Patient-reported outcome measures (PROMs): can they be used to guide patient-centered care and optimize outcomes in total knee replacement?

Abstract

As patient-reported outcome measures (PROMs) are increasingly integrated into clinical practice, there is a need to translate collected data into valuable information to guide and improve the quality and value of patient care. The purpose of this study was to investigate health-related quality-of-life (QoL) trajectories in the five years following total knee replacement (TKR) and the patient characteristics associated with these trajectories. The feasibility of translating QoL trajectories into valuable information for guiding patientcentered care was also explored. MethodsData on patients who underwent TKR between 2006 and 2011 from a single-institution registry were extracted including patient-reported QoL (captured using the Short Form Survey (SF-12) instrument) up to 5 years post-surgery. QoL trajectories were modelled using latent class growth analysis. Quality-adjusted life-years (QALYs) were calculated to illustrate longer term health benefit. Multinomial logistic regression analyses were performed to examine the association between trajectory groups and baseline patient characteristics. ResultsAfter exclusions, 1,553 patients out of 1,892 were included in the analysis. Six unique QoL trajectories were identified; with differing levels at baseline and improvement patterns postsurgery. Only 18.6% of patients were identified to be in the most positive QoL trajectory (low baseline, large sustainable improvement after surgery) associated with the greatest gain in QALY. These patients were likely to be younger, have no co-morbidities and report greater pain at pre-surgery than most in other QoL trajectories. ConclusionsOur findings demonstrate the importance of underlying heterogeneity in QoL trajectories, resulting in variable QALY gains. There is scope in translating routinely collected PROMs to improve shared decision making allowing for more patient engagement. However, further research is required to identify suitable approaches of its implementation into practice to guide clinical care and maximize patient outcomes.

Introducing Patient Reported Measures (PRMs) Into Finnish Public Maternity Service: A Study on Professionals’ Views

“…In particular, PREMs which cover issues like patient's active role, birth experience, and satisfaction [30] were rated by almost all participants as being "important". This nding is in accordance with the observations made by Laureij et al (2019) from Netherlands [3]. However, the contents of patient reported measures need to be customized and adapted to Finnish culture and maternity care service setting.…”

“…PRMs help service providers understand what matters to patients, and they have become accepted as a core dimension of healthcare quality [1,2]. Increasing the use of these measures and incorporating them into existing measurement dashboards are considered as effective strategies to achieve patient-centered care and value-based health care, a widely accepted healthcare delivery model introduced by Michael Porter [1,[3][4][5][6][7][8]. In PRMs, patient-reported outcome measures (PROMs) capture patients' perceptions of their health status and help evaluate the result of a clinical intervention, while patient-reported experience measures (PREMs) collect information on patients' personal experience of the healthcare services they have received [6].…”

Patient-Reported Outcomes Following Total Knee Replacement in Patients <65 Years of Age—A Systematic Review and Meta-Analysis

“…The focus of investigation should now shift towards strategies aimed at maintaining the benefit of TKR throughout the longer-term and minimising dissatisfaction following surgery. Research suggests that there is a strong role for the identification of long-term pain, function, and quality of life trajectories following TKR, where strategies targeting the modifiable predictors of poor response to surgery may have the potential to improve longer-term patient-reported outcomes [ 51 , 52 ]. Furthermore, clinical joint replacement registries have been highly effective in monitoring the long-term survivorship of prostheses to inform practice, and are similarly well placed to facilitate the systematic collection and monitoring of quality metrics including patient-reported outcomes over longer periods of sustained follow-up [ 10 , 47 , 53 , 54 ].…”

Patients Reported Outcomes Measures (PROMs) Trajectories After Elective Hip Arthroplasty: A Latent Class Growth Analysis

“…The trajectories of PROMs scores indicate that most patients showed a considerable improvement within 6 months, followed by a slightly less prominent one at 12 months. This kind of trajectory is frequently reported for patients undergoing hip surgery [8]. However, unlike much of the available literature [5,7,8,12], this study underlines the importance of analyzing 6-months PROMs trends to identify the early effects of HA surgery on patients' QoL and hip-speci c functioning.…”