Once you know from whom you are going to collect data (the patient population), what patient reported outcome (PRO) tools you are going to use, and when you will administer the surveys… the next step is to determine how you are going to execute. The key is to develop a system with a strong infrastructure that renders a high capture rate and promotes data integrity.
It takes a long time to build up a meaningful set of PRO data, so you will want to make sure that you do not miss any opportunities by letting a patient fall through the cracks. The goal should be to collect 100% of the patient reported data for every eligible patient — and this is no easy task. It takes a lot of dedication and structure to make this happen.
Every clinic and hospital has a slightly different workflow, so there is no “cookie cutter” program that you can just “plug and play” — but there are certain things that all successful programs have in place. Creating a solid foundation for enrolling eligible patients is the best place to start, and this is how you do it:
First things first — you’ve got to establish some estimates on the number of patients that will be eligible for participation. The best way to do this is to pull the previous year’s numbers for the patient population. You’ll want to find out the total number of cases performed, and also a breakdown of the numbers for each provider. These numbers will come in very handy when you start monitoring the success of your patient enrollment process… which is coming up next!
The foundation of good outcome program is making sure that all eligible patients participate. The first step is to clearly define the criteria for what makes a patient eligible. For example, if your outcome program’s plan is to collect data on total joint patients — are you including revision cases and partial knee patients? Or is it just primary total joint replacement surgery?
Next, identify which staff members will be responsible for identifying and enrolling patients. Each clinic and organization’s flow is different. A helpful exercise is to visualize the patient flow through your system. Often times, outcome programs are designed around an intervention or procedure, and a great way to identify and enroll eligible patients is to do it while they are being scheduled for their intervention/procedure. Once you have determined who will be responsible for enrollment, make sure that everyone has a clear understanding of the eligibility criteria so they know which patients they need to enroll.
Once you have a process in place for enrolling eligible patients, the next step is to determine how you will collect the PRO surveys. Let’s start with the preintervention PROs. This is by far the most important, and here’s why: if a patient does not fill out the pre-op PRO, he or she is not eligible for post-op data collection. Once the patient has had surgery, you can’t go back and get the pre-op PRO data. If he or she doesn’t fill out the pre-op surveys, the patient is no longer eligible for participation in the postintervention data collection.
So the pre-intervention PRO surveys are the most critical to capture… the good news is the are by far the easiest to collect. Patients always have a pre-op appointment of some sort. If you are not using a software product and plan on using paper forms or a tablet, an easy way to ensure the pre-op PROs are collected is to have the patients fill them out during their clinic visit.
The process for collecting post-intervention is much more tricky, because often times patients’ follow-up appointments do not coincide with the PRO administration intervals… we will talk about that in more detail later. The reality is, if your process for enrolling patients and collecting pre-op data is not strong, the post-op surveys are not even worth collecting. When you first start an outcome program, you should focus primarily on pre-op data collection, and set a goal that all eligible patients are 1) enrolled and 2) complete their PRO surveys.
Once your program is up and running, the historical numbers that you calculated at the beginning of this process will serve as a helpful tool for monitoring the enrollment process, and help you determine whether or not all eligible patients are participating. If you are 2 months in with 60 patients enrolled, and last year there were 5000 patients annually in the same population… you can say with a fair amount of confidence that many eligible patients are not being enrolled, and there is something broken with your process.
When the historic case volume doesn’t jive with the number of patients you have enrolled, breaking down the stats on a per-provider basis will give you some valuable insight. This will help you identify both the bright spots and the problem areas. If you have a provider whose enrollment rate is awesome, find out what he or she is doing, and see if it is something that can be implemented elsewhere to improve other providers’ rates.
Don’t do this just once or twice, and then assume everything will continue to run smoothly. It is important to check your enrollment numbers on a regular basis. If you have a high surgical volume, we recommending doing this weekly.