Patient-reported outcome (PRO) measures are an excellent way to measure function, pain and quality of life from the best source of the information: the patient. They are an increasingly sought-after, highly-utilized type of performance measurement; however, this fairly new measurement activity often requires adjustments to medical groups’ processes and patient touch points which can be challenging for clinicians and staff.
Sharing best practices from medical groups that have successfully implemented PRO tools is critical to increasing administration rates across the market. As a result, MN Community Measurement conducted and just released the results of a survey of high-performing medical groups that are administering the Oxford Knee Score (OKS) questionnaire to patients undergoing a total knee replacement. OKS is a patient-reported outcome tool that assesses a patient’s functional status and pain related to the knee.
While the resource is specific to total knee patients, many of the recommended tactics could be used to implement any PRO tool in practices.
After several years of measure development and data collection, MNCM began publicly reporting total knee replacement process measures in late 2014. The three measures currently reported on our consumer-focused, public reporting website, MNHealthScores.org, evaluate the percentage of patients who completed the OKS questionnaire prior to and/or one year following their total knee replacement procedure.
Tool administration rates were lower than MNCM hoped during the first year of reporting, which made it impossible to produce valid outcome measures for public reporting. Process measures were reported as a first step toward public reporting of the outcome measures and in the hopes that they would encourage medical groups to increase implementation of PRO tools in their practices. In 2014, only 18 percent of patients were assessed utilizing the OKS tool both before and after surgery. Medical groups ranged from 0 to 77 percent of patients being assessed before and after surgery.
Key staff from seven high-performing medical groups were asked to participate in a survey to identify workflow practices and methods that led to higher PRO tool administration rates in their clinics. The findings are part of a new medical group resource, available in Provider Tools and Resources.
Some of the best practices identified include:
- Include pre-operative tool in chart prep process and/or pre-op classes
- Mail tool to patients ahead of procedure if not completed during office visit
- Conduct post-operative assessment at follow up visit
- Mail tool with self-addressed, stamped return envelope to patients who do not have follow up visits
- Develop registry within electronic medical record to track and schedule post-operative visits and tool administration
These best practices can be implemented by other medical groups to increase the administration of PRO tools, which will help groups assess their patients’ functional status pre- and post-operatively – a key component in providing good care and measuring the outcomes and effectiveness of that care – as well as help ensure MNCM’s ability to publicly report the outcome measures in the future.