beginning in 2017, the clinic began collecting PROMs data on all patients who underwent total knee arthroplasty (TKA) or total hip arthroplasty (THA), including assessments of joint function, general health and function, and patient satisfaction.
How was this information used at the point of care? To find out, Dr. Ziegenfuss and colleagues analyzed how often data for PROMs listed in electronic health records was accessed by orthopedic surgeons and other members of the care team for patients undergoing TKA or THA over a 15-month period in 2019-20.
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The analysis included data on 2,400 TKAs performed by 22 surgeons and 1545 THAs performed by 20 surgeons. Most patients completed PROM questionnaires, with response rates ranging from 68% before surgery to 55% at 12 months of follow-up.
However, in more than 16,000 care encounters associated with these surgeries, clinicians viewed data for PROMs in electronic health records only 156 times. Patient ratings were accessed by care teams for 0.9% of clinical encounters.
Data observations of PROMs were aggregated “largely by the surgeon” – only 4 surgeons accounted for more than three-quarters of the views. For most patients, data for PROMs was never accessed as part of clinical encounters.
Thus, while survey response rates were relatively high and the data was successfully integrated into the electronic health records,”The use of PROMs data between surgeons and care teams was virtually non-existent… indicating that a critical step in the path toward the promise of using PROMs to improve the individual patient encounter was not achieved.Dr. Zigenfuss and colleagues write.
The researchers note that their analysis was limited to two types of surgeries in one department. However, they also indicated that their project may represent a “best case scenario” for clinical use of data for PROMs – implemented in an environment with a long history of supporting measurement and quality reporting.
“If the use of PROMs for clinical care is not addressed here, it is likely that this problem is present in other systems without these supporting agents.Dr. Zigenfuss and co-authors conclude. They highlight the need forAdditional effort…to identify barriers to the use of PROMs in clinical care and to test methods to enhance use. ”
Co-author Megan Rimes, director of orthopedic research and education, TRIA Institute notes: “As a health system, we recognize the importance of this work and are excited to bring reported outcome data into our electronic medical record and continue to find ways to improve our physicians’ involvement in the use of this information while they care for our patients.. ”
Goat feet, JY, et al. (2022) Has the promise of output promotions been fulfilled? Implementation experience in a large orthopedic practice. American Journal of Medical Quality. doi.org/10.1097/JMQ.0000000000000079.