THE USE OF PATIENT REPORTED OUTCOME MEASURES BY PRIMARY MEDICAL PROVIDERS IN THE PEDIATRIC SPORTS POPULATION

Jamila N. Aberdeen; Rebecca K. Frank Burnett; Heather F. Stewart; Elliot Greenberg

摘要

Background: Patient reported outcome measures (PROs) allow medical providers to assess functional limitations, track progress, and evaluate outcomes. Although progress has been made developing and validating PROs, much of this work has been done within the adult population, and only a limited number of pediatric specific PROs exist. The use of PROs within pediatric orthopedics remains unstudied. The purposes of this study are to evaluate the current use of PROs within pediatric sports medicine and determine how the information from PROs is used for treatment decisions. Methods: An online email survey was sent to members of the Pediatric Research in Sports Medicine Society (PRiSM) using REDCap?. The survey was developed and pilot tested by 4 physical therapists and 3 orthopedic surgeons. The final survey consisted of 24 multiple choice questions, designed to garner information relative to provider use of PROs. Some questions allowed free text for answers not previously-defined. The survey took 3-5 minutes to complete and was open for an 8 week period. Although PRiSM is a multi-disciplinary society, only data from primary medical providers (PMPs -orthopedic surgeons, sports medicine primary care physicians, nurse practitioners, physician assistants) was utilized. Descriptive statistics and frequency tallies were used to analyze the data. Results: Seventy-two surveys were used for analysis; a response rate of 45% given total membership. The sample distribution can be seen in Table 1. The use of PROs was reported by 57% (n=41) of PMPs. PROs administration occurred at post-operative encounters (83%, n=34), new patient visits (73%, n=30), pre-op visits 44% (n=18), when there is a change in statusew injury 27% (n=11), and every visit 12% (n=5). The majority of information from PROs was used for research (85%, n=35), assess response to treatment (51%), inform clinical prognosis (37%) and guide clinical decisions (32%). There were no PMPs that reported distributing PROs to satisfy insurance requirements. PRO use was reported at the highest frequency for knee (98%, n=40) and shoulder (68%, n=28) injuries. There was variability in specific PRO selection with 80%, 56% and 34% using the Pedi-IKDC, IKDC, and KOOS, respectively. For the shoulder, the DASH and QuickDASH garnered the highest use (32% each) however variability in scale selection persisted with 24% using “other” scales, including activity and fear avoidance scales. PRO use for the hip (41%), ankle (39%), back (20%) and neck (17%) were reported less frequently. (Figure 3 details scale specifics). Nearly half the sample (46%) reported using affective domain or quality of life scales like the Pedi-Fabs (24%) and ACL-RSI (17%) and PROMIS (12%). Interestingly, 43% (n=31/41) of the sample indicated they do not use PROs, with 39% of these respondents citing inadequate time as the primary barrier to use, 23% were unsure of which measure to use and 16% did not find them useful or relevant. Additional barriers are presented in Figure 4. Conclusions: Only 57% of PMPs are using PROs within their practice. The information from PROs is largely used to perform research and demonstrate the effectiveness of treatment. Interestingly, no one used PROs to satisfy insurance requirements. Within all body regions, there is little consistency in scale selection. A large number of respondents indicated that PROs for hip, ankle and spine were “not applicable” to their practice, making generalization of this data difficult. Although it cannot be determined why there was such a low percentage of PRO use for these body regions, the authors feel this may be related to a small volume of patients seen with diagnoses of these regions among our sample or perceptions that no existing scale is useful for this population. It was surprising that over 40% of the sample did not use PROs in their practice. Among those respondents, inadequate time for administration and indecision regarding which measure to use, were indicated as the greatest barriers to use. Clinical Relevance: Healthcare policy within the United States is undergoing a transformation towards a value-based system, under which PROs will be heavily relied upon to demonstrate effectiveness of treatment and help determine reimbursement; this transition has already occurred in adults/the Medicare system. Our results show that although 85% of PMPs use PROs for research purposes, the use of PROs in the clinical setting is low. Given the changing payment model and increased emphasis on patient-centered care, our results highlight the importance of integrating PROs into clinical practice and support the need for ongoing research related to the validation research and scale development as many of the scales have not been evaluated in pediatrics. Tables and Figures: Table 1. Sample Distribution Sample Characteristic %(N) Discipline Orthopaedic Surgeon 78%(56) Primary Care Sports Medicine Physician 19%(14) Nurse Practitioners/Physician Assist

