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Patient Reported Outcomes 

Increasing patient engagement for a forward-thinking orthopedic clinic


Musculoskeletal Institute (MSKI) @ UT Health Austin

My Involvement

8 months

My Contributions

Primary & Secondary Research,

Process Mapping,

Design Development,

Solution Evaluation,



Jacob Rader

A Different Approach to Musculoskeletal Care

The Musculoskeletal Institute (MSKI) at the UTHA (University of Texas Health Austin) is a forward-thinking clinical practice utilizing an Integrated Practice Unit (IPU) care team structure. Each IPU care team includes a diverse team of experts. They ask, and listen to, patient preferences and incorporate those into shared decision-making, provide personalized risk/benefit analyses across the journey and work to prove the viability of Value-Based Care (VBC)

Champions of Design

The Musculoskeletal Institute is a believer in quality improvement through human-centered design methodologies, having partnered with the Design Institute for Health (DIH) in the past. We were re-engaged to help re-imagine their technical operations and engagement strategy.

Analyzing Processes and Exploring Opportunities

To comprehend the structure, processes, and systems of MSKI, we dedicated the first two months of this project to interviewing a variety of specialists at MSKI and consulting organizational documents and presentations.

The combined team of MSKI and Design Institute initially identified four key areas: the MSKI brand, the scheduling process, relationships with external providers, and PROMs (Patient Reported Outcome Measures). After thorough consideration,

MSKI decided to prioritize PROMs for further prototyping.

Patient Reported Outcome Measures (PROMs)

What are PROMs and why are they important?

Patient Reported Outcome Measures(PROMs) are legacy surveys that clinicians distribute to patients in the clinic and after their care to set health baselines and measure outcomes for returning patients.

What is the challenge with current PROMs?

PROMs are repetitive and technical surveys. These documents, not designed for patients' understanding, don't engender a high level of engagement, especially post-care. Every single clinic at UT Health Austin uses a different set of PROMs. This reflects the needs of their clinics; it also creates a lot of redundancy and confusion for patients.

Dozens of Concepts, Five Prototypes

Working with the MSKI team, we developed dozens of concepts to improve the delivery of PROMs. To explore these concepts, we developed, deployed, and tested five working prototypes with actual patients in MSKI’s clinic at UT Health Austin.

Prototype 1: Unifying the PROM Experience

Our first prototype was a radical redesign of the PROM forms. We had two goals for our redesign: first, to standardize the structure; and second, to unify the visual language.

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Prototype 2: Educational Poster

Educate patients about the value of PROMs and Value-Based Care.

Prototype 3:

Mobile PROMs

Deliver PROMs to patients in new ways, including via text message.

Prototype 4:

Data Visualization

Incentivize patients to complete their PROMs and visualize their data back to them to motivate them.

Prototype 5: Reminder Cards

Physical reminders with added incentives for completing forms.

In Clinic Testing

Four Key Moments for Patient Engagement

These prototypes reflected 4 key moments in the patient journey primed for improving engagement.

1. On Their Way In

As a patient, your experience begins not when you enter the clinic but at home; most doctors now ask you to fill-out forms ahead of time. This paperwork is often lengthy, repetitive, and clinically inclined. This includes PROMs. Our first priority was to improve that experience for patients. By creating a better, patient-centric design around PROMs, we hoped to encourage a higher level of engagement before, during, and after care. To test, we created a redesigned survey for select patients at MSKI’s clinic. When patients arrived for their appointment, we offered them the opportunity to try out our new version.

2. In the Clinic

Once in the clinic, we wanted to explore how education could help patients better understand their role in this new Value-Based Care model and the importance of their engagement with PROMs.

To test this, we placed educational posters in each MSKI exam room explaining what Value-Based Care is, how it’s different from what they’re used to, and the importance of PROMs in that care.

To evaluate the impact of our posters, we asked each participant what, if anything, they learned about value-based care in their post-visit interview.


3. On Their Way Out

As patients exit the clinic, we want to reinforce that their care does not end when they leave. As part of our prototyping, we created several behavioral nudges designed to help patients buy into this journey:

  • Asking patients for permission to send their follow-up PROMs via text message.

  • Incentivizing patients to complete their post-care PROMs with a $10 donation to a charity of their choice.

  • Providing patients reminder cards with the charity they selected and the date they’ll receive their PROMs


4. At Home

Every in-clinic intervention we created was designed to shape a better experience for patients and develop their understanding of PROMs so that when they’re home, they might have a better chance at completing these critical follow-ups.

As part of our prototyping, a week after their visit, patients received a second set of interventions:

  • A postcard mailed to patients highlighting the charity they selected and a QR code linking them to their PROMs.

  • A text message with a friendly note and link to complete their PROMs.

The structural redesign of the PROMs experience was one of the solutions implemented by MSKI. Some of the other solution prototypes led to longer term, longitudinal studies that will inform MSKI's practices.

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