Research News

For the past decade, Cleveland Clinic orthopaedic surgeons have been collecting patient-reported outcome measures, or PROMs, to act as “partners in care.” Using these responses, they have built Cleveland Clinic’s Orthopaedic Outcome Measurement and Evaluation (OME) program.

By asking patients to answer validated questions before and after surgeries, the OME enables individual surgeons and hospital systems to prospectively examine why outcomes might have differed and make changes as needed. This also shapes how patients choose where they go for care and how outcomes improve over time.

Kurt Spindler, MD, Associate Chief, Clinical Research, and Joseph Iannotti, MD, PhD, Chief Research and Academic Officer of Cleveland Clinic Florida, recounted the origins of and shared growth plans for the OME Program.

Building a system that became the standard of care

When Dr. Iannotti became the chair of orthopaedic surgery in 1999, his strategic plan included the systematic collection of patient-reported clinical and outcome data. These data points were first collected on paper, and one-year follow-up outreach required multiple patient service representatives to call patients. It was difficult to get the system scaled and consistent and ensure the right patient got the right questionnaire at the right time.

“The true innovation to the OME Program happened when Dr. Spindler joined Cleveland Clinic,” says Dr. Iannotti. “Not only did he bring experience collecting PROMs around ACL surgeries through the Multicenter Orthopaedic Outcomes Network (MOON) and a grant funded by the National Institutes of Health, he implemented strategies to create a scalable system. We also improved surgeon participation by stressing accountability. Everyone realized that this data collection was part of the department’s mission and direction.”

Improving that system involved incorporating technology in multiple places in the patient’s journey. Now, patients respond to PROMs questions before their procedure on tablets; data capture tools collect responses that can be viewed and sorted. In addition, a dedicated team of research assistants still follow up by phone one year after surgery. PROMs are also captured before surgery and a year later through patients’ MyChart portals, along with other electronic tools.

Through the eyes of the patient

The OME Program, which includes PROMs from more than 150,000 patients and more than 1 million data points, does more than show surgeons and hospital systems statistics around volume, procedure cost and outcome trends. The information prospectively collected can then be applied to individual patients to help with surgical decision making.

Drs. Spindler and Iannotti believe it illustrates orthopaedic surgery and recovery through the eyes of the patient. By collecting information early on about pain level and modifiable risk factors and measuring activity level and improvement one year after surgery, data points around patients’ lived experiences are used to help improve future outcomes.

“The process of improving outcomes for the next set of patients is all about looking at variations—not only what those variations are, but why they exist,” says Dr. Iannotti. If a variation across surgeon outcomes is identified, the PROMs in the OME database are one resource for determining what that surgeon might be doing differently. Other variation factors could be related to the patient or their treatment.

Both individually and as groups, surgeons regularly review the outcomes data from patient PROMs. The reviews prompt conversation and enhance accountability to ensure that everyone is upholding the objective for Cleveland Clinic to be the best place for care.

Ahead of the curve for making PROMs useful

Data collection for the OME has expanded to include Cleveland Clinic sites in Florida and London. More clinical departments across the enterprise are showing interest in collecting their own PROMs. Outcomes-based evaluation and rankings are becoming more of a norm for payors and rating organizations, which is also prompting others to investigate implementing standardized PROMs.

Most importantly, PROMs help to shape evidence-backed answers to patients who ask, “Where should I go for care?” When it comes to orthopaedic surgery, they want to know who has the best outcomes. And thanks to those ten years of collected PROMs, patients who choose Cleveland Clinic can easily receive personalized recommendations and outcome predictions—while also contributing their own outcome measures along the way.

“Cleveland Clinic analyzes these PROMs at so many intricate levels to ensure optimal surgeon performance and positive patient outcomes,” Dr. Spindler says. “This is the system of care every patient should be in. Why would you go anywhere else?”