Moving towards patient-reported outcomes in routine clinical practice: implementation lessons from the BREAST-Q

Nelson, Jonas A.; Chu, Jacqueline J.; Dabic, Stefan; Kenworthy, Elizabeth; Shamsunder, Meghana G.; McCarthy, Colleen M.; Mehrara, Babak J.; Pusic, Andrea L.

doi:10.1007/s11136-022-03213-z

Cited by 11 publications

(7 citation statements)

References 41 publications

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“…Women who underwent breast reconstruction from January 2018 to December 2021 and completed at least one of the BREAST‐Q modules postoperatively at 1‐year were included. 2018 was chosen as the starting point as quality improvement initiative was implemented to increase BREAST‐Q completion rates at that year 19 . Patients without any BREAST‐Q data at 1‐year, younger than 18 years old, or did not undergo postmastectomy breast reconstruction were excluded.…”

Section: Methodsmentioning

confidence: 99%

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Nonresponse data in sexual well‐being among breast reconstruction patients—who are we overlooking?

Kim,

Vingan,

Boe

et al. 2024

Journal of Surgical Oncology

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BackgroundMissing data can affect the representativeness and accuracy of survey results, and sexual health‐related surveys are especially at a higher risk of nonresponse due to their sensitive nature and stigma. The purpose of this study was to evaluate the proportion of patients who do not complete the BREAST‐Q Sexual Well‐being relative to other BREAST‐Q modules and compare responders versus nonresponders of Sexual Well‐being. We secondarily examined variables associated with Sexual Well‐being at 1‐year.MethodsA retrospective analysis of patients who underwent breast reconstruction from January 2018 to December 2021 and completed any of the BREAST‐Q modules postoperatively at 1‐year was performed.ResultsThe 2941 patients were included. Of the four BREAST‐Q domains, Sexual Well‐being had the highest rate of nonresponse (47%). Patients who were separated (vs. married, OR = 0.69), whose primary language was not English (vs. English, OR = 0.60), and had Medicaid insurance (vs. commercial, OR = 0.67) were significantly less likely to complete the Sexual Well‐being. Postmenopausal patients were significantly more likely to complete the survey than premenopausal patients. Lastly, autologous reconstruction patients were 2.93 times more likely to respond than implant‐based reconstruction patients (p < 0.001) while delayed (vs. immediate, OR = 0.70, p = 0.022) and unilateral (vs. bilateral, OR = 0.80, p = 0.008) reconstruction patients were less likely to respond. History of psychiatric diagnosis, aromatase inhibitors, and immediate breast reconstruction were significantly associated with lower Sexual Well‐being at 1‐year.ConclusionSexual Well‐being is the least frequently completed BREAST‐Q domain, and there are demographic and clinical differences between responders and nonresponders. We encourage providers to recognize patterns in nonresponse data for Sexual‐Well‐being to ensure that certain patient population's sexual health concerns are not overlooked.

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Section: Methodsmentioning

confidence: 99%

“…2018 was chosen as the starting point as quality improvement initiative was implemented to increase BREAST-Q completion rates at that year. 19 Patients without any BREAST-Q data at 1-year, younger than 18 years old, or did not undergo postmastectomy breast reconstruction were excluded.…”

Section: Study Populationmentioning

confidence: 99%

Nonresponse data in sexual well‐being among breast reconstruction patients—who are we overlooking?

Kim,

Vingan,

Boe

et al. 2024

Journal of Surgical Oncology

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“…[24][25][26][27][28] Although health information technology shifts the burden of data collection to patients, investments in infrastructure, data teams, and adaptations to clinic workflow are still necessary. In addition to real-time monitoring by individual departments, 26 these incentives will likely also require top-down investment and cultural shifts at the hospital system level, 29 alongside pressure from payers for outcome collection. Although private practices may face greater challenges with the administrative overhead associated with PRO collection, gathering these data may help them better market their services or anticipate the incorporation of PROs as quality metrics in payment policies.…”

Section: Improving the Way We Measure Outcomesmentioning

confidence: 99%

“…23 Encouragingly, recent reports suggest that widespread collection of PROs in plastic surgery is feasible, especially with digital symptom monitoring. [24][25][26][27][28] Although health information technology shifts the burden of data collection to patients, investments in infrastructure, data teams, and adaptations to clinic workflow are still necessary. In addition to real-time monitoring by individual departments, 26 these incentives will likely also require top-down investment and cultural shifts at the hospital system level, 29 alongside pressure from payers for outcome collection.…”

