Patient-reported outcome measures carry a degree of weight in spine surgeons’ decisionmaking, but they’re only part of a fuller story.
Four spine surgeons discuss where PROMs play a factor in their work.
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Question: How are you using patient-reported outcome measures in real time, and have they ever changed a clinical decision you had already made?
Philip Louie, MD. Virginia Mason Franciscan Health (Seattle): We have shifted toward fewer, sharper PROMs at decision-relevant timepoints. Two metrics carry the most weight: expectations-outcomes mismatch and willingness to undergo the procedure again. These often tell us more about a patient’s true result than composite functional scores. The harder challenge is balancing meaningful data collection with survey fatigue. As we all know, quality drops with more survey requests.
We try to periodically review these outcomes to see if there are any changes that we need to make on a larger scale, rather than on an individual basis. Knowing that we also cannot just apply large population data to individual situations broadly.
Noam Stadlan, MD. Endeavor Health Neurosciences Institute (Skokie and Highland Park, Ill.): I think that patient-reported outcome measures are very important for research, especially outcome research. However, they are inherently insensitive to nuance. Therefore, while they may be useful to alert the clinician to a potential issue, they are not a substitute for an in-depth personal discussion and examination by the physician.
Vijay Yanamadala, MD. Hartford (Conn.) HealthCare: We collect PROMs routinely: PROMIS, ODI, NRS pain scores, and disease-specific measures depending on the pathology. For most of my career, those data lived in a dashboard that I reviewed in aggregate, for quality reporting purposes. The shift came when I started reviewing them at the point of care and pulling up a patient’s trajectory before I walked into the room.
I had a patient I was planning to take to the operating room for a revision decompression. Clinically, she seemed to be deteriorating, and her complaints in the office were escalating. But her PROMIS scores over the prior three visits showed a modest but consistent improvement in function. The pain was still high, and function was trending up.
We talked longer than I’d planned. I learned that she was going through a significant personal stressor that she hadn’t mentioned in prior visits. Her functional gains were real; her pain reporting was amplified by anxiety. We deferred surgery, connected her with support resources, and six weeks later she was meaningfully better without an operation.
The PROM didn’t make the decision. But it created a question I wouldn’t have asked. That’s the honest value of real-time outcome data. It’s not as a replacement for clinical judgment, but a prompt to interrogate your own assumptions before you act on them.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): In recent times, the Patient Reported Outcome Measures (PROM) dovetailed into Patient Engagement tools, and both are utilized by participating health systems as a ‘Patient Experience’ metric. Regionally, there are for-profit institutions that obviate patient outcomes reporting for reasons that remain unexplained. For better or worse, these teachable moments that are gleaned from concept engagement, minimize opportunities for awareness and improvement. Even this old soldier is capable of adjustment, as contracted consulting groups meet with our entire practice annually to discuss improvement opportunities in documentation, through-put, coding immensity, and efficiencies are based on tertiary internal reviews.
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