Evaluating Patient-Reported Outcome Measure Collection and Attainment of Substantial Clinical Benefit in Total Joint Arthroplasty Patients

Authors: Soham Ghoshal ¹, Joyce Harary ², Jean Flanagan Jay ³, Zaid Al-Nassir ²; BWH PROMs Workgroup ⁴; Antonia F Chen ¹

BWH PROMs Workgroup: Richard Iorio, Jeffrey Lange, Peter Meyers, Adam Olsen, Andrea L Pusic, Vivek Shah

¹Harvard Medical School, Boston, Massachusetts; Brigham and Women's Hospital, Department of Orthopaedic Surgery, Boston, Massachusetts.

²Force Therapeutics, New York, New York.

³Brigham and Women's Hospital, Department of Orthopaedic Surgery, Boston, Massachusetts.

⁴Harvard Medical School, Boston, Massachusetts; Brigham and Women's Hospital, Department of Orthopaedic Surgery, Boston, Massachusetts; Mass General Brigham, Department of Patient Reported Outcome Measures, Somerville, Massachusetts; Brigham and Women's Hospital, Department of Plastic and Reconstructive Surgery, Boston, Massachusetts.

Abstract

Background

‍Patient-reported outcome measures (PROMs) are important markers of postsurgical outcomes following total joint arthroplasty (TJA). Recent policies by the Centers for Medicare & Medicaid Services will require hospitals to achieve at least 50% postoperative PROM collection rates in order to qualify for their full annual payment in fiscal year 2028. This study aimed to: (1) quantify provider PROMs collection rates for TJA patients; (2) compare mean improvements in postoperative PROMs in TJA patients; (3) identify the proportion of TJA patients achieving substantial clinical benefit (SCB); and (4) identify factors associated with TJA patient completion of matched PROMs and achievement of SCB at one year.

Methods

‍This retrospective cohort study included 1,493 primary total hip arthroplasty (THA) and 2,959 primary total knee arthroplasty (TKA) patients who underwent surgery at a single institution from May 2019 to December 2023. The primary outcomes were 1-year paired hip or knee PROM collection, measured by the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement and Hip Disability and Osteoarthritis Outcome Score for Joint Replacement surveys, and SCB achievement rates (22 for Hip Disability and Osteoarthritis Outcome Score for Joint Replacement and 20 for Knee Injury and Osteoarthritis Outcome Score for Joint Replacement). Secondary outcomes involved identifying factors associated with PROM completion and SCB achievement. Statistical analyses included descriptive statistics, t-tests, and logistic regression analysis.

Results

‍There were 61.2% of THA patients and 61.1% of TKA patients who completed 1-year paired PROMs, with 72.8% of THA and 53.3% of TKA patients achieving SCB. Factors associated with higher PROMs completion included technology use (PROMs application, text reminders). For TJA patients, a lower preoperative PROM was associated with achievement of SCB at one year. For THA patients, lower body mass index was associated with SCB attainment. For TKA patients, men were significantly associated with SCB attainment.

Conclusions

‍The study indicates compliance with the 50% PROM collection requirement, but this required significant allocation of resources, including the use of a digital care platform. Substantial clinical benefit was achieved in 72.8% of THA patients but only 53.3% of TKA patients at one year, and this was associated with certain patient demographic factors. Achieving compliance with the Centers for Medicare & Medicaid Services requirement may be difficult for many providers and institutions.