Real-World Adherence to Patient-Reported Outcome Monitoring as a Cancer Care Quality Metric

Takvorian, Samuel U; Anderson, Ryan T.; Gabriel, Peter; Poznyak, Dmitriy; Lee, Sooin; Simon, Samuel; Barrett, Kirsten; Shulman, Lawrence N.

doi:10.1200/op.21.00855

Cited by 10 publications

(8 citation statements)

References 26 publications

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“…While the focus of this intervention was on surgical wounds, there is increasing interest in broader perioperative monitoring in the literature 24 , particularly how these can be used within “virtual ward” pathways to prevent admission and facilitate discharge 25 . While this may further reduce health service utilisation and present an avenue for future development, these potential benefits must be balanced with the burden on patients to complete a more complex series of patient-reported outcomes 26 , and on health services to review and respond 27 .…”

Section: Discussionmentioning

confidence: 99%

Evaluation of remote digital postoperative wound monitoring in routine surgical practice

et al. 2023

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Remote digital postoperative wound monitoring provides an opportunity to strengthen postoperative community care and minimise the burden of surgical-site infection (SSI). This study aimed to pilot a remote digital postoperative wound monitoring service and evaluate the readiness for implementation in routine clinical practice. This was a single-arm pilot implementational study of remote digital postoperative wound monitoring across two tertiary care hospitals in the UK (IDEAL stage 2b, clinicaltrials.gov: NCT05069103). Adults undergoing abdominal surgery were recruited and received a smartphone-delivered wound assessment tool for 30-days postoperatively. Patients received 30-day postoperative follow-up, including the Telehealth Usability Questionnaire (TUQ). A thematic mixed-methods approach was used, according to the WHO framework for monitoring and evaluating digital health interventions. 200 patients were enroled, of whom 115 (57.5%) underwent emergency surgical procedures. Overall, the 30-day SSI rate was 16.5% (n = 33/200), with 72.7% (n = 24) diagnosed post-discharge. Usage of the intervention was 83.0% (n = 166/200), with subsequently 74.1% (n = 123/166) TUQ completion. There were no issues reported with feasibility of the technology, with the reliability (3.87, 95% CI: 3.73–4.00) and quality of the interface rated highly (4.18, 95%: 4.06–4.30). Patient acceptance was similarly high with regards to ease of use (4.51, 95% CI: 4.41–4.62), satisfaction (4.27, 95% CI: 4.13–4.41), and usefulness (4.07, 95% CI: 3.92–4.23). Despite the desire for more frequent and personalised interactions, the majority viewed the intervention as providing meaningful benefit over routine postoperative care. Remote digital postoperative wound monitoring successfully demonstrated readiness for implementation with regards to the technology, usability, and healthcare process improvement.

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Section: Discussionmentioning

confidence: 99%

Evaluation of remote digital postoperative wound monitoring in routine surgical practice

et al. 2023

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“…The systematic introduction of PRO monitoring into clinical practice is often difficult due to operational and financial barriers to the implementation of these complex interventions, as well as the uncertainty among physicians regarding their usefulness in actual practice [ 3 , 40 ]. Therefore, it is important to identify the categories of patients who are most likely to benefit and consequently focus efforts on these populations [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

The Effects of Patient-Reported Outcome Screening on the Survival of People with Cancer: A Systematic Review and Meta-Analysis

Caminiti

Maglietta

Diodati

et al. 2022

Cancers

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This study examined the effects of the routine assessment of patient-reported outcomes (PROs) on the overall survival of adult patients with cancer. We included clinical trials and observational studies with a control group that compared PRO monitoring interventions in cancer clinical practice to usual care. The Cochrane risk-of-bias tools were used. In total, six studies were included in the systematic review: two randomized trials, one population-based retrospectively matched cohort study, two pre–post with historical control studies and one non-randomized controlled trial. Half were multicenter, two were conducted in Europe, three were conducted in the USA and was conducted in Canada. Two studies considered any type of cancer, two were restricted to lung cancer and two were restricted to advanced forms of cancer. PRO screening was electronic in four of the six studies. The meta-analysis included all six studies (intervention = 130.094; control = 129.903). The pooled mortality outcome at 1 year was RR = 0.77 (95%CI 0.76–0.78) as determined by the common effect model and RR = 0.82 (95%CI 0.60–1.12; p = 0.16) as determined by the random-effects model. Heterogeneity was statistically significant (I2 = 73%; p < 0.01). The overall risk of bias was rated as moderate in five studies and serious in one study. This meta-analysis seemed to indicate the survival benefits of PRO screening. As routine PRO monitoring is often challenging, more robust evidence regarding the effects of PROs on mortality would support systematic applications.