机译：背景：患者报告的结局指标（PRO）允许医疗提供者评估功能限制，跟踪进展并评估结局。尽管在开发和验证PRO方面已经取得了进展，但大部分工作已在成年人口中完成，并且仅存在有限数量的儿科专用PRO。尚未在儿科骨科中使用PRO。这项研究的目的是评估小儿运动医学中PRO的当前使用情况，并确定如何将PRO的信息用于治疗决策。方法：使用REDCap？将在线电子邮件调查发送给运动医学会儿科研究（PRiSM）的成员。该调查由4位物理治疗师和3位骨科外科医生开发并进行了先导测试。最终调查包括24个多项选择题，旨在收集有关提供商使用PRO的信息。有些问题允许使用自由文本来提供先前未定义的答案。该调查需要3-5分钟才能完成，并且为期8周。尽管PRiSM是一个多学科的社会，但仅使用了来自初级医疗服务提供者（PMP-整形外科医生，运动医学初级保健医生，护士，医生助理）的数据。描述性统计数据和频率统计数据用于分析数据。结果：共进行了72项调查分析。会员总数达到45％。样本分布见表1。据报告，有57％（n = 41）的PMP使用了PRO。当状态/新状态发生变化时，PRO的管理发生在术后相遇（83％，n = 34），新患者就诊（73％，n = 30），术前就诊44％（n = 18）。伤害27％（n = 11），每次就诊12％（n = 5）。来自PRO的大部分信息用于研究（85％，n = 35），评估对治疗的反应（51％），告知临床预后（37％）和指导临床决策（32％）。没有PMP报告可以分发PRO来满足保险要求。据报告，使用PRO的膝盖受伤（98％，n = 40）和肩部受伤（68％，n = 28）的频率最高。使用Pedi-IKDC，IKDC和KOOS的特定PRO选择分别存在80％，56％和34％的可变性。对于肩膀，DASH和QuickDASH的使用率最高（各占32％），但是使用“其他”量表（包括活动和避免恐惧量表）时，量表选择的可变性持续到24％。髋关节（41％），踝关节（39％），背部（20％）和颈部（17％）的PRO使用率较低。（图3详细说明了比例尺细节）。接近一半的样本（46％）报告使用情感域或生活质量量表，例如Pedi-Fabs（24％）和ACL-RSI（17％）和PROMIS（12％）。有趣的是，有43％（n = 31/41）的样本表明他们没有使用PRO，其中39％的受访者认为时间不足是使用的主要障碍，23％的人不确定使用哪种测量方法，16％的人使用了测量方法找不到有用或相关的内容。图4中显示了其他障碍。结论：在实践中，只有57％的PMP在使用PRO。来自PRO的信息主要用于进行研究和证明治疗的有效性。有趣的是，没有人使用PRO来满足保险要求。在所有身体区域中，体重秤的选择几乎没有一致性。大量受访者表示，髋部，踝部和脊柱的PRO在他们的实践中“不适用”，这使得该数据难以推广。尽管无法确定为何在这些身体部位使用PRO的比例如此之低，但作者认为这可能与我们样本中诊断为这些部位的少量患者有关，或者认为没有现有的量表有用对于这个人群。令人惊讶的是，超过40％的样本在实践中并未使用PRO。在这些答复者中，行政时间不足和对使用哪种措施的犹豫不决被认为是最大的使用障碍。临床意义：美国的医疗保健政策正在向基于价值的体系转变，在这种体系下，将严重依赖PRO来证明治疗的有效性并帮助确定报销;这种转变已经在成人/医疗保险系统中发生。我们的结果表明，尽管有85％的PMP出于研究目的使用PRO，但在临床环境中PRO的使用率很低。考虑到不断变化的付款模式和对以患者为中心的护理的日益重视，我们的结果强调了将PRO整合到临床实践中的重要性，并支持与验证研究和量表开发相关的正在进行的研究的需要，因为许多量表尚未在儿科。表和表格：表1.样本分布样本特征％（N）整形外科医师78％（56）基层医疗运动医学医师19％（14）护士执业医师/医师协助

THE USE OF PATIENT REPORTED OUTCOME MEASURES BY PRIMARY MEDICAL PROVIDERS IN THE PEDIATRIC SPORTS POPULATION

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