What Factors Are Associated with Patient-reported Outcome Measure Questionnaire Completion for an Electronic Shoulder Arthroplasty Registry?

Abstract

Background There has been an increase in the use of electronic systems to collect patient-reported outcome measures. There is limited data on the added value of electronic reporting on increasing patient response proportions and little knowledge of which patients are more likely to respond. Questions/purposes (1) What proportion of patients completed patient-reported outcome questionnaires at baseline and at 1 year and 2 years of follow-up after shoulder arthroplasty, and what methods did they use to complete these questionnaires (either automated or manual data collection)? (2) What factors were associated with questionnaire completion? Methods Our shoulder arthroplasty registry from a high-volume, tertiary care center implemented an electronic platform to collect patient-reported outcomes. A total of 2128 patients underwent shoulder arthroplasty between 2016 and 2019. Patients without an email address on file were excluded; 90% (1907 of 2128) of patients were included in the study. The population was 50% women (954 of 1907) with a mean age of 67 ± 9 years. A query was performed to determine whether patients completed questionnaires by either automated or manual data collection at baseline and 1 year and 2 years of follow-up after shoulder arthroplasty. In a logistic regression analysis, patient factors (such as demographics, education, and living arrangements) were evaluated for their association with whether patients completed these questionnaires. Results The proportion of questionnaire completion at baseline, 1 year, and 2 years were 72% (1369 of 1907), 47% (456 of 972), and 33% (128 of 393), respectively. Of the patients who completed their questionnaires, 63% (868 of 1369) did so through automated emails at baseline, 84% (381 of 456) did so at 1 year, and 81% (103 of 128) did so at 2 years. The remainder completed their questionnaires through manual data collection with a research assistant: 37% (501 of 1369) at baseline, 16% (75 of 456) at 1 year, and 19% (25 of 128) at 2 years. After controlling for potentially confounding variables like patient demographics, college education, and living arrangements, women were less likely to complete baseline questionnaires than men (odds ratio 0.78 [95% confidence interval 0.62 to 0.99]; p = 0.04), and white patients (OR 1.6 [95% CI 1.05 to 2.44]; p = 0.03) were more likely than nonwhite patients to have complete baseline questionnaires. At 2 years of follow-up, patients with a college education (OR 2.06 [95% CI 1.14 to 3.71]; p = 0.02), those who lived alone (OR 2.11 [95% CI 1.13 to 3.94]; p = 0.02), and those who had higher baseline Shoulder Activity Scale scores (OR 1.05 [95% CI 1.00 to 1.11]; p = 0.04) were more likely to have complete questionnaires than those without a college education, those who lived with other people, and those with lower SAS scores, respectively. Conclusion The challenges of adopting an online platform include low follow-up proportions and the need for manual assistance by a research assistant to increase patient completion of questionnaires. Clinical Relevance The knowledge of which patient characteristics are associated with a higher likelihood of completing questionnaires has implications for targeted follow-up or representative sampling of the population in a registry. Populations that are less likely to respond may require more effort to reach to prevent exacerbating health outcome disparities. Random sampling with upweighting of hard-to-reach populations may also provide a solution to achieve a representative population of patients undergoing shoulder arthroplasty.

Compliance with Electronic Patient Reported Outcome Measure System Data Collection Is 51% Two-years After Shoulder Arthroscopy

“…One study of an electronic shoulder arthroplasty registry even described subpopulations that were more or less likely to complete PROMs at different follow-up intervals. 19 Only one-third of our cohort completed assigned PROMs at all follow-up time points, and we did not identify any trends in patient noncompliance over time.…”

“…The most cited demographics for PROM noncompletion following elective orthopaedic procedures are male sex, younger age, and non-White race. 5 , 14 , 16 , 17 , 18 , 19 Although these are commonly cited, a recent study analyzing 9 factors concluded no single patient characteristic can accurately predict loss to follow-up. 20 This study failed to replicate the results of previous orthopaedic studies; however, one publication specific to shoulder arthroscopy did not find differences in PROM compliance, according to patient age or gender.…”

Are responders to patient health surveys representative of those invited to participate? An analysis of the Patient-Reported Outcome Measures Pilot from the Australian Orthopaedic Association National Joint Replacement Registry

“…Similar to our study, the differences between responders and non-responders in both these studies were small. A study of shoulder arthroplasty patients, however, showed that female patients were less likely to respond [ 13 ].…”

Scoping review: Evidence for long-term follow-up and monitoring in shoulder and elbow arthroplasty

“…The use of PROMs to target surveillance would require robust systems to facilitate PROM data collection. Ling et al 25 retrospectively assessed PROM completion for 1907 patients in their tertiary care centre shoulder arthroplasty register following the introduction of an electronic automated system. The proportion of questionnaires completed at baseline, 1 year, and 2 years were 72%, 47% and 33%, respectively.…”