Pure Sports Medicine offers Sports Exercise and Musculoskeletal Medicine services across 8 clinics in London, UK, and through a virtual clinic accessible nationwide. They recognised early on the importance of great data in facilitating the best care for patients. Their commitment to research and innovation led them to implement a robust Patient-Reported Outcome Measures (PROMs) programme in partnership with Cemplicity.

Head of Research, Simon Lack, shares insights into their innovative journey as pioneers in PROMs for musculoskeletal services. He discusses the value they have gained, the challenges encountered, and the lessons learned along the way.

Simon shares how they addressed clinicians’ barriers to engagement, empowered their front of staff and optimised patient participation.

Read on for the full story, or watch our conversation below!

Simon Lack, Head of Research, drives a culture of data-driven insights at Pure Sports Medicine. His vision is that this culture of research informs the values and behaviours of every person within the organisation, ensuring evidence-informed care now and into the future.

Pure Sports Medicine embarked on a journey to create a shared philosophy of research in every corner of their organisation, transforming the way they operate.

This evidence-led decision-making has helped challenge long-held assumptions within the organisation.

“There’s this cultural umbrella, this activity of research. It filters down to every single consultation and permeates out to company-wide understanding of how well we’re performing.”

In 2021, Simon’s search for improvement led him to Cemplicity, finding it the most pragmatic platform and approach to integrate into current practices. Understanding the impact of survey length on engagement, he opted for collecting big data at a shallow but relevant level, identifying patterns for deeper analysis later.

“Anybody we’d spoken to who were adopting that type would say that their retention, their completion rates on those were really, really small.”

Implementing a large-scale digital PROMs programme, Pure Sports Medicine collaborates closely with Cemplicity, learning and optimising along the way.

Key features include:

This process starts with two simple baseline questions, repeated at set intervals to track progress and trigger alerts for necessary interventions.

1. Accurate and long-term data collection.

2. Real world data to benchmark against clinical research.

Prior to this programme, Pure Sports Medicine clinicians would ask patients: How are you feeling? Roughly better or worse than last time? This lack of standardised questions meant the answers couldn’t be compared and they left a poor record of outcomes as they relied heavily on the clinician’s point of view and record keeping. Also, vitally, when patients left treatment, Pure Sports Medicine had no idea what the long-term outcomes were.

Now, with an aligned set of questions and a systemised approach to follow-ups after care, Pure Sports Medicine has a much more detailed understanding of the quality of the care.

Pure Sports Medicine now has data to compare the outcomes it drives against published studies. Having this litmus test is vital to ensuring quality of care - knowing when the organisation is working at its peak for patient care and when more needs to be done in certain areas.

“If we’re collecting outcomes or delivering treatment that’s comparable to a randomised controlled trial (RCT) for an individual with that diagnosis code, brilliant. If we’re not, and if we’re off the mark, then we know where to invest time, energy and effort into improving clinical skills to ensure outcomes are achieved. Otherwise we’re doing a disservice to patients.”

For the first time, Pure Sports Medicine has evidence-based information on the success of the care they are delivering to their patients. Their journey now is to dig down level by level to get more detailed comparisons.

“...for example, next level down would be everyone with shoulder problems, then next level down from that being a particular diagnosis within a shoulder problem.”

Pure Sports Medicine are two years down the track and building their own data bank from which to pull their own insights. Currently they have data to accurately benchmark their outcomes against the existing evidence base but to go further they are collecting and refining the background information about their own patients to get even more layers of insight from the PROMs.

“That is set up really nicely within Cemplicity. We are pulling out these diagnostic codes so in time that the volume builds, we will be able to make direct comparisons here.”

This is new. This is not something that Pure Sports Medicine have done in this format and to this extent before. Even more widely, it’s not something that patients are regularly coming across.

“So the challenge is that when you’re starting something genuinely new, you can’t expect it to change overnight. Don’t expect everyone to just get on board, and immediately see exactly the same value in this as you do.”
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While Simon could see the huge value in the research programme, he had to look into barriers to engagement for other clinicians who were new to the programme. Focus groups came up with some unforeseen barriers that were largely to do with unfamiliarity rather than the substance of the programme.

