Outcomes is a hot topic in the healthcare industry. It is one of the criteria being used to define value-based reimbursement strategies and, more importantly, to drive better care for patients.
For some time now, payers and government agencies have been using traditional measures to evaluate outcomes, assessing the number of patients who were readmitted within 30 days, or how many post-surgical infections occurred. For the most part, this data was retrospectively analyzed; it was used to put process improvements into place, but it seldom took into account patients’ own opinions on how they were doing. Ultimately, how can we claim a successful outcome if the patient doesn’t subjectively experience an improvement in health and well-being?
Many EHRs provide some level of clinical decision support—reminding doctors of how long it has been since an osteoporosis patient’s last bone scan, or when it’s time to review an arthritis patient’s therapy and order blood tests for his or her medications. Some might put this in the category of outcomes, but to me, they are really alerts. Can they affect outcomes—of course! But do they really tell us how the patient is doing?
To change this paradigm, practices are moving toward collecting and measuring patient reported outcomes (PROs). The National Quality Forum defines PROs as, “any report of the status of a patient’s health condition that comes directly from the patient, without interpretation of the patient’s response by a clinician or anyone else.” PROs provide data on what patients are able to do and how they feel by asking questions. They not only cover the clinical aspects of pain, swelling, and range of motion, they assess the patient’s reported status for physical, mental, and social well-being.
In orthopaedics, standardized surveys such as PROMIS, HOOS, and KOOS have been designed to collect patient-reported information before and after surgical procedures. This allows physicians to prospectively and retrospectively evaluate data provided by their patients.
Prospectively, the surveys can be used to determine the factors that will drive a better outcome for the patient. Using best practices standards, physicians can make a determination prior to taking action as to how successful the outcome will be. By discussing potential outcomes, lifestyle factors, and behavioral changes with the patient before surgery is scheduled, doctors can better predict the outcome and recommend the best path—all while controlling costs. For example, if a patient does not have reliable transportation to get to follow-up appointments and physical therapy, physicians might provide information on local transportation services or decide on inpatient versus outpatient rehab.
Retrospectively, if a patient reports unsatisfactory results, doctors can gauge the patient’s feedback against the original expectations of the treatment plan. It might be that the patient is meeting, or even surpassing, the predicted outcome. That little piece of information might change the patient’s outlook and get him or her back on the path to success. Alternately, doctors can determine what could have been done to either reach a better outcome, or develop a more accurate prediction. These learnings can be implemented as best practice to drive better outcomes for future patients.
PROs can also be used as a benchmarking tool, as a way to gauge success against others in the same practice or the same market.
Today, only 35% of orthopaedic practices are collecting outcomes data. Part of this is due to the complexity of managing the process—of collecting, analyzing, and making the data relevant. The most critical step is of course getting the patient to respond to surveys, but equally important is presenting that data in a way that orthopaedists can review it and share it with the patient at the point of care, during the appointment. This allows them to intervene quickly when a negative outcome is reported. Imagine a future when a patient reporting a pain level of 9, a knee that is red and swollen, and an inability to stand without assistance automatically triggers a message to your office to call and intervene. Not only can this save the patient an unnecessary trip to the emergency room, but it can potentially save the practice money if it is doing bundled payments.
At SRS, we believe that the process of collecting and acting on patient reported outcomes should be as automated as possible, and should all take place in the same system you work in, day in and day out—your EHR. That is why we have made this vision a reality with our integrated Outcomes solution.