Patient Outcome Measures Within a Surgical Quality Improvement Program (2024)

• ¹Surgical Health Outcomes and Research for Equity (SHORE) Center, Department of Surgery, University of Rochester Medical Center, Rochester, New York

• ²Division of Colon and Rectal Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, New York

• ³Patient-Reported Outcomes, Value, and Experience Center (PROVE) Center, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts

• ⁴Division of Plastic and Reconstructive Surgery, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts

• ⁵Harvard Medical School, Boston, Massachusetts

• ⁶Division of Surgical Oncology, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts

• ⁷Division of General and Gastrointestinal Surgery, Department of Surgery, The Ohio State University, Columbus

• ⁸Division of Surgical Oncology, Department of Surgery, Duke University School of Medicine, Durham, North Carolina

• ⁹Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois

• ¹⁰The David Geffen School of Medicine at UCLA, Los Angeles, California

Key Points

Question Is it feasible to leverage health information technology to collect patient-reported outcome measures (PROMs) within a national surgical quality improvement program at scale?

Findings This pragmatic cohort study of 65 hospitals (including 130 365 patients) participating in the American College of Surgeons National Surgical Quality Improvement Program achieved the 30% or greater target collection rate after the implementation of 15 strategies over a 3-year period. Fifty-eight hospitals (89.2%) achieved collection rates of 30% or greater, and 9 (13.8%) achieved collection rates 50% or greater; platform functionality and patient engagement were the keys to success.

Meaning The large-scale electronic collection of PROMs into a national multispecialty surgical registry was feasible.

Importance Patient-reported outcome measures (PROMs) are increasingly recognized for their ability to promote patient-centered care, but concerted health information technology (HIT)–enabled PROM implementations have yet to be achieved for national surgical quality improvement.

Objective To evaluate the feasibility of collecting PROMs within a national surgical quality improvement program.

Design, Setting, and Participants This was a pragmatic implementation cohort study conducted from February 2020 to March 2023. Hospitals in the US participating in the American College of Surgeons National Surgical Quality Improvement Program and their patients were included in this analysis.

Exposures Strategies to increase PROM collection rates were identified using the Institute for Healthcare Improvement (IHI) Framework for Spread and the Consolidated Framework for Implementation Research and operationalized with the IHI Model for Improvement’s Plan-Do-Study-Act (PDSA) cycles.

Main Outcomes and Measures The primary goal was to accrue more than 30 hospitals and achieve collection rates of 30% or greater in the first 3 years. Logistic regression was used to identify hospital-level factors associated with achieving collection rates of 30% or greater and to identify patient-level factors associated with response to PROMs.

Results At project close, 65 hospitals administered PROMs to 130 365 patients (median [IQR] age, 60.1 [46.2-70.0] years; 77 369 female [59.4%]). Fifteen PDSA cycles were conducted to facilitate implementation, primarily targeting the Consolidated Framework for Implementation Research domains of Inner Setting (ie, HIT platform) and Individuals (ie, patients). The target collection rate was exceeded in quarter 3 (2022). Fifty-eight hospitals (89.2%) achieved collection rates of 30% or greater, and 9 (13.8%) achieved collection rates of 50% or greater. The median (IQR) maximum hospital-level collection rate was 40.7% (34.6%-46.7%). The greatest increases in collection rates occurred when both email and short-message service text messaging were used, communications to patients were personalized with their surgeon’s and hospital’s information, and the number of reminders increased from 2 to 5. No identifiable hospital characteristic was associated with achieving the target collection rate. Patient age and insurance status contributed to nonresponse.

Conclusions and Relevance Results of this cohort study suggest that the large-scale electronic collection of PROMs into a national multispecialty surgical registry was feasible. Findings suggest that HIT platform functionality and earning patient trust were the keys to success; although, iterative opportunities to increase collection rates and address nonresponse remain. Future work to drive continuous surgical quality improvement with PROMs are ongoing.

Health Care Quality Surgery

Citation

Temple LKF, Pusic AL, Liu JB, et al. Patient-Reported Outcome Measures Within a National Multispecialty Surgical Quality Improvement Program. JAMA Surg. Published online June 26, 2024. doi:10.1001/jamasurg.2024.1757

Manage citations:

© 2024