Ghoshal Soham, Harary Joyce, Jay Jean Flanagan, Al-Nassir Zaid, Chen Antonia F
Harvard Medical School, Boston, Massachusetts; Brigham and Women's Hospital, Department of Orthopaedic Surgery, Boston, Massachusetts.
Force Therapeutics, New York, New York.
J Arthroplasty. 2025 Jun;40(6):1452-1459. doi: 10.1016/j.arth.2024.11.044. Epub 2024 Nov 23.
Patient-reported outcome measures (PROMs) are important markers of postsurgical outcomes following total joint arthroplasty (TJA). Recent policies by the Centers for Medicare & Medicaid Services will require hospitals to achieve at least 50% postoperative PROM collection rates in order to qualify for their full annual payment in fiscal year 2028. This study aimed to: (1) quantify provider PROMs collection rates for TJA patients; (2) compare mean improvements in postoperative PROMs in TJA patients; (3) identify the proportion of TJA patients achieving substantial clinical benefit (SCB); and (4) identify factors associated with TJA patient completion of matched PROMs and achievement of SCB at one year.
This retrospective cohort study included 1,493 primary total hip arthroplasty (THA) and 2,959 primary total knee arthroplasty (TKA) patients who underwent surgery at a single institution from May 2019 to December 2023. The primary outcomes were 1-year paired hip or knee PROM collection, measured by the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement and Hip Disability and Osteoarthritis Outcome Score for Joint Replacement surveys, and SCB achievement rates (22 for Hip Disability and Osteoarthritis Outcome Score for Joint Replacement and 20 for Knee Injury and Osteoarthritis Outcome Score for Joint Replacement). Secondary outcomes involved identifying factors associated with PROM completion and SCB achievement. Statistical analyses included descriptive statistics, t-tests, and logistic regression analysis.
There were 61.2% of THA patients and 61.1% of TKA patients who completed 1-year paired PROMs, with 72.8% of THA and 53.3% of TKA patients achieving SCB. Factors associated with higher PROMs completion included technology use (PROMs application, text reminders). For TJA patients, a lower preoperative PROM was associated with achievement of SCB at one year. For THA patients, lower body mass index was associated with SCB attainment. For TKA patients, men were significantly associated with SCB attainment.
The study indicates compliance with the 50% PROM collection requirement, but this required significant allocation of resources, including the use of a digital care platform. Substantial clinical benefit was achieved in 72.8% of THA patients but only 53.3% of TKA patients at one year, and this was associated with certain patient demographic factors. Achieving compliance with the Centers for Medicare & Medicaid Services requirement may be difficult for many providers and institutions.
患者报告结局测量指标（PROMs）是全关节置换术（TJA）术后结局的重要指标。医疗保险和医疗补助服务中心最近的政策要求医院术后PROMs收集率至少达到50%，以便在2028财年获得全额年度付款。本研究旨在：（1）量化TJA患者的医疗服务提供者PROMs收集率；（2）比较TJA患者术后PROMs的平均改善情况；（3）确定实现显著临床获益（SCB）的TJA患者比例；（4）确定与TJA患者完成匹配的PROMs以及在1年内实现SCB相关的因素。
这项回顾性队列研究纳入了2019年5月至2023年12月在单一机构接受手术的1493例初次全髋关节置换术（THA）患者和2959例初次全膝关节置换术（TKA）患者。主要结局指标为1年配对髋部或膝部PROMs收集情况，通过关节置换的膝关节损伤和骨关节炎结局评分以及关节置换的髋部残疾和骨关节炎结局评分进行测量，以及SCB达成率（关节置换的髋部残疾和骨关节炎结局评分为22分，关节置换的膝关节损伤和骨关节炎结局评分为20分）。次要结局包括确定与PROMs完成和SCB达成相关的因素。统计分析包括描述性统计、t检验和逻辑回归分析。
61.2%的THA患者和61.1%的TKA患者完成了1年配对PROMs，72.8%的THA患者和53.3%的TKA患者实现了SCB。与更高的PROMs完成率相关的因素包括技术使用（PROMs应用程序、短信提醒）。对于TJA患者，术前PROM较低与1年内实现SCB相关。对于THA患者，较低的体重指数与实现SCB相关。对于TKA患者，男性与实现SCB显著相关。
该研究表明符合50%的PROMs收集要求，但这需要大量资源分配，包括使用数字护理平台。1年内72.8%的THA患者实现了显著临床获益，但TKA患者仅为53.3%，这与某些患者人口统计学因素有关。许多医疗服务提供者和机构可能难以符合医疗保险和医疗补助服务中心的要求。
