The AO patient outcome measurement initiative has been launched by AOPOC US Inc., and funded by the AO Foundation and AO North America. The project was initiated to create a software platform that a typical orthopedic surgeon could use to collect scientifically-validated patient reported outcome measures to help improve clinical care. The project team included multiple surgeons from different subspecialties as well as National Institute of Health (NIH) researchers from Northwestern University.
AOPOC builds on outcome measures and computer adaptive tests created by the NIH PROMIS (Patient Reported Outcomes Measurement Information System®) and allows patients to respond to questions on any internet connected device with a web browser. Computer adaptive tests make it possible to collect very accurate information in just a few questions. Patient data is stored securely in electronic form and can be shared graphically with patients at any time to help them better understand their recovery.
AOPOC has been developed specifically to support US Orthopedic surgeons’ efforts, with particular emphasis on single-provider or small practices. The AOPOC system does not depend on any other electronic systems, and instead delivers a comprehensive patient-reported outcome data collection system that is ready to use with very little configuration.
AOPOC is a stand-alone, web-based SaaS (software-as-a-service) application used by clinicians and researchers to collect patient- and physician-reported data. The platform allows flexible, surgeon-driven collection of standard, validated measures. It is a low-cost solution to a gap in patient data that many surgeons are currently looking to fill.
AOPOC can be used on any device with an internet connection and a web browser installed (i.e. a computer or tablet). A registration/license fee is required to use the system, as well as the cost of the computer or tablet used to administer the assessments.
The user starts by choosing measures from an ever-expanding list, and combining them into an assessment (or battery) that will be given to specified patients at every clinical encounter. The provider can register a patient into the system ahead of a visit, or on-the-fly when a patient arrives. During the clinical encounter, the patient completes the short group of measures while in the waiting room or in the exam room. Depending on the number of measures the provider decides to include, data collection time could be as little as under 2 minutes. After the patient completes the assessment, the provider may choose to enter data specific to that patient’s injury or surgery. The data entered is immediately available through AOPOC, in a graphical form, for review by the provider, potentially with the patient, to spur discussion. The process repeats for every clinical encounter, if desired by the provider. See Figure 1 for a graphical representation of the AOPOC Clinic Workflow.
This data can be used for many purposes, at the discretion of the provider and is owned by the entity, in full.
The system can be used by any professional or support staff in the clinical setting, as authorized by the contracted provider. The provider has full control over adding accounts, deleting accounts and modifying permissions within each of the accounts.
Currently, AOPOC is intended for use in a clinic, on a clinic-owned device, where a provider or support staff can log into the system and set-up an assessment for a patient; a patient cannot complete the assessment on his/her own device, or from home, although this may be a feature added to the system in the future.
Data can easily and immediately be exported in CSV format, for use in statistical software, or to upload to a larger database. Data aggregation across providers, or within predefined systems (e.g. a statewide orthopaedic association) can be negotiated in concert with the AOPOC business team. Measures are designed to be administered and reported in a standard format, for ease of aggregation of datasets and interpretation of pooled results.
AOPOC instruments and data formats are recognized by qualified PQRS reporting registries as satisfying multiple required measures. PROMIS measures, specifically, are intended to cut across disease and population boundaries, to quickly obtain validated data to satisfy many quality indicators. CMS has put an emphasis on patient-reported data in recent years, and requirements for this type of data collection are predicted to expand every reporting year. The AOPOC product team is committed to staying informed about changes to CMS requirements, and ensuring the compatibility of AOPOC for use in reporting.
The list of instruments available in AOPOC is ever-expanding to accommodate additional disease-specific or newly validated. All instruments are scientifically validated. The system also has the ability to collect data points relevant to the specific practice, such as patient demographic data or patient record number. Generally, AOPOC can handle any standard type of data that a provide may want to collect, and is flexible in this manner.
A unique feature of AOPOC is the inclusion of PROMIS CATs. PROMIS CATs are reliable, valid, precise, quick, psychometrically sound measures, developed using state of the science methodology and modern psychometric theory. Patients are presented with a minimum of 4 items per measure, and a maximum of 12 items. Data collection during the beta phase revealed results similar to other studies using PROMIS CAT measures. Beta patient-participants were presented, on average, 4.49 items when completing the PROMIS Physical Function CAT (n=7965), and 5.01 items when completing the PROMIS Pain Interference CAT (n=7896). Previous research shows that PROMIS items, when computer-administered, can be answered at an average rate of 5-6 items/minute. This results in AOPOC patients completing the standard battery (PROMIS Physical Function and PROMIS Pain Interference) in under 2 minutes.
PROMIS CAT measures, as administered in AOPOC, provide real-time scoring and reporting functionality. Scores reference the US population. No population-specific (e.g. total joint replacement) norms are available at this time, but research is ongoing. AOPOC will benefit from new norms as they are developed.
Scores for PROMIS CATs are displayed graphically and available to the provider immediately following data collection. All scores collected in AOPOC for that patient are displayed on one graph, for easy interpretation of self-reported health over time. The AOPOC report (see Figure 2 for an example) can easily be printed and filed with the patient’s chart, or saved as a file to be uploaded to another system. This workflow is flexible and at the discretion of the individual provider.
To get started using AOPOC in your practice, contact firstname.lastname@example.org (610.249.0388).
For all other inquiries, visit our website at www.aopatientoutcomescenter.com.