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“…2,[6][7][8][9][10] To that extent, multiple organizations, including the American Heart Association and the Centers for Medicare and Medicaid Services, have introduced quality measures promoting routine PRO assessment in clinical care, including for patients with heart failure (HF). [11][12][13] The HF community has shown increasing interest in incorporating PROs into clinical care. 14 The 2022 American College of Cardiology/American Heart Association/ Heart Failure Society of America Heart Failure Clinical Practice Guidelines included a new class-IIA recommendation to capture patient-reported health status as part of HF care.…”

Section: Sandhu Et Almentioning

confidence: 99%

Clinical Impact of Routine Assessment of Patient-Reported Health Status in Heart Failure Clinic: The PRO-HF Trial

Sandhu,

Calma,

Skye

et al. 2024

Circulation

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Background: The impact of routine clinic use of patient-reported outcome (PRO) measures on clinical outcomes in patients with heart failure (HF) has not been well-characterized. We tested if clinic-based use of a disease-specific PRO improves patient-reported quality of life at 1 year. Methods: PRO-HF was an open-label, parallel, patient-level randomized clinical trial of routine PRO assessment or usual care at an academic HF clinic between August 30, 2021, and June 30, 2022, with 1 year of follow-up. In the PRO assessment arm, participants completed the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) at each HF clinic visit and results were shared with their treating clinician. The usual care arm completed the KCCQ-12 at randomization and 1 year later, which was not shared with the treating clinician. The primary outcome was the KCCQ-12 Overall Summary Score (OSS) between 12-15 months post-randomization. Secondary outcomes included domains of the KCCQ-12, hospitalization and emergency department visit rates, HF medication therapy, clinic visit frequency, and testing rates. Results: Across 17 clinicians, 1,248 participants were enrolled and randomized to PRO assessment (n=624) or usual care (n=624). The median age was 63.9 (interquartile range [IQR] 51.8-72.8), 38.9% were women, and the median baseline KCCQ-12 OSS was 82.3 (IQR 58.3-94.8). Final KCCQ-12 (available in 87.9% of the PRO arm and 85.1% in usual care [p=0.16]) median OSS scores were 87.5 (IQR 68.8-96.9) in the PRO arm and 87.6 (IQR 69.7-96.9) in the usual care arm with a baseline-adjusted mean difference of 0.2 (95% CI: -1.7 to 2.0; p=0.85). The results were consistent across pre-specified subgroups. A post hoc analysis demonstrated a significant interaction with greater benefit among participants with baseline KCCQ-12 OSS scores of 60-80 but not in less or more symptomatic participants. No significant differences were found in 1-year mortality, hospitalizations, ED visits, medication therapy, clinic follow-up, or testing rates between arms. Conclusions: Routine PRO assessment in HF clinic visits did not impact patient-reported quality of life or other clinical outcomes. Alternate strategies and settings for embedding PROs into routine clinical care should be tested.

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Real-World Adherence to Patient-Reported Outcome Monitoring as a Cancer Care Quality Metric

Cited by 10 publications

References 26 publications

Evaluation of remote digital postoperative wound monitoring in routine surgical practice

Evaluation of remote digital postoperative wound monitoring in routine surgical practice

The Effects of Patient-Reported Outcome Screening on the Survival of People with Cancer: A Systematic Review and Meta-Analysis

Clinical Impact of Routine Assessment of Patient-Reported Health Status in Heart Failure Clinic: The PRO-HF Trial

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