Prioritizing Health Equity in Patient-reported Outcome Measurement to Improve Surgical Care

Abstract

Racial, ethnic, and economic disparities in health care are among the most egregious injustices in our society. For decades studies have shown that disparities in access to surgery, surgical treatment and surgical outcomes have shortened and reduced quality of life for underserved and minority patients yet there has been little progress in narrowing the gap. The surgical literature is with replete descriptive data describing disparities across specialties, but there is a relative paucity of studies designed to eliminate disparities and improve health outcomes. Innovative, cross disciplinary surgical health services research is required so that we may stop ''staring at the problem'' and move towards actionable change. As part of our commitment to advancing social justice and eliminating inequities in surgery, Annals of Surgery will prioritize innovative, high quality and high impact research that advances science and policy towards equity. In this issue of we launch our series, ''Rethinking Surgical Disparities Research: Improving the Science to Promote Equity,'' about key topics germane to advancing surgical disparities research to eliminate rather than to solely describe inequities in surgical treatment and outcomes. We hope that these articles will inform and inspire rigorous research to abolish inequities in surgical care and outcomes.

Patterns of malpractice claims and compensation after surgical procedures: a retrospective analysis of 8,901 claims from the Finnish patient insurance registry

“…Communication about adverse events beforehand, patient education [18,19], and proper rehabilitation [20][21][22] improve the quality of surgical care. A patient-reported outcome measurement after surgery should be part of standard data collection in order to further develop the quality of invasive procedures [23].…”

Patients’ perspectives on the benefits of feedback on patient-reported outcome measures in a web-based personalized decision report for hip and knee osteoarthritis

“…However, racial differences in perceived value of PROM feedback [ 53 ] underscore the need for more diverse sampling in future work. Understanding patient perspectives in the context of social determinants of health is imperative to address equity concerns with clinical expansion of PROMs, including differential ability to complete, interpret, and act on PROMs [ 54 , 55 ]. Disparities must be specifically examined related to digital PROM-based applications as certain subgroups may require additional training and support for their use.…”

Implementing patient-reported outcomes in routine clinical care for diverse and underrepresented patients in the United States

“…Third, our study focused on the implementation of already developed and validated PROMs. Addressing disparities in PRO data collection will also require equitable PROM development, testing, and validation within diverse and underrepresented populations before implementation occurs [ 15 ].…”

“…As existing healthcare systems expand and new systems develop PRO data collection programs, it will be imperative to ensure that PRO data collection is not only representative of all patients but also equitable in its implementation in routine clinical care [ 15 ]. While this study highlights several important considerations for PRO implementation in diverse and underrepresented populations, it simultaneously calls attention to the paucity of research in this area to date.…”

“…Routine PRO data collection is therefore likely predominant in White, higher socioeconomic, and English-speaking populations [ 15 ]. This is further supported by a systematic review of PRO implementation in routine care for patients with breast cancer, in which only 2 of 34 identified studies targeted minority patient populations [ 16 ] and a study of PRO implementation in integrative medicine, in which the majority of patients were White and had commercial insurance [ 17 ].…”