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Patient-reported outcome measures (PROMs): can they be used to guide patient-centered care and optimize outcomes in total knee replacement?

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Abstract

Purpose

As patient-reported outcome measures (PROMs) are increasingly integrated into clinical practice, there is a need to translate collected data into valuable information to guide and improve the quality and value of patient care. The purpose of this study was to investigate health-related quality-of-life (QoL) trajectories in the 5 years following total knee replacement (TKR) and the patient characteristics associated with these trajectories. The feasibility of translating QoL trajectories into valuable information for guiding patient-centered care was also explored.

Methods

Data on patients who underwent TKR between 2006 and 2011 from a single-institution registry were extracted including patient-reported QoL (captured using the Short Form Survey (SF-12) instrument) up to 5 years post-surgery. QoL trajectories were modelled using latent class growth analysis. Quality-adjusted life-years (QALYs) were calculated to illustrate longer term health benefit. Multinomial logistic regression analyses were performed to examine the association between trajectory groups and baseline patient characteristics.

Results

After exclusions, 1553 patients out of 1892 were included in the analysis. Six unique QoL trajectories were identified; with differing levels at baseline and improvement patterns post-surgery. Only 18.4% of patients were identified to be in the most positive QoL trajectory (low baseline, large sustainable improvement after surgery) associated with the greatest gain in QALY. These patients were likely to be younger, have no co-morbidities and report greater pain at pre-surgery than most in other QoL trajectories.

Conclusions

Our findings demonstrate the importance of underlying heterogeneity in QoL trajectories, resulting in variable QALY gains. There is scope in translating routinely collected PROMs to improve shared decision-making allowing for more patient engagement. However, further research is required to identify suitable approaches of its implementation into practice to guide clinical care and maximize patient outcomes.

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Acknowledgements

A version of this paper was previously presented to the July 2019 meeting of the Health Economists’ Study Group. We would like to thank Catherine Henderson and others present who commented on the paper.

Funding

This study was supported by the Australian National Health and Medical Research Council (NHMRC) funded Centre for Research Excellence in Total Joint Replacement (1116325). Michelle Dowsey holds a National Health and Medical Research Council of Australia Career Development Fellowship (1122526). Peter Choong holds a National Health and Medical Research Council of Australia Practitioner Fellowship (1154203). Peter Choong, Michelle Dowsey, Anne Smith and Philip Clarke are recipients of a National Health and Medical Research Council Centre for Research Excellence Grant in Total Joint Replacement (1116325). Michelle Tew is jointly supported by the NHMRC funded Centre for Research Excellence in Total Joint Replacement (1116325) and Centre for Improving Cancer Outcomes Through Enhanced Infection Services (1116876), Melbourne Research Scholarship and Australian Research Council Centre of Excellence in Population Ageing Research.

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Authors and Affiliations

  1. Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton 3053, Victoria, Australia

    Michelle Tew, Kim Dalziel & Philip Clarke

  2. Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK

    Philip Clarke

  3. School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia

    Anne Smith

  4. Department of Surgery, The University of Melbourne, Melbourne, Australia

    Peter F. Choong & Michelle Dowsey

  5. Department of Orthopaedics, St. Vincent’s Hospital, Melbourne, Australia

    Peter F. Choong & Michelle Dowsey

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  1. Michelle Tew
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  2. Kim Dalziel
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  3. Philip Clarke
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  4. Anne Smith
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Correspondence to Michelle Tew.

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Conflicts of interest

None reported for Philip Clarke, Kim Dalziel, Anne Smith and Michelle Tew. Dr. Dowsey reports grants from National Health & Medical Research Council, during the conduct of the study; grants from Medacta International, grants from Medibank Foundation and grants from MSK Australia outside of the submitted work. Professor Chong reports grants from National Health & Medical Research Council during the conduct of the study; fees from Stryker Corporation and Depuy, Johnson & Johnson outside of the submitted work.

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This study was approved by the St. Vincent’s Hospital Melbourne Human Research Ethics Committee (HREC) (LNR/17/SVHM/136).

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This study involved the use of anonymised data extracted from a registry and was granted a waiver of informed consent.

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Tew, M., Dalziel, K., Clarke, P. et al. Patient-reported outcome measures (PROMs): can they be used to guide patient-centered care and optimize outcomes in total knee replacement?. Qual Life Res 29, 3273–3283 (2020). https://doi.org/10.1007/s11136-020-02577-4

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