Healthcare Outcomes: A Patient Perspective

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Analysis by Kelly Emrick, MBA, Ph.D.

Healthcare Outcomes: A Patient Perspective

Patient-Reported Outcome Measures: The following is an analysis of patient-reported outcome measures (PROMs) across 4,504 healthcare facilities in the context of total hip arthroplasty (THA) and total knee arthroplasty (TKA) highlights significant disparities in performance. PROMs have emerged as a critical metric for evaluating the quality of care from the patient's perspective, providing insight into postoperative recovery, function, and quality of life. This dataset reflects voluntary and mandatory reporting by facilities, underscoring the importance of transparency and accountability in healthcare quality.

Key Findings: Top 50 Hospitals: The facilities with the highest PROM scores, ranging from 96.8 to 86.1, demonstrate a consistent commitment to high-quality orthopedic care, particularly in THA and TKA procedures. These hospitals, many of which are large academic medical centers or regional health systems, likely have well-established perioperative care protocols, multidisciplinary teams, and robust patient education programs, which contribute to superior patient-reported outcomes. For instance, UPMC Presbyterian Shadyside, with a score of 96.8, represents an exemplar of high-performance care. The consistent performance across similar facilities highlights the correlation between institutional investment in quality improvement initiatives and superior patient outcomes. Factors contributing to these high scores may include rigorous follow-up care, advanced surgical techniques, and effective pain management strategies that address postoperative complications and improve functional recovery.

Bottom 50 Hospitals: On the opposite end of the spectrum, the hospitals with the lowest PROM scores, including several with a score of 0, present a stark contrast in care quality. In many cases, the lack of available data suggests potential issues in data reporting or the absence of comprehensive patient follow-up. These lower-ranked facilities may face systemic challenges, including resource limitations, understaffing, or insufficient postoperative care coordination, leading to suboptimal patient outcomes. Hospitals with scores of 0 may indicate deficiencies in patient engagement, postoperative rehabilitation, or even administrative hurdles in data reporting. The absence of PROM data, particularly for significant surgeries like THA and TKA, raises questions about the underlying care structures and whether these facilities sufficiently address patients' recovery trajectories.

1. Voluntary vs. Mandatory Reporting: A key feature of the dataset is the distinction between voluntary and mandatory reporting. Most facilities in the top 50 engaged in voluntary reporting, suggesting that these hospitals are more invested in maintaining high transparency and patient-centered care standards. By contrast, many of the bottom-ranked hospitals were likely mandated to report outcomes, which might reflect a lack of proactive quality improvement efforts. Voluntary reporting can be a proxy for institutional commitment to continuous improvement and accountability.
2. Data Gaps and Limitations: A significant portion of the dataset reports scores as "Not Available," which could indicate issues in data collection, patient engagement, or reporting protocols. This raises critical questions about the accessibility and consistency of healthcare data across institutions. The lack of reported outcomes from many facilities prevents a comprehensive sector analysis. It highlights the need for more substantial incentives and regulatory frameworks to ensure the widespread adoption of PROMs.
3. Institutional Characteristics and Quality Outcomes: It is essential to consider that higher-score institutions are often larger, urban-based hospitals with greater access to financial and human resources compared to smaller, rural hospitals, which may struggle with fewer resources and more significant operational challenges. This disparity reflects broader structural inequities in the healthcare system that affect the ability of institutions to deliver high-quality care across diverse geographic and socioeconomic populations.

Theoretical Implications: From a theoretical perspective, the findings support the hypothesis that healthcare institutions with more established infrastructure, multidisciplinary collaboration, and patient-centered care protocols are better positioned to deliver superior patient-reported outcomes. This aligns with Donabedian's model of healthcare quality, which emphasizes the triad of structure, process, and outcomes. High-scoring facilities likely have robust "structures" in place (such as well-trained staff and advanced medical technologies), which facilitate "processes" (like coordinated post-surgical care) that lead to better "outcomes" in terms of patient recovery and satisfaction. Furthermore, the disparities between top and bottom-ranked hospitals reveal potential healthcare access and equity gaps. Socioeconomic factors, such as regional disparities in healthcare funding, may contribute to the inability of lower-ranked hospitals to achieve the same levels of quality and patient satisfaction as their higher-ranked counterparts. These findings encourage further exploration of healthcare policy reform, particularly in underserved areas where patient outcomes are critically affected by systemic underfunding and inadequate healthcare infrastructure.

Policy Implications: The prominence of voluntary reporting among high-performing hospitals suggests that policy initiatives should incentivize more hospitals to engage in proactive quality reporting. Expanding mandatory reporting requirements, financial incentives, and support for lower-resourced institutions may enhance transparency and drive improvements across the board. Additionally, most hospitals with "Not Available" scores highlight the need for more stringent data collection and reporting policies. Policy frameworks that standardize PROMs reporting and penalize non-compliance could be implemented to address these gaps, ensuring that patient-reported outcomes become a universal measure of healthcare quality. Here is a list of the top 10 hospitals by facility name and their state based on patient-reported outcomes (PRO) scores for total hip and knee arthroplasty:

1. UPMC Presbyterian Shadyside – Pennsylvania (PA)
2. Reading Hospital – Pennsylvania (PA)
3. Community Hospital East – Indiana (IN)
4. Glenwood Regional Medical Center – Louisiana (LA)
5. UPMC Hamot – Pennsylvania (PA)
6. Community Hospital South, Inc. – Indiana (IN)
7. UF Health Shands Hospital – Florida (FL)
8. UPMC Passavant – Pennsylvania (PA)
9. Avala – Louisiana (LA)
10. Community Hospital of Anderson and Madison County – Indiana (IN)

What are Patient-Reported Outcome Measures (PROMs)? Patient-reported outcome Measures (PROMs) are tools used in healthcare to assess patients' perspectives on their health, quality of life, and functional outcomes following medical interventions. PROMs are questionnaires or surveys that patients complete themselves, providing valuable data on aspects such as pain, physical function, and emotional well-being that may not be captured by traditional clinical outcomes (e.g., complication rates or readmission statistics). In the context of surgeries like total hip arthroplasty (THA) and total knee arthroplasty (TKA), PROMs help quantify the procedure's effectiveness from the patient's point of view. This approach shifts some focus from purely clinical results to patient-centered outcomes, emphasizing the impact of healthcare interventions on everyday activities, recovery experiences, and the patient's overall satisfaction with the care they received. PROMs are widely recognized as a critical component of healthcare quality improvement. They allow healthcare providers and institutions to assess and improve care based on patient feedback, ensuring that medical interventions genuinely enhance patients' lives. ​

References

Medicare dataset of Patient-Reported Outcome Measures (PROMs) for various healthcare facilities, specifically focused on Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA) procedures.