背景:全球重视将关节置换手术的数据收集范围扩大到植入物属性和翻修手术。从患者的角度来看,患者报告的结果指标(PROM)越来越被认为是手术结果的重要指标。然而,妨碍在国家数据收集中更广泛地使用PROMs数据的一个主要限制是无法以全面和财务可持续的方式系统地收集和与相关利益攸关方共享电子信息。
目的:本研究报告了国家注册局开发的电子数据采集和报告系统,用于收集PROM,以及用于识别和克服实施和采用障碍的过程。该研究还旨在提供建立和维护全国电子PROM计划的成本细分。
方法:在2018年至2020年之间,成立了3个治理和咨询委员会,以制定和实施嵌套在全国联合替换注册表中的PROM试点计划。该程序包括术前电子收集和术后6个月的髋关节数据,膝盖,或来自44家澳大利亚医院的肩部置换手术。该计划的资源需求包括项目经理,软件开发人员,数据管理器,统计学家。测试了一个在线平台,精致,并为电子PROM收集实施,具有可扩展性,可考虑将来扩展到所有澳大利亚医院和其他数据字段。技术能力包括多种用户类型的不同访问权限,患者登记,通过短信和电子邮件自动提醒,网上同意,和患者结果实时仪表板可供不同用户组访问(外科医生、病人,医院,和项目利益相关者)。
结果:在PROM试点期间,电子系统中进行了19,699个主要程序,其中10,204个注册程序。这相当于在此期间参与医院进行关节置换的51.80%。患者登记和数据收集效率很高(20-30秒和10-12分钟,分别)。报告仪表板的参与度(占查看仪表板的比例)因用户组而异:197/277(71.1%)医院管理员,68/129(52.7%)项目干系人,177/391(45.3%)外科医生,1138/8840例(12.9%)。一旦程序建立,成本分析确定每位患者的总费用为7-15澳元(约5-12美元),每次关节置换程序收集2个PROM。
结论:成功实施具有计划可扩展性的骨科PROM计划,以实现更广泛的国家推广,需要大量资金和人力资源。然而,这笔支出可以被认为是值得的,鉴于PROM的收集和报告可以推动医疗保健改进进程。进一步考虑改善利益相关者与电子报告仪表板(特别是对于患者和外科医生)的互动策略对于国家PROM计划的持续成功至关重要。
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: This study reports 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. The study also aims to provide a cost breakdown of establishing and maintaining a nationwide electronic PROMs program.
METHODS: Between 2018 and 2020, 3 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 preoperative and 6-month postoperative 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 text messages 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 19,699 primary procedures undertaken with 10,204 registered procedures in the electronic system. This equated to 51.80% 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 (as a proportion of those who viewed their dashboard) varied by user group: 197/277 (71.1%) hospital administrators, 68/129 (52.7%) project stakeholders, 177/391 (45.3%) surgeons, and 1138/8840 patients (12.9%). Cost analysis determined an overall cost per patient of Aus $7-15 (approximately US $5-12) for 2 PROMs collections per joint replacement procedure once the program was established.
CONCLUSIONS: Successful implementation of an orthopedic 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 health care 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.