Implementing PROMS for elective surgery patients: feasibility, response rate, degree of recovery and patient acceptability

Natasha K Brusco, Victoria Atkinson, Jeffrey Woods, Paul S Myles, Anita Hodge, Cathy Jones, Damien Lloyd, Vincent Rovtar, Amanda M Clifford, Meg E Morris, Natasha K Brusco, Victoria Atkinson, Jeffrey Woods, Paul S Myles, Anita Hodge, Cathy Jones, Damien Lloyd, Vincent Rovtar, Amanda M Clifford, Meg E Morris

Abstract

Background: Patient reported outcome measures (PROMs) engage patients in co-evaluation of their health and wellbeing outcomes. This study aimed to determine the feasibility, response rate, degree of recovery and patient acceptability of a PROM survey for elective surgery.

Methods: We sampled patients with a broad range of elective surgeries from four major Australian hospitals to evaluate (1) feasibility of the technology used to implement the PROMs across geographically dispersed sites, (2) response rates for automated short message service (SMS) versus email survey delivery formats, (3) the degree of recovery at one and four weeks post-surgery as measured by the Quality of Recovery 15 Item PROM (QoR-15), and (4) patient acceptability of PROMS based on survey and focus group results. Feasibility and acceptability recommendations were then co-designed with stakeholders, based on the data.

Results: Over three months there were 5985 surveys responses from 20,052 surveys (30% response rate). Feasibility testing revealed minor and infrequent technical difficulties in automated email and SMS administration of PROMs prior to surgery. The response rate for the QoR-15 was 34.8% (n = 3108/8919) for SMS and 25.8% (n = 2877/11,133) for email. Mean QoR-15 scores were 122.1 (SD 25.2; n = 1021); 113.1 (SD 27.7; n = 1906) and 123.4 (SD 26.84; n = 1051) for pre-surgery and one and four weeks post-surgery, respectively. One week after surgery, 825 of the 1906 responses (43%) exceeded 122.6 (pre-surgery average), and at four weeks post-surgery, 676 of the 1051 responses (64%) exceeded 122.6 (pre-surgery average). The PROM survey was highly acceptable with 76% (n = 2830/3739) of patients rating 8/10 or above for acceptability. Fourteen patient driven recommendations were then co-developed.

Conclusion: Administering PROMS electronically for elective surgery hospital patients was feasible, acceptable and discriminated changes in surgical recovery over time. Patient co-design and involvement provided innovative and practical solutions to implementation and new recommendations for implementation. Trial Registration and Ethical Approval ACTRN12621000298819 (Phase I and II) and ACTRN12621000969864 (Phase III). Ethics approval has been obtained from La Trobe University (Australia) Human Research Ethics Committee (HEC20479).

Key points: Patient reported outcome measures (PROMs) help to engage patients in understanding their health and wellbeing outcomes. This study aimed to determine how patients feel about completing a PROM survey before and after elective surgery, and to develop a set of recommendations on how to roll out the survey, based on patient feedback. We found that implementing an electronic PROM survey before and after elective surgery was relatively easy to do and was well accepted by patients. Consumer feedback throughout the project enabled co-design of innovative and practical solutions to PROM survey administration.

Keywords: Acceptability; Co-design; Consumer; Feasibility; Hospital; Implementation science; Patient reported outcome measure (PROM); Quality of recovery; Safety.

