Good afternoon. So, this study will be focusing on how do we start managing our patient report outcome measure capture in novel and unique ways. I want to thank my co-authors and the AOSSM for allowing us to present on behalf of Henry Ford. My disclosures are here, otherwise they're not relevant to the presentation. So, right now, the United States, as we all know, is facing a major utilization problem. Major journals, news organizations are telling us that the patients we're doing surgery on are not getting better, and major industries such as low back pain is now being called a hoax. And why is that? Well, it's because we have documented evidence that large proportions of patients undergoing our quote-unquote successful surgeries are not getting better. This is a huge problem, and what's happening is it's creating a lot more emphasis on trying to figure out how we can make better decisions. In our fee-for-service world, we as surgeons are getting, we get paid to do surgery not to make people better. Now, we don't like to admit that, but that's the reality. Now, as we switch to a value-based system, we're going to be paid to make people better, regardless of treatment. And so, there's been a lot more emphasis on trying to understand how can we use patient report outcome measures to really understand who should get what treatment. And if you look at that value-based healthcare equation that we see all the time, it comes down to quality over cost. Now, what is quality? Quality actually is not surgical site infection, mortality, readmission. Quality is what the outcomes are from the patient's perspective, and that's where patient report outcome measures come in. Also known as PROMs, these are validated health assessments that can help us report health from a different number of domains, physical health, pain health, mental health. And the most important thing is from the patient's perspective. So, this really is the best measure we have on the patient's assessment of health because an MRI, a CT, an ultrasound, strength testing doesn't matter. It matters how happy the patient is. Now, despite the emphasis on PROMs and the need to start collecting them in practice, you would think that we would all be doing them, but as I mentioned earlier, we are paid to do surgeries and to do interventions, not to make people better. And what's happened is our reimbursement system is not contingent upon measuring this data. And so, it becomes very challenging to start measuring outcomes in an already busy ambulatory workflow. And Kevin Bozek brings this up all the time, that we have no problem taking patients, putting them on a cold metal slab, irradiating them, really for not really much reason whatsoever, because we bill for that interpretation, yet to fill out a three-minute questionnaire is ludicrous. And so, to get PROMs into practice is very challenging to do, especially in today's workforce situation where it's hard to find a labor force. As some of you may know, the new CMS rules are going to mandate PROM capture, and it's starting now with patients getting surgery in October of 2022. So, it's coming. And so, there's a really strong need for a high-fidelity, low-cost way to implement PROM capture. Our group has looked at PROM capture in the ambulatory setting, remote, and in different post-surgical settings, but we haven't looked at it in the day-to-day surgical pathway. So, our study question was, can PROM collection be integrated in a high-fidelity, over 80% capture rate into existing surgical pathways? We looked at sports medicine patients undergoing shoulder surgery and ACL reconstruction over the 2021 year, and the PROMs we looked at were PROMIS physical function and IKDC for lower extremity, PROMIS upper extremity and ASCS for upper extremity, and everyone got a PROMIS pain interference. And so, the way it worked is, we look at our patients that are eligible. When they're in clinic, we already have a system where we measure these PROMs. Now, when they get to surgery, if they have PROMs within the last 25 days, we consider that active, and they didn't get any new PROMs. If they did not complete it within the last 25 days, or it's been longer than that, we assign them again. So, really, our end point is, will we have PROMs within 25 days of surgery? The way it works is, we use Epic, and we built in a customized workflow that tags PROMs as surgical encounters, and the front desk, through existing workflows, will scan the QR codes to get PROMs going. Not much here, except the fact that we have about 900 patients in the study, or sorry, 800 patients in the study. And if you look at our completion rates, again, we did not hire anyone to do this. We just kind of integrated this in the check-in process. Across the board, on a PROM level, we were at almost 90% or higher across all PROMs. So, that achieved our cutoff of 80%. For patients undergoing rotator cuff repair, at 90%. A little lower for patients undergoing orthoplasty. Again, 90% collection for ACL reconstruction and labral tear. So, in conclusion, we demonstrated that we could integrate seamlessly a day of surgery PROM capture, and feasible among sports medicine patients. A little lower on the orthoplasty, probably because of an age-related impact. And the participation in future CMS quality measures will be contingent upon coming up with these pathways at different hospitals. Now, the limitation is that we already had a mature pathway for ambulatory collection, so it was more of an application of that. So, this is not generalizable to all institutions. And there will need to be a foundational investment for practices in hospitals to be up to speed for CMS measurements.

patient-reported outcome measures

PROMs

healthcare

implementation challenges

patient perspective