This team led the Arthritis care through Shared Knowledge (A.S.K.) research, where over 14,900 patients with knee and hip osteoarthritis completed PROs and a risk assessment before their visit to an orthopedic. In return, patients received a report that summarizes (a) their arthritis symptom severity, (b) a prediction of likely symptom improvement if they chose orthopedic surgery to relieve symptoms, and (c) expert information on non-surgical treatments for their symptoms, including physical therapy, oral medications, and injections in their joint.
This research was funded through a Patient-Centered Outcomes Research Institute (PCORI) Award (IHS-1507-31714). The information presented in this website are solely the responsibility of the author(s) and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute (PCORI), its Board of Governors or Methodology Committee.
We learned several important lessons below:
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Patients and clinicians can successfully define content, presentation, and organization of a report using PROs to summarize symptoms with clinical risk factors, predictions of likely outcomes if the patient elects TJR, and a decision grid of non- surgical treatments.
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Patients are willing and able to complete the PROs and risk assessment in the A.S.K. report, before orthopedic office visits and at intervals following treatment. Over 14,900 patients completed the A.S.K. assessment and a report was generated for use by 36 surgeons at 12 sites. Two-thirds of patients completed the assessment from home; half independently and one-half with staff prompts. The remaining patients completed the assessment in the office with staff support. During COVID, 75% of patients completed the assessment from home.
80% of patients reported PROs at 6 and 12 months after the initial visit; over 90% reported PROs at one of these time points. These methods demonstrate that patients can report longitudinal PROs to monitor symptoms over time.
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Patients and clinicians support use of the A.S.K report. Three publications summarize clinician and patient value in using PROs and the report including improved education, expectation setting, shared decisions, and affirming treatment decisions. They can be accessed using the links below:
Clinician value - Demonstrates that surgeons tailor their use of a PROM-based report with individual patients to achieve a range of aims.
Patient value - Provides insight into patients’ perspectives on how digital PROM data can promote patient-centered care.
Patient value - Reviews patients' acceptability of a personalized web-based decision report for total knee or hip replacementUse of the A.S.K. report among patients is independently (and significantly) associated with improved decision quality. Patients reported improved decision confidence when they used the report. When surgeons consistently used the report with >70% of patients, patient decision quality was improved. However, a minority of patients, especially those with lower educational attainment (less than high school) and Black or African American race and Hispanic ethnicity reported less benefit. Additional research will explore alternative reports to support these patients.
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Use of PROs and the A.S.K. report among patients who chose surgery was associated with better outcomes, including greater post-operative pain relief and gain in function.
