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In an orthopedic setting, for example, PROMs can help clinicians determine whether interventions like joint replacements helped patients live better or more fulfilling lives. PROMs might ask patients how they are feeling, whether they can comfortably move around their homes, and if they can complete certain tasks of daily living.
For clinicians, this data captures whether an intervention actually worked.
It’s taken a little while for PROMs to take off in healthcare. In 2016, the National Quality Forum—which has long advocated for integrating PROMs into clinical workflows—reported that just 18 percent of hospitals were using PROMs as part of the care process. Explanations ranged, with some hospitals saying they didn’t have the time to dedicate to PROMs integration and others saying they didn’t have the technology to support PROMs.
But now, in 2022, the AJMQ researchers posited it may be time to take a second look at what’s limiting PROMs adoption. In this latest study focusing on a single orthopedic medical center in Minnesota, the researchers found that PROMs adoption wasn’t limited by poor response rates or technical woes.
The researchers particularly looked at how clinicians used PROMs submitted by patients who underwent total knee or hip surgery. The practice had implemented an EHR system that could support PROMs collection and integration back in 2018, the researchers said. This system allowed clinicians to access PROMs data within the workflow and was supplemented by EHR training programs, they added.
Nevertheless, very few clinicians actually adopted PROMs in their clinical workflows. Despite high patient response rates—68 percent at baseline, 58 percent three months post-surgery, and 55 percent 12 months post-surgery—a mere 1 percent of clinicians actually used the PROMs as part of their clinical work.
“The use of these PROMs data among surgeons and care teams was nearly nonexistent and largely clustered by surgeon, suggesting that a critical step in the pathway to the promise of using PROMs to improve the individual patient encounter was not being realized,” the researchers wrote in the study’s discussion section.
“Thus, a system-wide approach that is championed by leadership, fully integrated into clinic systems, and embraced by patients as indicated by high response rates, was not sufficient for full integration of PROMs in practice,” they continued.
Said otherwise, the researchers posited there is still a major, unidentified barrier keeping healthcare providers from using PROMs.
This finding is especially troubling in a state like Minnesota, where the researchers said statewide medical leadership has prioritized quality measurement and reporting.
“If the use of PROMs for clinical care was not taken up here, this problem might be even more likely to be present in other systems without these supporting factors, suggesting the need to create a system to elevate the data’s use, operationalize the organizational priority for PROMs, and increase the value of measurable patient engagement,” they added.
Limited PROMs adoption could be credited to the usual subjects: insufficient time, logistical barriers, data redundancy, and concerns about validity and reliability. Even still, the researchers said future research should look at the specific barriers to help craft a better approach to PROMs integration.
By Sara Heath