Paul Bruning on Building Clinical Pathways around MCID & PROs

“Patient-Reported Outcomes (PROs) provide essential insights into quality of surgical intervention. Challenges remain in how best to use PROs and determine value. Minimum Clinically Important Difference (MCID) recently has become a consideration for establishing benchmarks using PROs.”

A Note From CODE: We are pleased to welcome Paul Bruning, Executive Director of Orthopedics, and a member of AAOE. Read Paul’s other articles, The Real Value of Patient-Reported Outcomes, Why Executives Should Care About Patient-Reported Outcomes, and What it Will Take to Reach Transparency in Health Care.

How to best use PROs and determine value

Patient-Reported Outcomes (PROs) provide essential insights into the quality of surgical intervention. Challenges remain in how best to use PROs and determine value. Minimum Clinically Important Difference (MCID) recently has become a consideration for establishing benchmarks using PROs. However, defining a quantitative number that represents this value is problematic. Patients’ perceptions vary significantly and individuals rely on their previous experiences to score their outcomes. An example might be an active 70-year-old who plays tennis and has a high PRO score to begin and there is a small delta. However, that patient is very happy, as he is able to return to tennis, despite a small delta in PRO scores. 

Using the MCID benchmark may be difficult for such patients. This does not mean that MCID or PROs do not use to compare and demonstrate the value of surgical intervention or the quality of care provided. One needs to remember that PROs provide a quantitative perspective from each patient. Over a longer period of collecting data, outliers (such as the tennis player) would soon become part of the larger picture as the volume of PROs identifies trends. These trends create the best scenario for the MCID’s usefulness. Are there trends in PROs based on age, BMI, or comparisons to the initial PRO score? You may find that as age increases the MCID is a larger delta than young patients.  

Creating a value index with cost of care

Another way to look at PROs and MCID is to compare these values to the cost of care. With bundled payments, an organization can evaluate the potential value of intervention based on PROs (quality) and total cost of care (cost). Creating this value index and MCID benchmarks can provide for correlations to intervention, patient value, and organizational value of intervention. These correlations can then be used by organizations to counsel patients on surgical intervention value, negotiate with payers on quality of care provided, benchmark against other organizations, and improve the care provided by various physicians. 

Clinical pathways, built around PROs, MCID, and data analytics promote the best possible outcome and provide essential information for the education of patients. As data is gathered, analyzed, and synthesized for a practice: physicians, payers, administration, and patients can then adopt processes and policies to improve outcomes, decision making, and understand factors that may affect the MCID for different patient groups. Providing evidence-based decision support tools helps reduce risk as more organizations and providers enter into down-side risk contracts, bundled payments, and various value-based reimbursement policies.