Grogan Moore Meredith L, Jayakumar Prakash, Laverty David, Hill Austin D, Koenig Karl M
Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, TX.
J Orthop Trauma. 2019 Nov;33 Suppl 7:S38-S42. doi: 10.1097/BOT.0000000000001612.
The rise of patient-reported outcome (PRO) measurement across medicine has been swift and now extends to the world of orthopedic trauma. However, PRO measures (PROMs) applied to trauma patients pose special considerations; measuring "episodes of care" is less straightforward, injuries are heterogeneous in their severity, and the patient's initial visit is "postinjury." Obtaining baseline scores and assessing the impact of a traumatic event on mental health are key considerations. Currently, few, if any, trauma registries include PROs; though general and condition-specific PROMs plus the patient empowerment measure of Patient Activation represent meaningful inputs for the clinical decision-making process. To be useful in trauma care, PROMs should be psychometrically sound and validated, be used for capturing function, screen for mental state and substance use, and give the clinician a sense of the patient's "activation" (engagement in their own health). Although the implementation of routine PRO collection can seem daunting, clinicians can use a multitude of electronic resources to access validated measures and simplify the implementation process. Computer-adaptive testing has evolved to help minimize patient burden, and PROM collection must maximize efficiency. Once established as part of your practice, PROs become an important tool to track recovery, identify mental health issues, engage in the prevention of future injury, and enable care of the whole patient.
患者报告结局（PRO）测量在整个医学领域的兴起迅速，如今已扩展到骨科创伤领域。然而，应用于创伤患者的PRO测量（PROMs）存在特殊考量；测量“护理过程”并非那么直接，损伤的严重程度各不相同，且患者的初次就诊是“受伤后”。获取基线分数以及评估创伤事件对心理健康的影响是关键考量因素。目前，即便有创伤登记处，也很少纳入PROs；不过，一般的和特定疾病的PROMs以及患者激活这一患者赋权措施对临床决策过程而言是有意义的输入信息。为在创伤护理中发挥作用，PROMs应在心理测量学上合理且经过验证，用于获取功能状况、筛查精神状态和物质使用情况，并让临床医生了解患者的“激活”（参与自身健康管理）情况。尽管常规收集PROs的实施看似令人生畏，但临床医生可以利用多种电子资源来获取经过验证的测量方法并简化实施过程。计算机自适应测试已发展起来以帮助尽量减轻患者负担，且PROM收集必须实现效率最大化。一旦将PROs确立为医疗实践一部分，它们就会成为跟踪康复情况、识别心理健康问题、预防未来损伤以及实现对患者全面护理的重要工具。
