Patient-Reported Outcomes and Surgical Quality

Abstract

Delivering high-quality surgical care requires knowing how best to define and measure quality in surgery. Patient-reported outcomes (PROs) enable surgeons, health care systems, and payers to understand meaningful health outcomes from the patient's perspective and can be measured using patient-reported outcome measures (PROMs). As a result, there is much interest in using PROMs in routine surgical care, to guide quality improvement and to inform reimbursement pay structures. This chapter defines PROs and PROMs, differentiates PROMs from other quality measures such as patient-reported experience measures, describes PROMs in the context of routine clinical care, and provides an overview of interpreting PROM data. This chapter also describes how PROMs may be applied to quality improvement and value-based reimbursement in surgery.

Keywords

patient-reported outcomes - patient-reported outcome measures - quality of life - surgical quality

Publication History

Article published online:
10 February 2023

• References

• 1 Billig JI, Sears ED, Travis BN, Waljee JF. Patient-reported outcomes: understanding surgical efficacy and quality from the patient's perspective. Ann Surg Oncol 2020; 27 (01) 56-64
• 2 Nguyen H, Butow P, Dhillon H, Sundaresan P. A review of the barriers to using patient-reported outcomes (PROs) and patient-reported outcome measures (PROMs) in routine cancer care. J Med Radiat Sci 2021; 68 (02) 186-195
• 3 Weldring T, Smith SMS. Patient-reported outcomes (PROs) and patient-reported outcome measures (PROMs). Health Serv Insights 2013; 6: 61-68
• 4 Marshall S, Haywood K, Fitzpatrick R. Impact of patient-reported outcome measures on routine practice: a structured review. J Eval Clin Pract 2006; 12 (05) 559-568
• 5 Lavallee DC, Chenok KE, Love RM. et al. Incorporating patient-reported outcomes into health care to engage patients and enhance care. Health Aff (Millwood) 2016; 35 (04) 575-582
• 6 Weenink J-W, Braspenning J, Wensing M. Patient reported outcome measures (PROMs) in primary care: an observational pilot study of seven generic instruments. BMC Fam Pract 2014; 15: 88
• 7 Besson A, Deftereos I, Chan S, Faragher IG, Kinsella R, Yeung JM. Understanding patient-reported outcome measures in colorectal cancer. Future Oncol 2019; 15 (10) 1135-1146
• 8 McKenna SP, Heaney A, Langley PC. Fundamental Outcome Measurement: Selecting Patient Reported Outcome Instruments and Interpreting the Data they Produce. Innov Pharm 2021; 12 (02)
• 9 Mokkink LB, Terwee CB, Patrick DL. et al. The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes. J Clin Epidemiol 2010; 63 (07) 737-745
• 10 van der Willik EM, Terwee CB, Bos WJW. et al. Patient-reported outcome measures (PROMs): making sense of individual PROM scores and changes in PROM scores over time. Nephrology (Carlton) 2021; 26 (05) 391-399
• 11 Refolo P, Minacori R, Mele V, Sacchini D, Spagnolo AG. Patient-reported outcomes (PROs): the significance of using humanistic measures in clinical trial and clinical practice. Eur Rev Med Pharmacol Sci 2012; 16 (10) 1319-1323
• 12 Basch E, Deal AM, Kris MG. et al. Symptom monitoring with patient-reported outcomes during routine cancer treatment: a randomized controlled trial. J Clin Oncol 2016; 34 (06) 557-565
• 13 Boyce MB, Browne JP. Does providing feedback on patient-reported outcomes to healthcare professionals result in better outcomes for patients? A systematic review. Qual life Res an Int J Qual life Asp Treat care Rehabil. 2013; 22 (09) 2265-2278
• 14 Kotronoulas G, Kearney N, Maguire R. et al. What is the value of the routine use of patient-reported outcome measures toward improvement of patient outcomes, processes of care, and health service outcomes in cancer care? A systematic review of controlled trials. J Clin Oncol 2014; 32 (14) 1480-1501
