Optimizing the Value of Patient-Reported Outcome Measures in Improving Care Delivery through Health Information Technology

While patient outcome measures, such as health status and quality of life, have been a routine part of research and patient care, they are generally assessed from the clinician perspective. There is growing interest in using patient-reported outcome measures (PROMs), patient-centered care, and shared decision making, as ways to enhance the patient experience and improve outcomes. To date, many PROMs were developed without patient input, and many have focused only on the quantitative measurement of specific symptoms and bodily functions. In addition, despite the interest in using PROMs, there are few examples of health systems that routinely collect and use such information.

This project will expand upon an existing set of orthopedic surgery PROMs--such as the Oxford Knee Score for knee replacement, and the Oxford Hip Score for hip replacement--and evaluate their use and impact on care for patients undergoing spine, knee, or hip surgery. The investigators will identify outcomes most important to patients and study the effect of providing this information to patients and their doctors. Contextual information, such as patient values, preferences, and life circumstances, will be included to provide patient-level contextual data important in making realistic care decisions. Current collection of PROMs will be compared to an information technology (IT)-enhanced mechanism for collecting them. Patients and clinicians will receive patient-preferred outcomes and relevant context information as well as aggregate reports for quality improvement. In addition, care costs will be provided to surgeons along with the PROMs in a peer comparison view.

The specific aims of the project are as follows:

• Identify patient-preferred outcomes (PPOs) and patient contextual information (PCI) useful in care planning. 
• Test the impact on PROM survey and item response rates from adding other PPOs and PCI to surveys and from using health IT-enhanced patient outreach. 
• Compare the impact on outcomes and experience from making individual PROM and PPO scores available via the electronic health record (EHR) during patient care and via mobile devices versus that for other procedures whose scores are available only to physicians in aggregate. 
• Test the impact of providing surgeons with aggregate information from health IT claims, accounting systems, and the EHR on PROM and PPO scores and costs over time. 

Interviews and surveys will be used to collect patient and physician input on PROMs. A comparison will be made between patient outreach via email and office-based completion of outcomes surveys, versus the addition of cell phone technology to collect this data. Investigators will also compare patient and provider satisfaction and shared decision making between those procedures in which PROMs are integrated into an EHR, versus those that do not receive PROMs data via the EHR. Finally, the impact of providing surgeons their cost and outcomes data in comparison with their colleagues will be evaluated.

It is expected that providing PROMs data to patients and their physicians via an EHR will reinforce the likelihood of clinicians discussing the PROMs during office visits and more likely to impact care plans. The results of this research will be used to implement an advanced PROMs system applied to other conditions and specialties, while also serving as a real-life model that can be disseminated widely to other care systems.