JMIR Publications

ABSTRACT

Background:

There is a global emphasis on expanding data collection for joint replacement procedures beyond implant attributes and progression to revision surgery. Patient reported outcome measures (PROMs) are increasingly considered as an important measure of surgical outcomes from a patient’s perspective. However, a major limitation preventing wider use of PROMs data in national data collection has been the inability to systematically collect and share electronic information with relevant stakeholders in a comprehensive and financially sustainable manner.

Objective:

We aim to report on the development of an electronic data capture and reporting system by a national registry for the collection of PROMs and the processes used to identify and overcome barriers to implementation and uptake. We also aim to provide a cost breakdown of establishing and maintaining a nationwide electronic PROMs program.

Methods:

Between 2018 and 2020 three governance and advisory committees were established to develop and implement a PROMs pilot program nested within a nationwide joint replacement registry. The program involved electronic collection of pre- and 6-month post-operative data for hip, knee or shoulder replacement surgery from 44 Australian hospitals. Resource requirements for the program included a Project Manager, Software Developers, Data Manager and Statistician. An online platform was tested, refined, and implemented for electronic PROMs collection with scalability considered for future expansion to all Australian hospitals and additional data fields. Technical capabilities included different access for multiple user types, patient registration, automatic reminders via SMS and email, online consent and patient outcome real-time dashboards accessible for different user groups (surgeons, patients, hospitals and project stakeholders).

Results:

During the PROMs pilot period, there were 14,890 procedures registered in the electronic system. This equated to 60% of people who had a joint replacement at participating hospitals during this period. Patient registration and data collection were efficient (20-30 seconds and 10-12 minutes, respectively). Engagement with the reporting dashboards (proportion of those who viewed their dashboard) varied by user group: 197 (71.1%) hospital administrators, 68 (52.7%) project stakeholders, 177 (45.3%) surgeons and 1138 (12.9%). Cost analysis determined an overall cost per patient of AUD7 - AUD15 (approximately USD5 - USD12) for two PROMs collections per joint replacement procedure once the program was established.

Conclusions:

Successful implementation of an orthopaedic PROMs program with planned scalability for a broader national rollout requires significant funding and staffing resources. However, this expenditure can be considered worthwhile, given that collection and reporting of PROMs can drive healthcare improvement processes. Further consideration of strategies to improve stakeholder engagement with electronic reporting dashboards (particularly for patients and surgeons) will be critical to the ongoing success of a national PROMs program.