H. Warwick, C. Hutyra, C. Politzer, A. Francis, T. Risoli, Jr, C. Green, R. C. Mather III, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA N. Verma, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA S. Huettel, Department of Psychology and Neuroscience, Duke University, Durham, NC, USA.
Clin Orthop Relat Res. 2019 Jul;477(7):1648-1656. doi: 10.1097/CORR.0000000000000732.
The generalizability of data derived from patient-reported outcome measures (PROMs) depends largely on the proportion of the relevant population that completes PROM surveys. However, PROM survey responses remain low, despite efforts to increase participation. Social incentives, such as the offer to make a charitable donation on behalf of the survey respondent, have generally not been effective where online surveys are concerned, but this has not been extensively tested in medicine.
QUESTIONS/PURPOSES: (1) Do personalized social incentives increase response rates or response completeness for postoperative PROM surveys in an orthopaedic population? (2) Are there demographic factors associated with response and nonresponse to postoperative PROM surveys? (3) Are some demographic factors associated with increased response to social incentive offers?
Participants were selected from an institutional orthopaedics database. Patients were older than 18 years, had an email address on file, and had undergone one of the following procedures 1 to 2 years ago: Achilles tendon repair, ACL reconstruction, meniscectomy, hip arthroscopy, TKA, or THA. Of 4685 eligible patients, 3000 (64%) were randomly selected for inclusion in the study. Participants were randomized to one of four groups: (1) control: no incentive (n = 750); (2) patient donation: offer of a USD 5 donation to provide medical supplies to a pediatric orthopaedic patient (n = 751); (3) research donation: offer of a USD 5 donation to a procedure-specific research program (n = 749); or (4) explanation: explanation that response supports quality improvement (n = 750). The four groups did not differ regarding patient age, gender, race, procedure type, or time since procedure. All patients were sent an email invitation with the same PROM survey link. The proportion of patients who responded (defined here as the response rate) was measured at 4 weeks and compared between intervention groups. We used a logistic regression analysis to identify demographic factors associated with response while controlling for confounding variables and performed subgroup analyses to determine any demographic factors associated with increased response to social incentives.
There was no difference in the overall response rate (research donation: 49% [353 of 725], patient donation: 45% [333 of 734], control: 45% [322 of 723], explanation: 44% [314 of 719]; p = 0.239) or response completeness (research donation: 89% [315 of 353], patient donation: 90% [301 of 333], control: 89% [287 of 322], explanation: 87% [274 of 314]; p = 0.647) between the four groups. Women (odds ratio [OR], 1.175; p = 0.042), older patients (< 58 years: OR, 1.016 per 1-year increase; p = 0.001; 58-64 years: OR, 1.023 per 1-year increase; p < 0.001; > 64 years: OR, 1.021 per 1-year increase; p < 0.001), and white patients (OR 2.034 compared with black patients, p < 0.001) were slightly more likely to respond, after controlling for potential confounding variables such as gender, age, race, and procedure type. In subgroup analyses, men (research donation: 49% [155 of 316], patient donation: 45% [146 of 328], control: 40% [130 of 325], explanation: 39% [127 of 325]; p = 0.041) and patients younger than 58 years (research donation: 40% [140 of 351], control: 35% [130 of 371], patient donation: 32% [113 of 357], explanation: 27% [93 of 340]; p = 0.004) were slightly more likely to respond to the research donation than those with other interventions were.
Despite small effects in specific subgroups, personalized social incentives did not increase the overall response to postoperative orthopaedic surveys. Novel and targeted strategies will be necessary to reach response thresholds that enable healthcare stakeholders to use PROMs effectively.
Level I, therapeutic study.
患者报告结局测量（PROMs）数据的通用性在很大程度上取决于相关人群中完成 PROM 调查的比例。然而，尽管已经做出了努力来提高参与度，但 PROM 调查的回复率仍然很低。在在线调查中，社会激励措施（例如代表调查对象进行慈善捐赠）通常效果不佳，但在医学领域尚未得到广泛验证。
问题/目的：（1）在骨科人群中，针对术后 PROM 调查的个性化社会激励措施是否会提高回复率或回复完整性？（2）是否存在与术后 PROM 调查的回复和不回复相关的人口统计学因素？（3）某些人口统计学因素是否与对社会激励措施的回复增加相关？
参与者从机构骨科数据库中选择。患者年龄大于 18 岁，有电子邮件地址，并在 1 至 2 年前接受过以下程序之一：跟腱修复、ACL 重建、半月板切除术、髋关节镜检查、TKA 或 THA。在 4685 名合格患者中，随机选择 3000 名（64%）纳入研究。参与者随机分为四组：（1）对照组：无激励（n=750）；（2）患者捐赠：提供 5 美元的捐赠，用于为儿科骨科患者提供医疗用品（n=751）；（3）研究捐赠：提供 5 美元的捐赠，用于特定程序的研究计划（n=749）；或（4）解释：解释说回复支持质量改进（n=750）。四组在患者年龄、性别、种族、手术类型和手术时间方面没有差异。所有患者均收到带有相同 PROM 调查链接的电子邮件邀请。以 4 周时的回复率（定义为回复率）来衡量，并比较干预组之间的差异。我们使用逻辑回归分析来确定与回复相关的人口统计学因素，同时控制混杂变量，并进行亚组分析以确定与对社会激励措施的回复增加相关的任何人口统计学因素。
在总回复率（研究捐赠：49%[725 名中的 353 名]、患者捐赠：45%[734 名中的 333 名]、对照组：45%[723 名中的 322 名]、解释：44%[719 名中的 314 名]；p=0.239）或回复完整性（研究捐赠：89%[353 名中的 315 名]、患者捐赠：90%[333 名中的 301 名]、对照组：89%[322 名中的 287 名]、解释：87%[314 名中的 274 名]；p=0.647）方面，四组之间没有差异。女性（比值比[OR]，1.175；p=0.042）、年龄较大的患者（<58 岁：每增加 1 岁，OR 为 1.016；p=0.001；58-64 岁：每增加 1 岁，OR 为 1.023；p<0.001；>64 岁：每增加 1 岁，OR 为 1.021；p<0.001）和白人患者（与黑人患者相比，OR 为 2.034，p<0.001）在控制性别、年龄、种族和手术类型等潜在混杂变量后，更有可能回复。在亚组分析中，男性（研究捐赠：49%[316 名中的 155 名]、患者捐赠：45%[328 名中的 146 名]、对照组：40%[325 名中的 130 名]、解释：39%[325 名中的 127 名]；p=0.041）和年龄小于 58 岁的患者（研究捐赠：40%[351 名中的 140 名]、对照组：35%[371 名中的 130 名]、患者捐赠：32%[357 名中的 113 名]、解释：27%[340 名中的 93 名]；p=0.004）比其他干预组更有可能对研究捐赠做出回应。
尽管在特定亚组中存在微小影响，但个性化社会激励措施并未提高术后骨科调查的总体回复率。为了达到使医疗保健利益相关者能够有效使用 PROM 的回复率门槛，需要采取新的和有针对性的策略。
一级，治疗性研究。
