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Differences in Capture Rates of Patient-Reported Outcome Measures Between Ambulatory Surgery Centers and Hospitals
Aidan T Morrell1, Isabella Zaniletti2, James I Huddleston3
1Department of Orthopedics, RehabilitationOregon Health & Science University, Portland, Oregon.
Background:
The Centers for Medicare & Medicaid Services is requiring patient-reported outcome measures (PROMs) to demonstrate the value of total joint arthroplasty (TJA). While effective PROM utilization offers major benefits, capture rates and outcomes may vary across practice settings. This study aimed to (1) compare PROMs capture rates between ambulatory surgery centers (ASCs) and hospitals and (2) evaluate relationships between surgical setting, PROM capture rates, and clinical outcomes.
Methods:
Using a large national database, we conducted a retrospective cohort study of patients who underwent primary TJA between January 2020 and September 2023. The PROM capture was defined as AJRR submission of linked baseline and 1-year PROMs for four validated instruments and then compared in patients who underwent surgery at an ASC versus a hospital setting as the primary study outcome. Analyses of factors predicting PROM capture, mean score, and the likelihood of achieving minimum clinically important difference (MCID) for at least one PROM were performed using clustered logistic regression with inverse probability weighting. Statistical analyses were conducted with significance set at P < 0.05. Among 1,264,863 outpatient primary TJAs, 70,677 had linked baseline and 1-year PROMS.
Results:
Capture rates were higher in ASCs (30.6 to 56%) than hospitals (28.6 to 34%) for all instruments (P < 0.001). However, there was no difference in achievement of MCID between settings. Institutional characteristics, including smaller size, major teaching status, and location in Southern/Western regions, predicted lower PROM capture rates.
Conclusions:
Our findings suggest the surgical setting influences submission patterns to AJRR, which may reflect the PROMs capture rate, but did not correlate with patients achieving MCID on studied outcome measures. Efforts to improve both collection and submission workflows of PROMs are essential for compliance and quality improvement for ASCs, hospitals, and stakeholders to ensure compliance and optimize patient care.
Level Of Evidence:
Therapeutic level III.