Does Patient-Reported Outcome Measures Use at New Foot and Ankle Patient Clinic Visits Improve Patient Activation, Experience, and Satisfaction?

David N Bernstein; Courtney M C Jones; A Samuel Flemister; Benedict F DiGiovanni; Judith F Baumhauer

doi:10.1177/10711007231163119

Does Patient-Reported Outcome Measures Use at New Foot and Ankle Patient Clinic Visits Improve Patient Activation, Experience, and Satisfaction?

Foot Ankle Int. 2023 Jun;44(6):481-487. doi: 10.1177/10711007231163119. Epub 2023 Apr 9.

Authors

David N Bernstein^{1

2}, Courtney M C Jones³, A Samuel Flemister⁴, Benedict F DiGiovanni⁴, Judith F Baumhauer⁴

Affiliations

¹ Harvard Combined Orthopaedic Residency Program, Massachusetts General Hospital, Boston, MA, USA.
² Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands.
³ Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY, USA.
⁴ Department of Orthopaedics and Physical Performance, University of Rochester Medical Center, Rochester, NY, USA.

PMID: 37032526
DOI: 10.1177/10711007231163119

Abstract

Background: Patient-reported outcome measures (PROMs) can help predict clinical outcomes and improve shared clinical decision-making discussions. There remains a paucity of research assessing how the use of PROMs may drive improved patient experience and patient activation.

Methods: New foot and ankle patients completed PROMIS physical function (PF), pain interference (PI), and depression assessments. Patients were then randomized to viewing and discussing their PROMIS scores with their surgeon or not. Following the clinic visit, patients completed a series of Clinician & Group Survey-Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) questions and the Patient Activation Measure (PAM). Responses to the CG-CAHPS questions and PAM were compared between the 2 groups and after clustering on surgeon. Potential interaction effects by social deprivation were also explored.

Results: After enrolling patients but removing those lost to follow-up or with missing data, 97 and 116 patients remained in the intervention control cohorts, respectively. No difference was found in CG-CAHPS responses nor PAM scores between the 2 groups (P > .05). All surgeons were highly rated by all patients. When clustered by surgeon, intervention subjects were less likely to indicate "top box" scores for the understanding domain of the CG-CAHPS question (OR 0.51, P < .001) and had decreased odds of high patient activation compared to control subjects (OR 0.67; P = .005). Among the most socially disadvantaged patients, there was no difference in control and intervention subjects in their likelihood of having high patient activation (P = .09).

Conclusion: Highly rated foot and ankle surgeons who show and discuss PROM results may not improve patient experience or activation and may, in fact, decrease understanding or patient activation in select populations. Future work is needed to determine when PROM discussions are most beneficial and how best to present PROMs data, as we suspect that how the information was presented-and not the use of PROMs-resulted in our findings. Health literacy tools and/or communication training may better engage different patient groups regarding PROMs.

Level of evidence: Level I, randomized controlled trial.

Keywords: PROMIS; PROMs; Patient Activation Measure; activation; patient experience; patient-reported outcome measures; satisfaction; value-based health care.

Publication types

Randomized Controlled Trial

MeSH terms

Ankle*
Humans
Patient Participation*
Patient Reported Outcome Measures
Patient Satisfaction
Personal Satisfaction