Background:
Coronary revascularization by PCI is one of the most common medical procedures performed nationally. PCI for patients with chronic stable angina is performed primarily for symptomatic benefit, and has not been shown to provide survival benefit or reduction in MACE. Therefore, improvement in angina severity is an important marker of quality and procedural success for this patient population. Patient-reported outcome measures (PROMs) have been developed for chest pain and dyspnea which are valid and responsive to treatment, however they are not widely used in routine care. We present a model for use of PROMs in routine care.
Methods and Results:
Development of infrastructure to collect PROMs data and present it to medical providers was a strategic priority of Partners HealthCare. The health system funded a tablet computer software platform to efficiently collect PROMs responses from patients and integrate the responses in the electronic medical record. This platform was implemented in the catheterization laboratory at Massachusetts General Hospital, with a target population of patients with chronic stable angina presenting for diagnostic coronary angiography. Patients complete short-form Seattle Angina Questionnaires (SAQ-7), the Rose dyspnea scale, the short-form Patient Health Questionnaire (PHQ-2), and the PROMIS-10 general health-related quality of life instrument. These assessments take 5 to 10 minutes to perform while the patient is in the pre-procedure waiting room. A phased implementation resulted in a final program including pre-procedure measurement, presentation of data to clinical providers, and follow-up using an e-mail platform. The program successfully captured measures from 474 patients in the first six months of the program, comprising 57.9% of outpatient visits. The key factors for success were high-level leadership commitment, allocation of adequate resources, a user-friendly interface for patients and staff, easily interpretable measures, and clinical relevance.
Conclusions:
Our program demonstrates that the integration of patient-reported outcomes measurement is technically feasible in a real-world care environment. We share our experiences to provide others with a model for similar programs, and to accelerate implementation nationwide by helping others avoid pitfalls. We believe expansion of similar programs nationally may lead to more robust quality measurement infrastructure and higher-value care for patients.
State of the art papers Is there an additional benefit from coronary revascularization in diabetic patients with acute coronary syndromes or stable angina who are already on optimal medical treatment?