Suche
Mein Konto
According to the study, PROMs data is rarely accessed by clinical care members
Even when patient-reported outcome measures (PROMs) are successfully integrated into electronic health records (EHRs), these patient-centered data are rarely accessed by clinical care team members, suggests a study in the November/December issue of the American Journal of Medical Quality (AJMQ), official journal of the American College of Medical Quality (ACMQ). The journal is published in the Lippincott portfolio of Wolters Kluwer. According to the report by Jeanette Y. Ziegenfuss, PhD, of the HealthPartners Institute, Minneapolis, and colleagues, care teams in a large orthopedic practice accessed PROMs data in less than 1% of visits for patients undergoing knee or hip replacement surgery. You write: “The…
According to the study, PROMs data is rarely accessed by clinical care members
Even when patient-reported outcome measures (PROMs) are successfully integrated into electronic health records (EHRs), these patient-centered data are rarely accessed by clinical care team members, suggests a study in the November/December issue of the American Journal of Medical Quality (AJMQ), official journal of the American College of Medical Quality (ACMQ). The journal is published in the Lippincott portfolio of Wolters Kluwer.
According to the report by Jeanette Y. Ziegenfuss, PhD, of the HealthPartners Institute, Minneapolis, and colleagues, care teams in a large orthopedic practice accessed PROMs data in less than 1% of visits for patients undergoing knee or hip replacement surgery. They write: “Providing PROMs for review by the care team in the EHR…is not sufficient to promote the integration of PROMs into clinical care for patients.”
Why PROMs data is important in patient care
PROMs are a key focus of healthcare quality measurement efforts and are designed to capture data on outcomes that are important from the patient's perspective - such as daily functioning, quality of life, and experience of care. Data from PROMs have been used primarily for public reporting of system-wide outcomes 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 Midwest health network, the orthopedic studies department invested in integrating PROMs into electronic health records (EHRs). Beginning in 2017, the clinic began collecting PROMs data on all patients undergoing total knee arthroplasty (TKA) or total hip arthroplasty (THA), including assessments of joint function, general health and functioning, and patient satisfaction.
How was this information used at the point of care? To find out, Dr. Ziegenfuss and colleagues reported how often orthopedic surgeons and other members of the care team of patients undergoing TKA or THA accessed PROMs data contained in the EHR over a 15-month period in 2019-20.
Although readily available in EHRs, clinical use of PROMs data is “almost non-existent.”
The analysis included data on 2,400 TKAs performed by 22 surgeons and 1,545 THAs performed by 20 surgeons. Most patients completed the PROM questionnaires, with response rates ranging from 68% before surgery to 55% at 12 months follow-up.
However, in over 16,000 care encounters related to these surgeries, physicians only viewed PROMs data in the EHR 156 times. Patient ratings were obtained from care teams for 0.9% of clinical encounters.
The PROMs data views were “largely clustered by surgeon” – just 4 surgeons accounted for more than three-quarters of the views. For most patients, PROMs data were never accessed during clinical encounters.
Although survey response rates were relatively high and the data was successfully integrated into the EHR, "there was virtually no use of these PROMs data among surgeons and care teams...suggesting that a critical step toward the promise of using PROMs to improve the individual patient encounter has not been realized," write Drs. Ziegenfuss and colleagues.
The researchers note that their analysis was limited to two types of operations in a single department. However, they also note that their project could represent a “best-case scenario” for the clinical use of PROMs data – carried out in a setting with a long history of supporting measurement and quality reporting.
“If the use of PROMs for clinical care were not addressed here, this problem could be even more likely to exist in other systems without these supporting factors,” conclude Dr. Ziegenfuss and co-authors. They emphasize the need for “additional efforts…to identify barriers to the use of PROMs in clinical care and to test methods to improve use.”
Co-author Megan Reams, Director of Orthopedic Research & Education, TRIA Institute, notes, "As a health system, we recognize the importance of this work and are excited to integrate patient-reported outcomes data into our electronic medical record and continue to find ways to optimize our clinicians' engagement in using this information in the care of our patients."
Source:
Reference:
Ziegenfuss, JY, et al. (2022) Will the promise of PROMs be realized? Implementation experience in a large orthopedic practice. American Journal of Medical Quality. doi.org/10.1097/JMQ.0000000000000079.
.