Orthopedic surgeon and care team perceptions and use of patient-reported outcomes in total joint replacement patients

Background: The recent shift toward value-based health care and bundled payments in orthopedic surgery has increased the use patient-reported outcomes (PROs) in standard clinical care. Such assessments of patient function and satisfaction are particularly important among total joint arthroplasty (TJA) patients to monitor postoperative health. Purpose: The purpose of this study was to assess orthopedic care team perceptions of current and future PRO usage and compare current rates and modes of PRO collection between three urban, academic health care systems. Methods: A literature search was conducted on current PRO uses and barriers to their adoption to generate a 26-question survey. The survey was disseminated to orthopedic surgeons and care team members at three academic health care institutions (institutions A, B, and C). Responses were analyzed for qualitative and quantitative insights. Results: Among institutions A, B, and C, PRO collection generally declined from baseline (60%, 90%, 89%) to 6 weeks (67%, 82%, 71%) and 3 months postoperatively (44%, 36%, 47%). However, there were large variations in reported PRO collection intervals among institutions. Respondents reported assessing patient baseline functional status as the most useful current application of PROs and cited the prediction of patient benefit from TJA as the most useful future application for PROs. Though respondents were largely optimistic about PRO utility in clinical care, a small minority remained skeptical. Conclusions: Perceptions of PRO utilization and collection intervals varied considerably among respondents. For PROs to be an accurate and useful clinical tool, standardiza-tion and thorough understanding of PRO collection among orthopedic care team members is essential.