Conflict of interest statement

The authors declare no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Overall PROM response on the QoR-15 prior to surgery and one and four weeks following surgery
Fig. 2
Fig. 2
Patient rating for PROM survey acceptability

References

    1. Briggs MS, et al. Implementing patient-reported outcome measures in outpatient rehabilitation settings: a systematic review of facilitators and barriers using the consolidated framework for implementation research. Arch Phys Med Rehabil. 2020;101(10):1796–1812. doi: 10.1016/j.apmr.2020.04.007.
    1. Williams K, et al. Patient-reported outcome measures. Literature review. Sydney: Australian Commission on Safety and Quality in Health Care; 2016.
    1. Philpot LM, et al. Barriers and benefits to the use of patient-reported outcome measures in routine clinical care: a qualitative study. Am J Med Qual. 2018;33(4):359–364. doi: 10.1177/1062860617745986.
    1. Lim S, et al. Evaluating hospital tools and services that were co-produced with patients: a rapid review. Int J Qual Health Care. 2020;32(4):231–239. doi: 10.1093/intqhc/mzaa020.
    1. Bombard Y, et al. Engaging patients to improve quality of care: a systematic review. Implement Sci. 2018;13(1):1–22. doi: 10.1186/s13012-018-0784-z.
    1. Jones G. Raising the profile of pilot and feasibility studies in relation to the development, evaluation and implementation of patient-reported outcome measures. Pilot Feasibility Stud. 2018;4:1–4. doi: 10.1186/s40814-017-0145-8.
    1. McKercher JP, et al. Patient experiences of co-designed rehabilitation interventions: protocol for a rapid review. BMJ Open. 2020;12:e056927. doi: 10.1136/bmjopen-2021-056927.
    1. Bowen DJ, et al. How we design feasibility studies. Am J Prev Med. 2009;36(5):452–457. doi: 10.1016/j.amepre.2009.02.002.
    1. Sekhon M, Cartwright M, Francis JJ. Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework. BMC Health Serv Res. 2017;17(1):1–13. doi: 10.1186/s12913-017-2031-8.
    1. Al-Rayes SA. Development and early-stage validation of a questionnaire measuring patient acceptance of electronic patient reported outcome measures. Leeds: University of Leeds; 2015.
    1. Morris ME, et al. Protocol for implementation of the ‘AusPROM’recommendations for elective surgery patients: a mixed-methods cohort study. BMJ Open. 2021;11(9):e049937. doi: 10.1136/bmjopen-2021-049937.
    1. Stark PA, Myles PS, Burke JA. Development and psychometric evaluation of a postoperative quality of recovery scorethe QoR-15. J Am Soc Anesthesiol. 2013;118(6):1332–1340. doi: 10.1097/ALN.0b013e318289b84b.
    1. Myles PS. Measuring quality of recovery in perioperative clinical trials. Curr Opin Anesthesiol. 2018;31(4):396–401. doi: 10.1097/ACO.0000000000000612.
    1. Eldridge SM, et al. CONSORT 2010 statement: extension to randomised pilot and feasibility trials. BMJ. 2016;355:i5239. doi: 10.1136/bmj.i5239.
    1. Kleif J, et al. Systematic review of the QoR-15 score, a patient-reported outcome measure measuring quality of recovery after surgery and anaesthesia. Br J Anaesth. 2018;120:28–36. doi: 10.1016/j.bja.2017.11.013.
    1. Chazapis M, et al. Measuring quality of recovery-15 after day case surgery. BJA Br J Anaesth. 2016;116(2):241–248. doi: 10.1093/bja/aev413.
    1. Lyckner S, et al. Validation of the Swedish version of Quality of Recovery score-15: a multicentre, cohort study. Acta Anaesthesiol Scand. 2018;62(7):893–902. doi: 10.1111/aas.13086.
    1. Myles PS, et al. Minimal clinically important difference for three quality of recovery scales. Anesthesiology. 2016;125(1):39–45. doi: 10.1097/ALN.0000000000001158.
    1. Myles PS, et al. Validation of days at home as an outcome measure after surgery: a prospective cohort study in Australia. BMJ Open. 2017;7(8):e015828. doi: 10.1136/bmjopen-2017-015828.
