My name is Jeff Hunter, and in this presentation, we will be addressing the question of whether patient-reported outcomes that are collected in clinic can be used to predict the need for follow-up visits after surgery. Our team has no disclosures to report that are pertinent to this presentation. Recently, health care reform has had a large focus on patient-centered care and high-value care. Patient-centered care is ensuring that a patient's wishes and desires about their treatment are at the forefront of decisions being made about their health. And high-value care is ensuring that there is a quantifiable outcome tied to their treatment and that that outcome is being maximized at the lowest cost. This is really pertinent when it comes to follow-up visits, because we see in hip and fracture patients that 95% of their follow-up visits do not change their treatment of care. However, if you look at collectively patients, they're twice as likely to be readmitted to the hospital if they are discharged without a follow-up visit. So you can see a wide variety of benefits that can occur depending on how follow-up visits are managed and scheduled. There's not a lot of studies that look at this in foot and ankle patients and how those follow-up visits are optimally managed. That's going to be our focus today. And we'll be quantifying their outcomes by looking at using PROMIS scores, which is a patient-reported outcome that sends patients a series of questions. And then those questions can help assess the patient's health status and their symptoms. PROMIS scores use computer-adapted technology by adjusting the questions that patients receive depending on how they answer the first questions. And they typically have less four to seven questions. So our purpose was to determine how PROMIS scores can be used to monitor post-operative health after foot and ankle surgery, and then to predict the need for additional follow-up visits. For our methods, so we started with over 18,000 patients at the University of Rochester Department of Orthopedics and Rehabilitation. This covered a wide variety of specialties. So we narrowed this down to foot and ankle patients that were adults and had sufficient preoperative and post-operative PROMIS scores. This is a retrospective analysis. When we look at foot and ankle, we then divided those groups into quartiles based off of their preoperative PI PROMIS score. PI is going to be your pain interference, so how pain is interfering with the patient's life. And we broke into the quartiles because we thought that those that had higher preoperative pain scores, they're going to have more room to make up after surgery, and so they would progress differently. And specifically, we were looking at how long it took patients to achieve two consecutive improvements in their PROMIS PI score. And this was quantified with a minimal clinically important difference of a half a standard deviation. So we're saying, how long does it take patients to have two consecutive improvements that are at least a half standard deviation from the mean? And so here are results, and this is first for our foot surgeries. So you can see here on the y-axis the percentage of patients that achieved this mark of two consecutive improvements, and then on the x-axis, how long it took for the patients to achieve that status. So you can see that by right here at about 90 days, about 20% of patients had already achieved two consecutive improvements in their PROMIS PI scores. If you look at ankle surgeries, you see a very similar thing. Again, at 90 days, about 20% of patients have already achieved these two consecutive improvements in their PROMIS scores. And so now that we have this, what we want to know is, well, how many appointments are occurring after this point? Because if there's appointments that are occurring after people are already improving and on a good trend, maybe those appointments aren't necessary, and they're not providing the highest value of care. So when we look at that, we found that for ankle, there's 2.84 visits, and for foot, there was 1.83 visits that were occurring after they achieved the two consecutive improvements. So then we want to know, well, how much are these appointments costing? So we look at reimbursement rates, and for ankle, it's $238, and for foot, it's an average $160 that we estimated. And this is really interesting, because if their patients are coming in and they're already improving, perhaps what we can do is instead of them coming in to the visit, we can offer them the option of completing a PROMIS evaluation at home. We can send them a PROMIS evaluation electronically. They can complete that, and if they're doing well, then they don't need to come into the office. And that's going to be really beneficial, obviously, for the patient, because they are saving money, but it's also going to be valuable to the clinician, because they're now receiving objective information on the progress of their patients. Their patients aren't just saying, I'm doing well, I'm not going to come in the office or canceling. They're actually getting that objective information. And it's also going to be saving the clinician time, because they will be knowing they can spend time with patients that are in more acute situations. And so PROMIS scores, we find that they can be used to identify unnecessary follow-up visits. They can help clinics be more efficient, and it can improve that post-operative experience for patients and clinicians. So thank you so much for your time.

patient-reported outcomes

PROMIS scores

follow-up visits

foot and ankle surgery

high-value care