Section: Improving the Way We Measure Outcomesmentioning

confidence: 99%

Healthcare Value in Plastic Surgery Practice

Yang

Hyland

Tsai

et al. 2023

Plastic &Amp; Reconstructive Surgery

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Summary: As value-based care gains traction in response to towering health care expenditures and issues of health care inequity, hospital capacity, and labor shortages, it is important to consider how a value-based approach can be achieved in plastic surgery. Value is defined as outcomes divided by costs across entire cycles of care. Drawing on previous studies and policies, this article identifies key opportunities in plastic surgery to move the levers of costs and outcomes to deliver higher value care. Specifically, outcomes in plastic surgery should include conventional measures of complication rates and patient-reported outcome measures to drive quality improvement and benchmark payments. Meanwhile, cost reduction in plastic surgery can be achieved through value-based payment reform, efficient workflows, evidence-based and cost-conscious selection of medical devices, and greater use of outpatient surgical facilities. Lastly, the authors discuss how the diminished presence of third-party payers in aesthetic surgery exemplifies the cost-conscious and patient-centered nature of value-based plastic surgery. To lead in future health policy and care delivery reform, plastic surgeons should strive for high-value care, remain open to new ways of care delivery, and understand how plastic surgery fits into overall health care delivery.

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“…Finally, in Long et al's preliminary study of 45 patients, the authors determined that increased flap to mastectomy weight was correlated with higher Satisfaction with Breasts, one of the BREAST‐Q domains 14 . BREAST‐Q is a gold standard patient‐reported outcome measure for breast cancer surgeries 15 . These studies, however, are limited by sample size, lack a specific cutoff, and confounding variables, such as timing and laterality of reconstruction 13,14 .…”

Section: Introductionmentioning

confidence: 99%

Analyzing mastectomy and reconstruction weight in immediate autologous breast reconstruction: A preliminary study

Kim,

Ali,

Graziano

et al. 2024

Journal of Surgical Oncology

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BackgroundThis study aims to explore the ideal breast size by assessing the relationship between mastectomy to free flap weight ratio and complications as well as patient‐reported outcomes in autologous breast reconstruction (ABR).MethodA retrospective review of patients undergoing bilateral immediate ABR with mastectomy and flap weights available was completed. Patients were divided into three groups based on the ratio of mastectomy to flap weights. The patients were grouped as “maintained” if the flap weight was within 10% of the mastectomy weight. Patients with a weight difference greater than 10% were used to declare “downsized” or “upsized.” Outcomes included complications and four domains of the BREAST‐Q at 1‐year postoperatively.ResultsThree hundred and fifty‐nine patients were included in the analysis, of which 112 were downsized, 91 maintained, and 156 upsized, respectively. Presence of complications did not significantly differ among the groups. At 1‐year postoperatively, Sexual Well‐being significantly differed (p = 0.033). Between preoperative and 1 year, patients who upsized experienced an improvement in Satisfaction with Breasts by 16 points (p < 0.001), while patients who downsized experienced a decline in Physical Well‐being of the Chest by 7 points (p = 0.016). Multivariable linear regression model showed that Sexual Well‐being was 13 points lower in the downsized cohort than in the maintained cohort (β = −13, 95% confidence interval: −21 to −5.4; p = 0.001).ConclusionAlthough complication rates do not significantly differ between the three cohorts, patients who downsize may have lower Sexual Well‐being postoperatively. Surgeons should consider our preliminary findings to counsel patients preoperatively about the predicted breast size and the impact of downsizing on sexual health.

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Moving towards patient-reported outcomes in routine clinical practice: implementation lessons from the BREAST-Q

Cited by 11 publications

References 41 publications

Nonresponse data in sexual well‐being among breast reconstruction patients—who are we overlooking?

Nonresponse data in sexual well‐being among breast reconstruction patients—who are we overlooking?

Healthcare Value in Plastic Surgery Practice

Analyzing mastectomy and reconstruction weight in immediate autologous breast reconstruction: A preliminary study

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