“Some clinicians felt like it might be a case of Pure Sports monitoring how effective they are. Sure, I do get that nervousness, but surely you’ll want to know?”

The perceived administration burden is easily dealt with but the feeling of monitoring is more incrementally fixed with the building of a culture of research, and education about the programme’s uses and benefits. Pure Sports Medicine have highlighted the clinical insights gained, rather than the benchmarking of individual clinicians, and are supporting clinicians to understand the benefits the insights give to their own practice for their patients.

“I communicate what we are looking at in the data, how we interpretate this data and use it to understand our patient group better. At no point do we present data back saying, I can see your knee patients are not getting that much better. What’s going on? Instead, I provide a more general point of view. For example, what we can start to see is a group of people who typically present with this type of severity of symptom and dysfunction or disability and impairment, and that by three months we see on average, this amount of change.”

By creating scenarios and showing how it presents in the portal, then looking at how the clinicians might interact with that and how it might inform their practice, gives the impetus to see the value as it affects them.  

“It becomes a live learning environment. And then they go back and see how that would affect practice.”

Patients also need to engage with the surveys for the programme to work. This involves educational work with the front-of-house so they can play their part in collecting data. 

Simon looked at response rates to identify front-of-house staff who were achieving good response rates. He then looked into their process and the language they used. He even created training videos by pretending to be a patient and filming their interaction about the programme.

“Then I made a video of me being a patient walking through the door and then asking the front-of-house person to explain to me what it is that we’re doing and collecting. This induction resource included videos of how it was being done, some of the wording that was being used, some of the challenges that they were being faced by patients’ questions. Why am I doing this? How’s my data being handled? What’s that all about?” 

Upskilling staff to handle a variety of patient questions with confidence means patients get the answers straight away and staff aren’t put off bringing it up with the next patient, resulting in greater response rates.

Simon recommends looking at at least 3 types of responses:

“The super compliant, the slightly inquisitive questioning, the not really on board just yet, and then completely against it. I’d say overall we’re probably 90-95% successful in engaging the patients in the programme in-clinic but we’re still not successful a hundred percent of the time.”

Providing front-of-house staff with compelling supporting materials, helped them communicate the process and benefits to patients, increasing engagement. 

Pure Sports’ commitment to this research programme means their next step is to interview patients to dig down further into motivating their engagement.

This attitude of getting moving before perfecting the end destination has driven Pure Sports Medicine forward at a faster rate than other organisations. Their open minded approach has allowed them to hear unforeseen needs of patients and clinicians and to adapt and flex to meet those needs. They have collaborated closely with Cemplicity too, moving through different iterations to keep improving their programme.

"Don't let the level of uncertainty about exactly what it [PROMs programme] is going to give you be the barrier to you getting going... Start to pull information because there's definite richness in it. It's a case of seeing what that richness is as you start to bring it in."

Pure Sports Medicine also look forward to learning as a collective.

“One of the next most exciting things is that as we all do it, we can learn from each other’s practices as well as our own.”

Pure Sports Medicine are aiming to have a data set across 12 months that has enough engagement that it is representative of our overall cohort. This would allow them to draw really robust conclusions.

Another goal is to move from purely understanding how effective a particular diagnostic category is evaluated against clinical studies, but to then design their own studies to understand why they are more or less effective than the RCT ensuring best practice. 

“What are we doing? How are we treating these people? Let’s communicate this and have some data to back up the fact that we are presenting it as a gold standard way of treating people because it’s better than any of the published data that’s out there. So that would be with a real scientific lens.”

The overall goal of the programme is to improve patient outcomes, but a huge aspect of that is to enable clinicians to be the best versions of themselves they can be. This programme can provide individual insights into how effective a clinician’s approach is and also highlight approaches that have been very successful so others can learn from them. And that has to be great for everyone.

Pure Sports Medicine, thanks in large part to the effort of Head of Research Simon Lack, is leading the charge in using PROMs to drive wholesale culture change in its organisation. By taking an iterative approach and involving both clinicians and patients throughout the process, they are embedding their research-driven philosophies, benefiting the organisation, clinicians, and patients alike.