Patient-Reported Outcome Measures (PROMs): Orthopedic (Hip & Knee)

Patient-Reported Outcome Measures (PROMs) refer to any report on the status of a patient's health condition that comes directly from the patient, without interpretation by a health care provider or anyone else.

The Patient-Reported Outcomes Program improves quality of life for patients and their families by integrating the collection of patient-reported outcomes into routine clinical care. This helps patients be more involved in their own care by systematically reporting their symptoms in real time. Health care teams can then provide care at the right time to help manage those symptoms.

We are partnering with the Ministry of Health to collect patient-reported outcomes through short surveys from people having elective hip or knee replacement (orthopedic) surgery.

Purpose

• To measure and collect data on the pain, functional status and overall quality of life of individuals undergoing hip and knee replacement surgery
• To use collected data to assess surgical outcomes in accordance with the Quality-Based Procedure for orthopedic patients, as overseen by the Ministry of Health
• Provide data to the Canadian Institute for Health Information to conduct comparative reporting of provincial, national and international outcomes

PROMs take about five minutes to complete.

• PROMs complement existing clinical tools and give patients a chance to tell their care providers how they are doing
• patient answers allow care providers to track a patient’s progress over time and can be actively used during the patient’s clinic visit

• Pre-surgical assessment (within two months before surgery)
• One-year post-operative assessment (within nine to 15 months post-surgery)

Collection at the Rapid Assess Clinic (RAC) is optional.

PROMs can be completed in several languages electronically and on paper. Connect with the clinic staff to get PROMs on paper.

The electronic platform, called ISAAC, is available on tablets and kiosks at hospitals across Ontario. Once the patient is registered in ISAAC by the clinic staff, the patient can complete PROMs at clinic visits or online from anywhere, including home by following these steps:

1. Using any electronic device that has internet access – such as desktop computer, laptop, tablet, iPad or smartphone – go to https://promsortho.ontariohealth.ca.
2. Enter your Health Card Number (no letters, no spaces) OR Medical Record Number (MRN).
3. Answer the questions.

All of the questions must be answered. Each question must be answered to get to the next one, and skipping ahead is not possible.

To change an answer, click the ‘Back’ button at any time to correct a response. Submitted answers cannot be changed, but the registration desk staff at the clinic can support with changes after answers are submitted.

• Include the URL and date required for completion in a patient’s appointment card.
• At the patient’s first visit, ask for their consent to send reminders by email.
• Call the patient to remind them.
• Mail a paper copy to the patient.

Clinic staff can show patients how to use the tablet, kiosk or personal devices at the clinic. Patients are encouraged to talk to a member of their health care team if they would like to see or change their past symptom scores.

Information collected includes:

• patient’s joint and laterality of focus
• three types of patient-reported outcome measures
  • Oxford Hip Score
  • Oxford Knee Score
  • EQ-5D-5L
• patient’s general health information
• patient’s satisfaction with care

Patients are not required to complete PROMs, but sites are required to offer them the opportunity to do so at each of the specified times. If a patient refuses to participate, this is no fault of the clinical team. The patient can proceed with their clinic visit without completing the patient reported measures.

There is no centrally reported response rate indicator linked to funding. Clinics or hospitals will not be penalized for patient refusals.

ISAAC (Integrated Symptom Assessment and Collection) is a secure web-based electronic platform used to collect PROMs responses.

• The hospital’s information technology super users, clinicians and other staff directly involved in clinic flow or patient care should have access to response data.
• Access to patient-level information is granted according to a Local Registration Authority (LRA) model, as outlined in the Service License Agreement. The LRA will grant a login user account to ISAAC administrators, who will, in turn, grant access to real-time patient-level PROMs data.

• To request access, health care providers can contact their facility’s designated Local Registration Authority (LRA), appointed by the facility’s legally responsible person.
• The LRA is responsible for performing user identity checks, completing and submitting the ISAAC User Registration Form to the ISAAC mailbox.
• Our service desk will process the submitted registration form after the ISAAC team confirms that it is complete. The access control team will then create the accounts and provide each new user with a security pin to access the ISAAC administrator portal.
• If you have questions about the request process or need help to identify your facility’s LRA, please email using our contact form.

• The patient should contact the hospital registration desk to withdraw from ISAAC. The hospital’s ISAAC administrator(s) can notify the ISAAC product team by email.
• The ISAAC product team will remove all requested data and records in the ISAAC system and return the data back to the ISAAC site (hospital) where the data originated. The data will be retained in accordance with the hospital’s records retention policy.

In ISAAC, each clinic is identified as either an oncology site or an orthopedics site. An ISAAC administrator can only access data for patients registered under their particular site (for example, oncology). They do not have access to patient data from another clinic site (for example, orthopedics) or hospital.

We use an anonymous version of the information to report to the Ministry of Health about patient-reported outcome trends. Patient information is combined with the information of other patients treated in the clinic to see if there are any trends and for the purpose of quality control and provincial reporting.

If an individual has completed the electronic survey on ISAAC and no longer wants to share their personal health information and previous responses, the hospital can remove their information from the ISAAC system. The hospital may keep a copy of their information according to their hospital’s policy. Please contact the hospital registration desk for more information.

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