Clinical Implementation Best Practices from the Military Orthopaedics Tracking Injuries and Outcomes Network (MOTION)- MHSRS 2026

m bradley, j dowe, MOTION Collaborative

Abstract accepted for poster presentation at the 2026 Military Health System Research Symposium (MHSRS)

Introduction: Patient-reported outcomes (PROs) are essential for value-based orthopaedic care, yet achieving high pre-operative completion rates remains challenging. The Military Orthopaedics Tracking Injuries and Outcomes Network (MOTION) is an ongoing effort enrolling TRICARE beneficiaries undergoing orthopaedic surgeries (upper extremity, lower extremity, or spine). Validated PROs are collected as part of pre- and post-operative standards of care. This study evaluates best practices for pre-operative PRO completion by comparing different implementation strategies across multiple centers.

Methods: Completion rates were calculated by comparing total patient enrollments to surveys completed before surgery. A total of 20 sites were categorized based on workflow strategy: [1] dedicated staff-driven (employees) vs. clinical staff-driven (surgeons/nurses), and [2] high-input (staff-driven interactions) vs. low-input (no staff interactions). Qualitative analysis assessed staff training, engagement levels, and technology usage (tablets, QR codes, or emails). Data from 2,792 patients were analyzed over a 6- month period.

Results: Cross-sectional analysis revealed that a "hybrid approach"—combining automated pre-visit emails with in-clinic assistance (tablet/QR code)—achieved the highest completion rates (average >80%). Clinics relying solely on patient-initiated QR code scanning had the lowest completion rates (average <50%). Sites utilizing dedicated employees (site coordinators) for collection achieved an average of 10-20% higher completion rates than those relying solely on existing clinical staff (surgeons/nurses). Furthermore, highly engaged staff who integrated PRO completion into the routine patient encounter increased compliance by an average of 30% compared to disengaged sites. While QR code availability was intended to reduce barriers, reliance on QR code-only methods in- clinic resulted in lower completion rates (range 0-50%).

Discussion: Optimal pre-operative PRO implementation requires a proactive hybrid approach, integrating automated pre-visit notifications with dedicated staff assistance in the clinic to overcome logistical barriers. Successful, long-term implementation depends heavily on active staff engagement and reducing the reliance on patient-initiated, remote-only enrollment. A structured hybrid approach is sustainable, effective, and crucial for high-fidelity data collection across diverse clinical settings.