Barriers to Collection and Use of Patient-Reported Outcomes A Multi-Institutional Survey of Surgeons and Care Teams

Currently there is a lack of insight into what total joint replacement (TJR) surgeons and care teams perceive to be the greatest barriers to collection and use of patient reported outcomes (PROs). The goal of this study was to provide insight on this topic using a multi-institutional survey.

A thorough literature review on PROs adoption and utilization was conducted to generate a 26-question survey. This survey was disseminated to joint replacement surgeons, associate providers (e.g., nurse practitioners and physician assistants), and other non-clinical health care staff involved in PRO collection at three institutions. Data from all respondents were analyzed qualitatively and using chi-square tests.

Of 37 responses, 24 (65%) were from orthopedic surgeons and 13 (35%) from other clinical and administrative staff. Seventy-one percent of surgeons thought that integration into clinical workflow was the greatest barrier to initial implementation of PROs, while the greatest long-term limitations were accessibility (50%), patient engagement and compliance (50%), ability to represent their health in PROs (54%), and consistency across providers (50%). For PROs to be clinically useful, surgeons required that they should be linked to the EMR interface (65%), immediately available (59%), and are trended over time (59%). Fifty-four percent of surgeons across institutions believed administrative leadership was ultimately responsible for successful PROs implementation, while 46% of other staff believed that responsibility fell to surgeons and clinical staff.

Surgeons perceive that the greatest barriers to PRO collection are workflow integration initially, and patient engagement, compliance, and ability to represent their health in PROs over the long term. Stakeholders inconsistently report which group is responsible for successful implementation.