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+++++++++++++++++++++++++++++++++++++++ + +++ + oRTHoPAEDICS SPECIAL SECTIoN +++ +++++++++++++++++++++++++++++++++++++++ Patient-Reported Outcome Registries Will assess Whether Patient health Is Improving by Steve fening, phD, and eric miller, mD T H E ROLE Of patients in the healthcare decision-making process for themselves and their families will become more prominent during the next decade as health care continues to evolve. Physicians typically care about choosing the right treatment, delivering the treatment well and preventing complications. Patients have their own priorities, which are often very different and more personal in nature. Often, the issues they focus on are: When can I return to work? Will I be able to return to my previous level of activity? Will I have pain? Until now, public and private organizations attempting to assess outcomes through clinical trials have mostly relied on measures of avoidable readmissions, hospital-acquired infections and mortality. They have also turned to objective measures of improvement. On the other hand, patients' views of their health status have rarely been sought outside of clinical trials.1 The term "patient-reported outcomes" has been successfully proposed for instruments measuring perceived health outcomes, but its relationship to current conceptual models remains to be established.2 Patient-reported outcomes are defined as "any report of the status of a patient's (or person's) health condition, health behavior or experience with health care that comes directly from the patient, 24 | Cleveland/Akron/Canton MD News ■ MDNEWS.COM without interpretation of the patient's response by a clinician or anyone else."3 The U.S. Department of Health and Human Services' Health Resources and Services Administration recognizes the importance of patient-reported outcomes. It has allocated grant funding to develop patient-reported outcomes registries for orthopaedic trauma patients. Trauma was chosen for the project because the high level of care in this specialty requires a customized approach delivered by a team of physicians committed to the care of the injured patient. At every visit, patients will fill out instruments that assess quality of life, activity level, pain and joint/area-specific metrics. While still in the implementation stage, the registry promises to immediately improve care by making patients partners in the administration of their own health care — both in the delivery and measurement of results. Data collected will be matched with traditional registry data including diagnosis, procedures, complications and readmissions. In coming years, patient-reported measures are expected to play a more prominent role in assessing performance and determining the comparative effectiveness of different treatments, in part because of a growing emphasis on patient-centered care and value-based payment approaches. By 2015, for example, healthcare providers participating in accountable care organizations will have to provide evidence that the care they've delivered produced value for the patient — as reported by the patient.4 By accessing this registry, physicians, scientists and researchers will have the ability to evaluate how current and novel treatments impact patients, providing improved care for the patients of tomorrow. Establishing this database will allow for the opportunity to track how well treatments are helping patients. Additionally, the information can be used to improve existing care for orthopaedic trauma patients. References 1 Using Patient-Reported Outcomes to Improve Health Care Quality, Quality Matters, Commonwealth Fund. Dec. 2012/Jan. 2013. 2 Valderas J.M., Alonso J. Patient reported outcome measures: a model-based classification system for research and clinical practice. Qual Life Res (2008) 17:1125–1135. 3 Patient-Reported Outcomes in Performance Measurement, National Quality Forum, Dec. 2012. 4 Using Patient-Reported Outcomes to Improve Health Care Quality, Quality Matters, Commonwealth Fund. Dec. 2012/Jan. 2013. Steve Fening, PhD, is the Director of Research and Innovation for the Department of Orthopaedics at Summa Health System. Eric Miller, MD, is an orthopaedic surgeon specializing in orthopaedic trauma with Summa Physicians Inc. – Orthopaedics/ Sports Medicine. ■

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