Implementing custom PRO and NPS tools in private practice: balancing simplicity and clinical value in a retrospective...

The authors describe the development of a custom survey centered around the Three C's and Net Promoter Scores in a high-volume surgical private practice with limited resources and no research coordinator. This paper aims to examine whether an abbreviated survey can serve as a practical alternative to lengthy validated PROMs in tracking post-surgical recovery outcomes in a private practice setting.

A retrospective, de-identified analysis was conducted on prospectively collected patient-reported outcome surveys administered via email preoperatively and 120-days postoperatively. Of 2,908 surveys administered, 101 patients undergoing four high-volume procedures (CTR, meniscectomy, TKR, hernia) with matched pre- and post-operative responses were included. Paired t-tests with Shapiro-Wilk normality testing were performed in R (version 4.3.2) at α = 0.001.

In total, 2,908 surveys were administered between 2021 and 2024 with 719 pre-surgery responses collected and 439 responses to both pre- and post-surgery surveys. The highest volume cases were selected for analysis based on their high surgical volume (> 8 cases), clinical relevance to orthopedics, and their frequent association with post operative recovery function. Surgical patients undergoing Carpal Tunnel Release (CTR) (t = 4.04, p < 0.001), Meniscectomy (t = 3.46, p < 0.001), Total Knee Replacement (TKR) (t = 4.15, p < 0.001), and Total Hip Replacement (THR) (t = 4.71, p < 0.001) demonstrated significant improvements in post-surgical numerical pain score. Similar results were observed in functionality and disruptive stress scores. Researchers observed a calculated NPS of 88.2 of which 400 were promoters, 26 were passives, and 13 were detractors.

The authors present this work as an initial signal study demonstrating that a brief and self-administered survey can capture statistically significant improvements in pain, functional difficulty, and psychological stress in a private practice setting with limited research infrastructure. While NPS and work metrics should not be used alone as a gauge of outcomes, they hold significant utility in conjunction with other patient reported outcomes. Reporting requirements by the Center for Medicare and Medicaid Services (CMS) require hospitals to collect pre surgery and one year post surgery (9-15 months) HOOS JR and KOOS JR scores for total joint replacement surgeries, with public reporting set for 2027 and reimbursement effects in 2028. These requirements underscore the need for streamlined solutions. As value-based care becomes a priority, practical strategies are needed to reduce the burden on providers and patients [1].