Using PROMIS Scores to Provide Cost-Conscious Follow-up After Foot and Ankle Surgery

Area of Science:

• Orthopedic Surgery
• Health Services Research
• Patient-Reported Outcomes

Background:

• National campaigns advocate for reducing low-value healthcare services.
• Patient-reported outcomes (PROs) are used for postoperative assessment but not to guide follow-up visit decisions.
• Elective foot and ankle surgeries incur significant follow-up visit frequency and costs.

Purpose of the Study:

• To assess the frequency and cost of in-person follow-up visits after substantial improvement in patient-reported outcomes.
• To evaluate the utility of Patient Reported Outcomes Measurement Information System (PROMIS) pain interference (PI) scores in guiding follow-up care.
• To determine if PROMIS PI can help identify patients who may not require further in-person visits.

Main Methods:

• Retrospective analysis of PROMIS PI data from 2015-2020 for elective foot and ankle surgeries.
• Definition of substantial improvement as two consecutive PROMIS PI scores above preoperative levels (MCID).
• Multivariable models used to analyze time to improvement, visit frequency, and associated costs.

Main Results:

• Substantial improvement was achieved within 3 months by 12-46% of foot and 16-61% of ankle surgery patients.
• Patients with higher preoperative pain scores experienced earlier substantial improvement.
• After substantial improvement, patients averaged 3.6-4.0 follow-up visits, costing $266-$322 per patient.

Conclusions:

• Postoperative follow-up visits are resource-intensive.
• PROMIS PI scores can serve as an objective measure to guide the necessity and timing of follow-up visits.
• Utilizing PROMIS PI may help optimize care and reduce costs for elective foot and ankle surgeries.