Collecting PROMs – Can You Improve Patient Compliance?

The necessary task of collecting patient-reported outcome measures (PROMs) wind up clogging most in-clinic systems. Might there be a more optimal time for collecting PROMs?

A team of orthopedic Henry Ford Health System researchers in Detroit, Michigan, tested three different ways of obtaining PROMs before patients come to the clinic.

Their work, “Pre-Visit Digital Messaging Improves Patient-Reported Outcome Measure Participation Prior to the Orthopaedic Ambulatory Visit,” was published in the January 4, 2023, edition of The Journal of Bone and Joint Surgery.

Eric Makhni, M.D., M.B.A. director of Quality and Informatics, Orthopedic Service Line at Henry Ford Health System and co-author of the study, explained the genesis of this work: “Patient-reported outcome measures (PROMs) are critical to collect as part of routine orthopedic care, especially in the ambulatory setting.”

“These assessments are necessary for shared decision-making, patient counseling, and post-treatment monitoring. To have this data available when needed, PROMs need to be administered and completed before seeing the orthopedic clinician. Given how busy most ambulatory orthopedic settings already are, we wanted to find out if electronic messaging could improve completion rates prior to the clinic visit, thereby lowering the administrative burden of collection for office staff.”

A total of 291 patients, all of whom were registered with the electronic medical record (EMR) patient portal and had e-mail addresses, were randomly assigned to 1 of 3 study arms. The control group had no pre-visit messages, while the EMR group received pre-visit messages via the portal and the e-mail group got pre-visit e-mail messages.

Patients could complete the Patient-Reported Outcomes Measurement Information System (PROMIS) forms via the portal seven days before scheduled visits. Pre-visit messages were sent seven days before the scheduled visit (except in the control group).

The pre-visit total completion rates for PROMs were higher in the EMR group (49% of 97 patients) and the e-mail group (52% of 100 patients) in comparison with the control arm (30% of 94 patients). Men were more likely than women to have partial pre-visit PROM completion (odds ratio [OR], 1.74), and Caucasian patients were more likely to have partial pre-visit PROM completion than African American patients (OR, 2.28).

“The most important result,” stated Dr. Makhni to OTW, “was that pre-visit messaging did, in fact, improve PROM collection by a statistically significant amount. This indicates that orthopedic practices should consider implementing this strategy as part of PROM collection in the ambulatory setting.”

“I was surprised that pre-visit EMR portal messages performed similarly to e-mail reminder messages. I had a feeling that e-mail outreach would improve pre-visit completion, but I was surprised that portal messaging did as well. For an email, the patient can see the contents of the message right there and easily access the questionnaires. For a portal message, the patient needs to first sign in to the EMR patient portal and then read the message, so I thought that those completion rates would be a little bit lower than e-mail, but they weren’t.”

“I believe that patients—and the population in general—are getting increasingly accustomed to text messaging as a primary form of communication. It would be great to assess completion rates with a text-message prompt, ideally integrated into the questionnaire/PROM workflow. This would lower the work needed to answer PROMs by patients.”