    1. Myles PS. More than just morbidity and mortality—quality of recovery and long-term fuctional recovery after surgery. Anaesthesia. 2020;75:e143. doi: 10.1111/anae.14786.
    1. van der Wees PJ, et al. Development of a framework with tools to support the selection and implementation of patient-reported outcome measures. J Patient-Rep Outcomes. 2019;3(1):1–10. doi: 10.1186/s41687-019-0092-7.
    1. Jones CH, et al. Implementation of the Australian Hospital Patient Experience Question Set (AHPEQS): a consumer-driven patient survey. Aust Health Rev. 2021;45(5):562–569. doi: 10.1071/AH20265.
    1. IBM I (2012) SPSS statistics 21.0. IBM, Chicago, 60606.
    1. Brusco N, et al (2022) Development of the ‘AusPROM’ recommendations for elective surgery patients. Australian Health Review. In Press
    1. Sokas C, et al. A review of PROM implementation in surgical practice. Ann Surg. 2022;275(1):85–90. doi: 10.1097/SLA.0000000000005029.
    1. Chen J, Ou L, Hollis SJ. A systematic review of the impact of routine collection of patient reported outcome measures on patients, providers and health organisations in an oncologic setting. BMC Health Serv Res. 2013;13(1):211. doi: 10.1186/1472-6963-13-211.
    1. Tew M, et al. Patient-reported outcome measures (PROMs): can they be used to guide patient-centered care and optimize outcomes in total knee replacement? Qual Life Res. 2020;29(12):3273–3283. doi: 10.1007/s11136-020-02577-4.
    1. Ishaque S, et al. A systematic review of randomised controlled trials evaluating the use of patient-reported outcome measures (PROMs) Qual Life Res. 2019;28(3):567–592. doi: 10.1007/s11136-018-2016-z.
    1. De Bruijne M, Wijnant A. Improving response rates and questionnaire design for mobile web surveys. Public Opin Q. 2014;78(4):951–962. doi: 10.1093/poq/nfu046.
    1. Mavletova A, Couper MP. Mobile web survey design: scrolling versus paging, SMS versus e-mail invitations. J Surv Stat Methodol. 2014;2(4):498–518. doi: 10.1093/jssam/smu015.
    1. Léger M, et al. Validation of an alternative French version of the Quality of Recovery-15 Score: the FQoR-15. Br J Anaesth. 2020;125(4):e345–e347. doi: 10.1016/j.bja.2020.05.052.
    1. Tan NLT, Hunt JL, Gwini SM. Does implementation of an enhanced recovery after surgery program for hip replacement improve quality of recovery in an Australian private hospital: a quality improvement study. BMC Anesthesiol. 2018;18(1):1–10. doi: 10.1186/s12871-017-0465-5.
    1. van Egdom LS, et al. Implementing patient-reported outcome measures in clinical breast cancer care: a systematic review. Value Health. 2019;22(10):1197–1226. doi: 10.1016/j.jval.2019.04.1927.
    1. Ratnayake I, Ahern S, Ruseckaite R. A systematic review of patient-reported outcome measures (PROMs) in cystic fibrosis. BMJ Open. 2020;10(10):e033867. doi: 10.1136/bmjopen-2019-033867.
    1. Aiyegbusi OL, et al. Measurement properties of patient-reported outcome measures (PROMs) used in adult patients with chronic kidney disease: a systematic review. PLoS ONE. 2017;12(6):e0179733. doi: 10.1371/journal.pone.0179733.
    1. Haywood KL, et al. Patient-reported outcome measures in older people with hip fracture: a systematic review of quality and acceptability. Qual Life Res. 2017;26(4):799–812. doi: 10.1007/s11136-016-1424-1.
    1. Haywood KL, Staniszewska S, Chapman S. Quality and acceptability of patient-reported outcome measures used in chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME): a systematic review. Qual Life Res. 2012;21(1):35–52. doi: 10.1007/s11136-011-9921-8.
    1. Coulter A, et al (2014) Collecting data on patient experience is not enough: they must be used to improve care. Bmj 348

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir