How to Use Patient-Reported Outcomes in Clinic with Your Patients

A Note From CODE: We are pleased to welcome Leon Scott, MD, (Wash U in St. Louis SOM ’07, Res. St Louis U, Fellow Harvard-BCH, Faculty Vanderbilt Dept Orthopaedics) to the blog. Dr. Scott is a primary care sports medicine specialist treating sports injuries & arthritis. He has a strong interest in using patient-reported data and value-based healthcare.

If you’re collecting patient-reported outcome (PRO) data, one of the easiest ways to start using your data is by sharing it with patients during the appointment, exactly like you do with radiography. Bringing PROs into the conversation empowers you to have a deeper, more personalized conversation with your patients about their options to improve their pain, function, and quality of life; demonstrating how their unique data impacts your decision-making.

CODE is Already Creating PRO Patient Reports for You

Behind the scenes, we are collecting, scoring, and organizing PRO data from you and your colleague’s patients starting at pre-op, and continuing through post-op at 3 months, 1 year, and beyond. We organize this data for you to view from various levels, one being the patient level. At the patient level, you can see their unique outcome score and how they answered every question. Further, we take all this information for you and put it into report format. Using this patient report, you’ll be able to show patients where they are in terms of pain and function – and how they compare to others having the exact same procedure. Another important feature of PRO reports is that they show improvement over time. That means you can share with your patient how you expect them to improve based on others with the same condition.

How to Get Started Using Patient-Reported Outcomes With Patients

Using PROs in-clinic is pretty straightforward, and doesn’t add much time to each consultation. In fact, according to a study out of Dell Medical School at the University of Austin, they found, “There was no significant difference in the duration of the in-office consultation or the proportion of patients opting for surgery between the shared decision-making group and the control group, and surgeons reported greater satisfaction with consultations under the shared decision-making program.”

Lately, we’ve been hearing from a lot of providers and organizations collecting PROs that they want to use the data with their patients, but don’t necessarily know how to get started. To help tackle this, we’ve collaborated with Leon Scott, MD, faculty member in the Vanderbilt Department of Orthopaedics. Dr. Scott is a long-time advocate for using PRO data with patients and has vast experience doing so in his practice at Vanderbilt. We gave him a real patient report (blinded of course) from the CODE registry and asked him to share how he would use the report to talk to the patient. To have a conversation like this with your patients, the method of collection doesn’t matter. This means regardless of how you are collecting (via pen & paper, your EHR, PRO Vendor, etc), as long as you have a scored PRO survey you can use his framework. Dr. Scott, take it away!

How to Use the Pre-Op PRO Patient Report

When I see a patient for the first time with an issue like knee osteoarthritis, I like to have a PRO report like the KOOS pre-op report to give me a baseline on my patient’s pain, function, and quality of life. Being a non-surgical specialist, the PRO report is used to support the history, clinical exam, and radiographs when counseling a patient on the expected benefits of non-operative and operative treatment. Although every treatment has uncertainty, patients find it incredibly helpful when I review the efficacy of these treatments in patients just like them. Most literature uses the KOOS or a similar tool, the WOMAC, to normalize measurable improvements on a 100 pt scale. When I apply those expected, average changes to their baseline, like the one provided above, it helps set expectations. I am able to take descriptions they have only heard before in vague terms (e.g. “it gets better” or “you’re more functional”) and convert them into more tangible changes.

Patients may also have questions about how they compare with other patients I see in the office. This is the classic, “Compared to others, how bad is it, doc?” question. The CODE Technology team allows you to plot a patient’s baseline against the results of other patients who visit your office. Admittedly, Vanderbilt University Medical Center is not using CODE Technology, and there are few opportunities to see a snapshot of our entire patient population’s unique functional characteristics outside of those enrolled in a research study. I personally collect data, but typically compare a person to their own previous scores. I don’t have the data for my and my partners’ patients’ functional scores readily available like CODE can provide. I wish I did.

How to Use the 3-Month PRO Patient Report

Many of CODE Technology’s clients are surgical groups. So their three-month report is titled as a post-op report. However, even for non-operative treatments, I want to collect PRO data over time so I can visualize the impact that my interventions are associated with.

This report also shows the results that an organization produces on average. Personally, I want to use this data to monitor my performance against my peers. Your organization has its own reasons to collect individual and group data; research, quality improvements, marketing, or negotiations with payers; but aside from all those great reasons to collect outcomes, we all need this data to drive meaningful changes in the current healthcare environment. M&M data and readmission rates are not enough anymore.

How to Use the 1 Year / Annual PRO Patient Report

CODE also provides a 1-year report, which can help patients visualize how they have progressed up to that point. In addition, if options are available, I can also suggest the next steps to maximize a patient’s function if scores are lower than I believe a patient can feasibly attain. For example, further weight management, regular exercise, and certain medications can predictably improve functional scores in post-op patients who are overweight and stopped being physically active when therapy stopped in the global period.

Overall, integrating PROs into my daily practice has allowed me to:

• Practice shared decision-making. PROs help me have conversations with my patients that I might not have otherwise.
• Set expectations properly for how a treatment plan might impact a patient.
• Supports patients getting the right type of care. For example, choosing non-op vs operative care
• Signal to the patient that I care about them. I’ve found patients don’t mind taking PRO surveys when you actually use the data with them. PROs show my patients I am invested in their health and want to work with them to get the outcome that is best for them.

Here’s what you need to start incorporating patient-reported outcomes into your consults with patients

1. Require a pre-op PRO from all of your patients.
2. Explain what a PRO is and how it helps you deliver better care.
3. Share your patient’s PRO results with them.
4. Talk to your patient about how different treatment options will impact the improvement of their pain, function, and quality of life.
5. If possible, supplement your patient report with PRO data that shows organizational data up to at least 1-year post-op. This gives you a high-level look at improvement over an entire care cycle and gives you the opportunity to share the benefits and risks associated with a specific intervention.