American Association for Hand Surgery

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Which PROMs do Patients Prefer? A Convergent Mixed Methods Analysis
Lauren Michelle Shapiro, MD1, Sara L Eppler, MPH, CHES1, Allison K Roe, MD1, Arden Morris, MD MPH2 and Robin N Kamal, MD1, (1)Stanford University, Redwood City, CA, (2)Stanford University, Palo Alto, CA


Patient-reported outcome measures (PROMs) are used to evaluate quality of care from the patient’s perspective. It is possible that standardized PROMs (e.g. QuickDASH) are inferior in their ability to assess outcomes important to patients when compared to patient-specific PROMs (e.g. Patient Specific Functional Scale) where patient-stated goals are measured longitudinally. We evaluated which PROM (QuickDASH, PSFS) patients preferred and why with a convergent mixed-methods approach.


Materials & Methods:

Patients 18 years undergoing elective hand surgery received the QuickDASH and PSFS pre-operatively and six-weeks post-operatively. Additional questions included: 1) “Which questionnaire better addressed your goals during this clinical experience?” 2) “Please explain why you chose that questionnaire.” Responsiveness was measured by pre- to post-op change in score (analyzed via paired t-test). We analyzed patients’ responses to identify themes in PROM preferences using content analysis. Results from the quantitative and qualitative analyses were combined into a convergent mixed-methods analysis.



25 (65.8%) patients completed all questionnaires. Mean age: 54.8 years (SD18.9), 60% female. Preferences were: 77% PSFS, 14% no preference, 9% QuickDASH. The mean improvement for the QuickDASH (-10.26; SD 20.4) was less than that of the PSFS (-27.24; SD26.2), p=0.0058. Content analysis revealed four themes for preferences of a PROM: survey simplicity, personalized assessment, goal-directed, distinct items.



Most patients felt the PSFS better measured their goals given that it is a simple, personalized, and goal-directed instrument with distinct domains. While standardized PROMs may be better to compare across populations, physicians, or conditions, employing PROMs that address patient-specific goals at point of care may better assess aspects of care most important to patients and improve patient-centered and goal-directed care. A combination of these two types of PROMs may best inform quality of care, such as using standardized PROMs to assess populations and patient-specific PROMs to evaluate individual patient outcomes.




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