Operationalizing PROMs at the Musculoskeletal Practice and Policy Levels

Abstract

There continues to be growing interest in patient-reported outcome measures (PROMs), especially as value-based healthcare initiatives gain more traction. Although it is well-established that PROMs can be useful in clinical research, how to operationalize PROMs in clinical care and policy initiatives remains a "work in progress." Following the design of a comprehensive PROM administration and routine collection system, orthopaedic surgeons and their patients can reap the benefits of PROMs in practice through improved shared clinical decisionmaking discussions at the individual patient level and closer symptom monitoring on a large scale, with improved resource allocation at the population health level. Although certain government and payer incentives exist to collect PROMs at present, it is reasonable to assume that future policy initiatives will begin to use the actual PROM scores to assess clinical outcomes. Orthopaedic surgeons with interest in this area should prioritize their involvement in policy discussion to ensure PROMs are being used appropriately in novel payment models and policy endeavors so that they are both evaluated and compensated fairly. Specifically, orthopaedic surgeons can help ensure appropriate risk adjustment of patients when this is being done. Undoubtedly, PROMs will only become a larger part of musculoskeletal care moving forward. Healthcare systems globally-including the United States-are unsustainable, with expenditures far outpacing gross domestic product and wages in many countries. 1 At the same time, quality is inconsistent and the outcomes that matter most to patients (eg, function, pain, mental health, and quality of life) are collected infrequently, measured by using unvalidated instruments, and are rarely used even when available. In the United States, there is a general consensus that this healthcare delivery system is broken; this has led to movement toward a system that focuses on optimizing value for patients. 2 The overarching goal of value-based health care (VBHC) is

Letter to the Editor: What Do Orthopaedists Believe is Needed for Incorporating Patient-reported Outcome Measures into Clinical Care? A Qualitative Study

“…The integration of PROMs in clinical practice and into the electronic record has gained traction over the past 10 years. Using PROMs in practice can provide clinicians a valuable source of efficient and pertinent information about patients’ well-being and function [3]. PROMs now are incorporated in clinical guidelines and board certification processes [1].…”