NYC hospital prioritizes collection of patient-reported outcomes data

The Hospital for Special Surgery has a unique interest in knowing how patients feel.

Most patients go to the New York City-based orthopedics provider for elective procedures to ease the pain and discomfort in their joints. But to truly know if patients are feeling better after a surgery, the hospital can't rely only on routine quality metrics. That's where collecting data on patient-reported outcome measures can help.

"We need to go beyond just measuring complications and getting at whether patients got better," said Dr. Catherine MacLean, chief value medical officer at the hospital. "With patient-reported outcomes, we can measure not just the pain but the quality of life."

To collect patient-reported outcomes, the hospital relies in part on its nursing staff. All patients receive a phone call from a nurse before a procedure to go over important information and to answer questions. In April, nurses also began asking patients 10 questions from the Patient-Reported Outcomes Measurement Information System, or Promis, a survey about the patient's quality of life and ability to function. Questions are related to the patient's social support system as well as pain intensity and sleep behavior.

Those responses are logged into the patient's electronic health record.

The patients then fill out the Promis survey after the procedure using the hospital's online MyChart tool, which is supported by EHR vendor Epic Systems Corp. This allows doctors to understand how the patient's quality of life changed before and after the procedure.

MacLean said doctors find it "so helpful" to have the information before meeting with the patient post-surgery. "It facilitates meaningful conversation," she said.

Since launching the hospitalwide effort in April, 24,000 patient responses have been collected. The vast majority—85%—were collected by nurses through the pre-surgery phone calls.

MacLean said it's been challenging to encourage patients to complete the Promis survey online after procedures and that the response rate is "quite low."

Patients are now emailed the survey and the hospital is working on ways to redesign the questionnaire so it's more user-friendly.

Encouragement from doctors has proven successful in raising online response rates, MacLean said. One doctor values the Promis survey so much that he won't see patients for follow-up appointments until they fill it out. As a result, the online survey response rate for his patients is near 100%.

Another challenge for the hospital was integrating the Promis survey responses into the EHR. MacLean said it was "a lot of work" and took many months for the hospital to build a place for the survey responses to go in the EHR so the care team can easily view the information.

Integrating the Promis survey into the EHR is a frustration for many providers. Last October, the National Institutes of Health awarded a $6.3 million grant for an initiative that is working to integrate the Promis tool into EHR systems, including those from Epic and Cerner Corp.

"There should be a special place in the EHR for Promis just like there is a place for lab tests," MacLean said.

The hospital hopes to eventually expand data collection so patients can take a disease-specific Promis survey in addition to the "global" Promis survey currently used.

The disease-specific questions will give the care team better insight into how their patients are improving over a period of time, MacLean said. For example, for patients with lumbar spine disease, they will be asked to fill out the Oswestry Low Back Disability Questionnaire, which evaluates functional status.

"We want to collect this for everyone and use the information to make informed clinical decisions," she said.