Patient Reported Outcomes
Patient Reported Outcomes (PROs) are outcome measures that are directly reported by the patient to help better understand a treatment's efficacy. PROs have been used at many facilities to assist surgeons in evaluating their practices. The ABOS has begun using PROs to assist in the Certification and Recertification processes. Collecting PROs will also contribute to a surgeon’s continual practice improvement.
For the 2019 Part II Oral Examination, Candidates are required, for surgeries performed during the months of April, May, and June 2018 for patients ages 12 and older, to enter each patient’s email address into the ABOS Scribe Case List System, unless the patient opts out. The ABOS will then contact the patient, via email, pre- (or peri-) operatively as well as at six and 12 months post-operatively. The email will link the patient to a PROMIS Physical Function survey. 2019 Part II Candidates can get more detailed information on PROs and how they enter the information, by logging into their password protected portal and clicking on the Part II tab.
Frequently Asked Questions
How will the ABOS use the patient’s email address?
The ABOS will send automated emails to the patient email addresses with a link to the PROMIS Physical Function and Pain (PRO) assessment pre-/peri-operatively and at approximately 6 and 12 months post-operatively. Patients will be sent a reminder email if they do not respond. The email addresses will be kept confidential and will not be used for any purpose other than this ABOS activity.
How will the ABOS use this PRO data?
This PRO information will be reviewed, along with the application, peer review, and the case list by the ABOS to determine a candidate’s eligibility to sit for the Part II Oral Examination. The candidate will also receive PRO survey results obtained from his/her patients to assist with practice improvement efforts.
Will the PROs be used in the Case Selection and Oral Examination process?
PRO survey data may be utilized by Case List Selectors. If a surgical case with PRO data is one of a Candidate’s 12 cases selected for presentation at the Oral Examination, that information will be provided to the Candidate and Examiners as part of the overall case presentation.
What if the patient declines to provide his or her email address or does not want to participate?
The ABOS understands that not all patients may wish to participate in the survey. If a patient tells you or your office staff that he or she does not want to participate, do not provide the patient’s email address and check the “Patient opts out” box. A patient who declines to provide his or her email address will not be sent a survey. Please inform your patients that their email address will not be shared, sold, or used for any purpose other than this ABOS activity. The ABOS considers patient input to be valuable and expects that you will encourage your patients to participate in this important activity. A Candidate with a significant number of “patient opt outs” may be reviewed by the Credentials Committee for eligibility to sit for the examination.
What if the patient fails to respond to the survey?
Those patients for whom we receive a valid email address and do not respond to the initial request will receive a follow-up email request. If there is no response to the second request, the ABOS will make no further contact. A Candidate with a significant number of non-responses may be reviewed by the Credentials Committee for eligibility to sit for the examination.
Is it possible to see what a PROMIS survey looks like?
The questions can vary depending on how the patient responds. However, you can register yourself as a patient to see what the survey looks like. Just remember to delete this case before finalizing your case list.
Do patients see their results?
No, patients do not see their results.
Will surgeons know which patients have completed a survey?
No, surgeons will not know which patients have completed a PRO assessment until the aggregate surgeon specific report is provided to the Candidate by the ABOS after the PRO follow-up data have been collected.
Can a staff member enter the patient's information?
Yes, there is a separate login for patient registration for the PRO, and a Candidate's staff member can enter the required information.
How do I know whether a staff member has entered all of the patients?
The Candidate can access Scribe from the password-protected portal at www.abos.org and will see which patients have been registered through the PRO registration page. It is the responsibility of the surgeon to provide oversight of his/her staff on this process.
How can I fix an email addresses that was submitted but we later learned was incorrect?
Log in at www.abos.org and click on the Part II tab. Click on the Scribe button and then find the record that was added with an incorrect email address. Delete that record. Login to the Patient PRO Registration Page using the Login information provided on your Part II tab. Register the patient with the correct email address, and the PRO survey will be sent to the correct address.
What happens if a patient’s surgery date changes? Will they receive another email?
On or after the new date of surgery, log in at www.abos.org and click on the Part II tab. Click on the Scribe button, and then find the patient and change the date of surgery. If the new surgery date is still within April-June, the patient is enrolled in PRO collection. If the new surgery date is after June, the patient will no longer enrolled in PRO collection. All patients receive up to two preoperative/perioperative emails: one on patient registration and another reminder if they haven’t completed it. Changing the date from April/May/June to another date in April/May/June in Scribe has no effect on PRO collection. Changing the date to something other than April/May/June will prevent the reminder from going out if it hasn’t already.
What happens if the surgery is canceled and not rescheduled?
Log in at www.abos.org. Click the Part II tab and then Scribe. Once in Scribe, click the Edit Case tab at the top and click on the case number to be deleted. Once in that case, click on “Delete This Case.” That patient will no longer be enrolled in PROs but may get up to one more additional email.
How do I enter a medical record number if it hasn’t been assigned yet by the hospital?
If you cannot obtain a medical record number from your hospital, use one assigned by your office. Then, once it has been assigned by the hospital, change it in Scribe.
Does this program involve ABOS Diplomates in the ABOS Recertification process?
No. This program is only for ABOS Part II Oral Examination Candidates.
Are there patient privacy or HIPAA issues?
Patients must consent to the submission of their email address. In addition, the use of patient emails for the PRO (PROMIS) survey is permissible as part of certification, licensing, and credentialing “health care” activities under HIPAA. This information, as well as survey responses, will be covered by the same business associate agreement that covers all of the patient identifiable information collected by the ABOS in support of ABOS Board Certification and Maintenance of Certification programs.
Will the Case List entry process be more difficult?
Outcome data have been a part of the Case List required elements for many years. This PRO assessment is an improvement in the collection of these data. This process should not add significant burden. Staff may submit the patient’s email address on the Scribe system at the time surgery is scheduled. The patients will submit their survey responses directly. The process takes the patient 1-2 minutes to complete. Other aspects of the Case List have been streamlined and several data points that were previously collected have been removed. We are committed to streamlining the process of Case List selection and entry.
What is the value to the Candidate?
This program will allow many candidates the opportunity to participate in a national, specialty-focused, computerized adaptive, Patient Reported Outcome program which is patient-centric and with very low patient burden. The physician-specific aggregate data provided by the patients will be available to the surgeon for self-regulated quality improvement. If an institution has a PRO program in place, the institution’s PRO program data may be an acceptable substitute for the ABOS in the future. In addition, the ABOS and ABMS are working with CMS to investigate the possibility that this participation would qualify for credit in the MACRA program.
Is the questionnaire only available in English?
Yes, the questionnaire is only available in English. If your patient does not understand English, please opt him or her out.
What if a patient has a second surgery? Do I enter the patient's email address twice?
For patients undergoing multiple operations during the PRO collection period, we would prefer that you enter the patient email address for each operation so that the patient may self-report physical function and pain prior to each surgery, but please use your best judgment to balance this goal with the burden on your patient. As a guide, if a patient undergoes a subsequent surgery four weeks or more after the prior surgery, it would be reasonable to enter the email address for the second surgery in order to obtain an updated PRO; if the patient undergoes a subsequent surgery fewer than four weeks after the prior surgery and the patient’s email was entered for the prior surgery, it would be reasonable to opt out the patient from completing an updated PRO in order to reduce patient burden.
What does the email to patients say?
On behalf of your orthopaedic surgeon, Dr. xxx, please click the link below to answer a few standard questions about how you are doing.
The American Board of Orthopaedic Surgery
400 Silver Cedar Court
Chapel Hill, North Carolina 27514