We asked some of the most influential orthopedic surgeons two questions:
1. What role do you see for patient-reported outcomes in healthcare as we transition to a value-based system?
2. What are the barriers to using PROs in your hospital?
Here’s what Dr. Thomas Parker Vail, Dr. Richard Iorio, and Dr. Lawrence Dorr had to say:
Dr. Thomas Parker Vail:
“There is clearly a role for patient-reported outcomes in healthcare. The patient’s perspective is very important and perhaps among the most important measures of success. However, patient reporting — similar to hospital reporting, physician reporting, or any other yardstick — is complicated, subject to bias, variable over time, consistent with other metrics and perhaps at odds with some others.
Therefore, in order to use patient-reported measures, we need to understand them and put them into context. Thus, it follows that the barriers to using PROs centers on the technology to implement them in alignment with the EHR and the ability to use them appropriately to measure quality.”
Dr. Richard Iorio:
“We collect PROs on all our patients, at every visit. We have an extensive infrastructure in place. PROs are ideal for research; they have very little validity in clinical practice, and I think they have been overblown. It is costly and unrealistic for all practitioners to collect PROs.Cost is the ultimate proxy for quality in a value-based environment. PROs are an unnecessary diversion.”
Dr. Lawrence Dorr:
“The concept of patients grading their care is actually helpful, but the design of the current program is flawed. PROs have the potential to improve overall patient care by requiring empathetic treatment of the patient by all caregivers, especially when paired with patient experience questions.
For 20 years, we have used a team approach to the patient, so there is interaction between office staff, hospital-floor nurses, internists, anesthesiologists, and surgeons.
In our experience, we’ve identified three barriers that impact the outcome of a PRO program. First, communication between the office caregivers and hospital staff is a necessity. Second, patient education is paramount to their confidence. The quintessential path to giving patients confidence is the preoperative class. In a class, the patient identifies with their group, and they no longer feel alone. They are “in it together.” Third, the surgeon needs to be a leader and hold the respect of their staff and patients! Having a strong coordinator who oversees the staff is a critical asset for the surgeon leader. If the staff detects detachment of the surgeon, they feel less respected, less engaged in their job, and lose focus on the patient’s needs.
The foremost barrier to success of a PRO program is a weak surgeon. The best indicator for success of a PRO program is a strong team.”