April 9, 2018
“I am interested in the patient’s experience. I want them to understand why we are doing surgery, and I want to meet their expectations during recovery.” - Brian Neuman
Brian Neuman, assistant professor of orthopaedic surgery, has taken a new, innovative approach to The Johns Hopkins Hospital’s primary mission: to improve the health of the community and set the standard of excellence in patient care.
Neuman aims to fine-tune the use of the Patient-Reported Outcomes Measurement Information System (PROMIS) for patients who have undergone spine surgery and optimize clinical care guidelines. PROMIS was developed by researchers at multiple academic institutions and the National Institutes of Health.“I am interested in the patient’s experience,” says Neuman. “I want them to understand why we are doing surgery, and I want to meet their expectations during recovery.”
The patient-centric measurement tool uses a computer-adaptive testing questionnaire to measure domains of health. “The goal is to create a spine-specific score using fewer than seven questions,” says Neuman, “which helps to distill the patient feedback and minimize the amount of time needed to implement the survey and analyze the data generated by the patient’s answers.” The end result is a score that can be compared with a national average for the domain being assessed.
“We asked spine patients, ‘What matters the most to you?’ The things they came up with were anxiety, depression, fatigue, pain, physical function, satisfaction with social roles and sleep disturbance,” explains Neuman.
The data generated enable Neuman to create a graph for each domain. “For example, the domain for pain has a baseline that represents the general population with pain. A score that falls below that line indicates that the patient is experiencing more pain than the general population and vice versa for a score that falls above the baseline,” says Neuman.
This use of PROMIS helps patients judge the effectiveness of their treatment by assessing changes in their symptoms over time. The graph of data from the questionnaire becomes a visual tool that validates the patient’s experience by providing a tangible representation of their progress.
“Clinically, the questionnaire we’re developing saves time because patients can fill it out before their follow-up appointments or while they are waiting to be seen,” says Neuman. “The scores are generated immediately, and they open communication about how they are doing, what variables might be affecting their recovery and what kind of changes might need to be made.”
Neuman’s current pilot study focuses on creating baseline scores for patients with back problems. His goal is to create a standardized, spine-specific PROMIS questionnaire that will support clinical decision-making, improve the quality of care and support successful practice management in orthopaedics.
