Commentary: Precision science and patient-centered care

Capturing patient-reported outcomes: paper versus electronic survey administration

Objective: To compare the capture rates and costs of paper patient-reported outcomes (pPRO) administered in-clinic and electronic PROs (ePRO) collected through emails and texts. Design: Retrospective review. Setting: Level 1 trauma center. Patients/Participants: The pPRO program enrolled 2164 patients for postsurgical follow-up in 4 fracture types: ankle, distal radius, proximal humerus, and implant removal from 2012 to 2017. The ePRO program enrolled 3096 patients in 13 fracture types from 2018 to 2020. Among the patients enrolled in the ePRO program, 1296 patients were matched to the 4 original fracture types and time points. Main Outcome Measures: PRO capture rates in 4 fracture types by matched time point and estimated cost of each program per enrolled patient. Results: At first follow-up, pPRO provided a higher capture rate than ePRO for 3 of 4 fracture types except for implant removal (P < 0.05). However, at 6-month and 1-year follow-ups, ePRO demonstrated statistically significant higher capture rates when compared with pPRO for all applicable modules (P < 0.05). The average cost for the pPRO program was $171 per patient versus $56 per patient in the ePRO program. Patients were 1.19 times more likely to complete ePRO compared with pPRO (P = 0.007) after controlling for age, sex, fracture type, and time point. Conclusion: The electronic PRO service has improved long-term capture rates compared with paper PROs, while minimizing cost. A combined program that includes both in-clinic and out of clinic effort may be the ideal model for collection of PROs. Level of Evidence: Level 3.

Outcomes research in childhood autoimmune diseases

This article provides an introduction to key aspects of outcomes research in pediatric rheumatology, focusing on arthritis. Patient-centered outcomes research addresses questions of interest to multiple stakeholders in order to guide the best health care decisions suited to a particular patient's circumstances and preferences. Discussion includes the importance of maintaining high-quality longitudinal patient registries and use of valid clinical and patient-reported outcome measures. Rapid, reliable translation of research on best practices into clinical care, as facilitated by quality improvement learning networks, leads to timely and meaningful improvement in patient outcomes.

A conceptual model of the multiple stages of communication necessary to support patient-centered care

Patient-centered care requires that both healthcare providers and patients have access to comparative effectiveness research (CER), which provides direct comparisons of the risks and benefits of available clinical options. However, insufficient attention has been paid to developing the comprehensive communication systems necessary to ensure that CER reaches patients and healthcare providers. In this review, we propose a model of the multiple stages of CER communication necessary for patient-centered care and review the existing research and gaps in knowledge relevant to each stage. These stages include: promotion of the underlying concepts and value of CER; translation of CER results; dissemination of CER results; and utilization of the results of CER in shared decision-making between patients and providers. A comprehensive approach to CER communication is necessary to ensure that the growing interest in and availability of CER is able to support a more patient-centered model of healthcare.

Barriers to completion of Patient Reported Outcome Measures

Patient Reported Outcomes Measures (PROMs) are commonly used in total joint arthroplasty (TJA) to assess surgical outcomes. However certain patient populations may be underrepresented due to lower survey completion rates. The purpose of this study is to evaluate factors that influence PROM completion rates for 1997 TJA patients between 7/1/2007 and 12/31/2010. Completion rates were lower among patients who were over 75, Hispanic or Black, had Medicare or Medicaid, TKA patients and revision TJA patients (P<0.05 for all comparisons). Having multiple risk factors further reduced completion rates (P<0.001). Overall participation increased significantly during the study period, after electronic data capture methods were introduced. Awareness of these factors may help physicians and researchers improve participation of all patient populations so they are well represented in TJA outcomes research.

Family medicine: a specialty for all ages

After a diminishing of its ranks following the post-World War II explosion of growth in medical discoveries, advanced medical technology, and the concomitant specialization of the physician workforce, family medicine is re-establishing itself as a leading medical specialty that has garnered growing interest among recent medical-school graduates. Family physicians provide care for patients of all ages, from newborns to the elderly. In addition to its wide scope of practice, family medicine is characterized by its emphasis on understanding of the whole person, its partnership approach with patients over many years, and its command of medical complexity. Family physicians are trained both to use community resources to assist individual patients in meeting medical or social needs and to identify and address community-wide needs. The specialty of family medicine is uniquely positioned to provide a leadership role in health-reform efforts that are accelerating across the country. Health care models that are gaining traction, such as the patient-centered medical home model, health homes, and accountable care organizations, share the characteristics of providing comprehensive, coordinated patient care with an emphasis on disease prevention and health promotion. This model of care, provided in the context of family and community, has been the hallmark of family medicine since its creation as a distinct medical specialty more than 40 years ago. In addition, family physicians' ability to care for patients of all ages make them particularly cost-effective as the new models of care move to improve access to care through expanded hours and locations.