Analysis of Patient Comments on Patient-Reported Outcome Measures in Orthopaedic Trauma

Background Patient-reported outcome measures (PROM) surveys are being increasingly utilized in orthopaedic trauma. However, the current validated outcome tools generally do not permit individualized patient narrative responses. With the implementation of a new electronic PROM program that allowed for additional comments, we sought to determine the comment rate on PROM surveys and to define the most common themes discussed by patients. Methods A prospectively collected orthopaedic trauma registry from a single metropolitan Level I trauma center from January 2018 to April 2020 was retrospectively reviewed for PROM data. Validated general and injury specific PROM surveys were sent to patients electronically at six weeks, three months, six months, one year and two years post-operatively. Patients were able to leave comments following the multiple-choice questions. These comments were categorized into groups based on their content. Results Out of 3068 completed PROM surveys, 1112 (36%) had additional comments. There was no statistically significant difference in age, gender, or PROMIS-10 scores between the group who left comments on completed PROMs and those who did not. A total of nine themes were identified including: positive communication, negative communication, empathy, pain management, positive functional outcome, negative functional outcome, appreciation for care, survey suggestions, and neutral comments. There were more positive comments (57%) than negative comments (35%). Eight percent of the comments had neither a positive nor negative theme. The most common themes were related to interactions with the surgical team and communication (68%). Only 14% of comments were related to functional outcome. Following the dissemination of these findings in our department, we observed a 2.5% increase in satisfaction rating in the proceeding three-month period. Conclusions More than one-third of the patients that completed PROM surveys provided additional comments regarding their care. Analysis of patient narrative responses provides valuable information to improve patient-centered, value-based care.