Abstract
BackgroundPatient-reported outcomes are increasingly utilized in routine orthopedic clinical care. Computer adaptive tests (CATs) from the Patient-Reported Outcomes Measurement Information System (PROMIS) offer a brief and precise assessment that is well suited for collection within busy clinical environments. However, software apps that support the administration and scoring of CATs, provide immediate access to patient-reported outcome (PRO) scores, and minimize clinician burden are not widely available.ObjectiveOur objective was to design, implement, and test the feasibility and usability of a Web-based system for collecting CATs in orthopedic clinics.MethodsAO Patient Outcomes Center (AOPOC) was subjected to 2 rounds of testing. Alpha testing was conducted in 3 orthopedic clinics to evaluate ease of use and feasibility of integration in clinics. Patients completed an assessment of PROMIS CATs and a usability survey. Clinicians participated in a brief semistructured interview. Beta-phase testing evaluated system performance through load testing and usability of the updated version of AOPOC. In both rounds of testing, user satisfaction, bugs, change requests, and performance of PROMIS CATs were captured.ResultsPatient feedback supported the ease of use in completing an assessment in AOPOC. Across both phases of testing, clinicians rated AOPOC as easy to use but noted difficulties in integrating a Web-based software application within their clinics. PROMIS CATs performed well; the default assessment of 2 CATs was completed quickly (mean 9.5 items) with a satisfactory range of measurement.ConclusionAOPOC was demonstrated to be an easy-to-learn and easy-to-use software application for patients and clinicians that can be integrated into orthopedic clinical care. The workflow disruption in integrating any type of PRO collection must be addressed if patients’ voices are to be better integrated in clinical care.
Highlights
MethodsThere is an increasing demand to utilize patient-reported outcomes (PROs) in clinical care for a variety of aims
Half of the subjects completed the entire assessment battery (3 computer adaptive test central processing units (CPUs) (CAT)) in under 3.7 min
About 85% of patients answered only the minimum of 4 questions for the Mobility (781/923, 84.6%) and Pain Interference (766/897, 85.4%) CATs compared with only 22.1% (200/907) of patients for the Upper Extremity CAT
Summary
There is an increasing demand to utilize patient-reported outcomes (PROs) in clinical care for a variety of aims. PROs that measure symptoms (eg, depression) and disability (eg, physical function) can be utilized to monitor response to treatment, detect unrecognized problems, improve patient and provider communication, and possibly improve health outcomes [1,2]. It is hoped that using PRO Performance Measures will alter the definition of health care quality to include the function and symptom burden of patients [8]. Computer adaptive tests (CATs) from the Patient-Reported Outcomes Measurement Information System (PROMIS) offer a brief and precise assessment that is well suited for collection within busy clinical environments. Software apps that support the administration and scoring of CATs, provide immediate access to patient-reported outcome (PRO) scores, and minimize clinician burden are not widely available
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