• 15 Basch E. Patient-reported outcomes—harnessing patients' voices to improve clinical care. N Engl J Med 2017; 376 (02) 105-108
• 16 Sokas C, Hu F, Edelen M, Sisodia R, Pusic A, Cooper Z. A review of PROM implementation in surgical practice. Ann Surg 2022; 275 (01) 85-90
• 17 Coons SJ, Eremenco S, Lundy JJ, O'Donohoe P, O'Gorman H, Malizia W. Capturing patient-reported outcome (PRO) data electronically: the past, present, and promise of ePRO measurement in clinical trials. Patient 2015; 8 (04) 301-309
• 18 Meirte J, Hellemans N, Anthonissen M. et al. Benefits and disadvantages of electronic patient-reported outcome measures: systematic review. JMIR Perioper Med 2020; 3 (01) e15588
• 19 Lyu H, Wick EC, Housman M, Freischlag JA, Makary MA. Patient satisfaction as a possible indicator of quality surgical care. JAMA Surg 2013; 148 (04) 362-367
• 20 CMS. Consumer Assessment of Healthcare Providers and Systems (CAHPS). cms.gov. Accessed December 6, 2022 at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/CAHPS. Published 2022
• 21 Mohan CS, Rotter JS, Tan H-J. et al. The association between patient experience and healthcare outcomes using SEER-CAHPS patient experience and outcomes among cancer survivors. J Geriatr Oncol 2021; 12 (04) 623-631
• 22 Sheetz KH, Waits SA, Girotti ME, Campbell Jr DAJ, Englesbe MJ. Patients' perspectives of care and surgical outcomes in Michigan: an analysis using the CAHPS hospital survey. Ann Surg 2014; 260 (01) 5-9
• 23 Press Ganey Associates LLC. Press Ganey. 2022. Accessed December 6, 2022 at: https://www.pressganey.com/
• 24 North F, Tulledge-Scheitel SM. Patient Satisfaction With Providers: Do Patient Surveys Give Enough Information to Help Providers Improve Specific Behaviors. Health Serv Res Manag Epidemiol 2019; 6: 2333392819885284
• 25 Newgard CD, Fu R, Heilman J. et al. Using Press Ganey provider feedback to improve patient satisfaction: a pilot randomized controlled trial. Acad Emerg Med 2017; 24 (09) 1051-1059
• 26 Chughtai M, Gwam CU, Khlopas A. et al. No correlation between Press Ganey survey responses and outcomes in post-total hip arthroplasty patients. J Arthroplasty 2018; 33 (03) 783-785
• 27 Kohring JM, Pelt CE, Anderson MB, Peters CL, Gililland JM. Press Ganey outpatient medical practice survey scores do not correlate with patient-reported outcomes after primary joint arthroplasty. J Arthroplasty 2018; 33 (08) 2417-2422
• 28 Squitieri L, Bozic KJ, Pusic AL. The role of patient-reported outcome measures in value-based payment reform. Value Health 2017; 20 (06) 834-836
• 29 National Health Services. Patient Reported Outcome Measures (PROMs). digital.nhs.uk. Accessed January 1, 2023 at: https://digital.nhs.uk/data-and-information/data-tools-and-services/data-services/patient-reported-outcome-measures-proms. Published 2022
• 30 ICHOM. ichom.org. Accessed January 1, 2023 at: https://www.ichom.org/patient-centered-outcome-measures/. Published 2022
• 31 Zerillo JA, Schouwenburg MG, van Bommel ACM. et al; Colorectal Cancer Working Group of the International Consortium for Health Outcomes Measurement (ICHOM). An International Collaborative Standardizing a Comprehensive Patient-Centered Outcomes Measurement Set for Colorectal Cancer. JAMA Oncol 2017; 3 (05) 686-694
• 32 Basch E, Spertus J, Dudley RA. et al. Methods for developing patient-reported outcome-based performance measures (PRO-PMs). Value Health 2015; 18 (04) 493-504
• 33 National Quality Forum. Building a Roadmap From Patient-Reported Outcome Measures to Patient-Reported Outcome Performance Measures. qualityforum.org. Accessed January 1, 2023 at: https://www.qualityforum.org/Publications/2021/11/Building_a_Roadmap_From_Patient-Reported_Outcome_Measures_to_Patient-Reported_Outcome_Performance_Measures_-_Final_Technical_Guidance_Report.aspx. Published 2021
• 34 Porter ME. Value-based health care delivery. Ann Surg 2008; 248 (04) 503-509