Disparities in Patient Reported Outcomes Completion Rates and Baseline Function in Newly Presenting Spine Patients

OBJECTIVES: Prior studies have demonstrated that minority patients and those of low socioeconomic status may present with worse physical and mental health on patient reported outcome measures (PROMs). As PROMs are increasingly used in clinical care, research, and health policy, accurate assessment of health status among populations relies on the successful completion of PROM instruments. The purpose of this study was to evaluate disparities in PROM (PROMIS-Physical Function, Pain Intensity, and Pain Interference) completion rates and baseline function scores among newly presenting spine patients.

METHODS: A retrospective review of 10,803 consecutive new patients presenting to a single multidisciplinary spine clinic from June 2020 to September 2022 was performed. Univariate statistics were performed to compare demographics between patients who did and did not complete PROMs. Multivariate analysis was used to compare PROM instrument completion rates by race, ethnicity, and Social Vulnerability Index (SVI) and baseline scores among responders.

RESULTS: 68.4% of patients completed PROMs at the first clinic visit. After adjusting for age, sex, body mass index, and diagnosis type, patients of non-white race (OR=0.661, p<0.001), Hispanic ethnicity (OR=0.569, p<0.001), and increased social vulnerability (OR=0.608, p<0.001) were less likely to complete PROMs. In the multivariate models, patients of non-white race reported lower levels of physical function (β=-6.5, p=0.032) and higher levels of pain intensity (β=0.6, p=0.005). Hispanic ethnicity (β=1.5, p=0.004) and increased social vulnerability (β=1.1, p=0.002) were each associated with increased pain intensity.

CONCLUSIONS: Our study highlights disparities in PROM completion rates and suggests that non-white patients, those of Hispanic ethnicity, and those at increased social vulnerability may be underrepresented in spine patient-reported outcomes. As these subpopulations may also have worse physical function or pain intensity, additional strategies are needed to better capture patient reported health status in order to avoid bias in clinical care, outcomes research and health policy.