Using patient-reported outcomes for technology assessment (TA) and quality improvement (QI) in prostate cancer brachytherapy

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 5139-5139
Author(s):  
R. C. Chen ◽  
A. L. Zietman ◽  
A. V. D’Amico ◽  
I. Kaplan ◽  
J. A. Clark ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Patient Reported Outcomes ◽  
Standard Technique ◽  
Bowel Function ◽  
Ultrasound Guided ◽  
Score Change ◽  
Patient Centered ◽  
Symptom Index ◽  
Patient Reported ◽  
Centered Care

5139 Background: Despite their sensitivity, validity and increasing prominence in clinical reports, patient-reported outcomes have played little role in TA and QI. We used our validated disease-specific instrument to compare outcomes after alternative brachytherapy techniques for early prostate cancer, both experimental vs. standard technique and between implementations of the standard technique. Methods: One radiation oncologist performed experimental MRI-guided brachytherapy (MRB) on protocol and 2 performed standard ultrasound-guided brachytherapy (USB1 and USB2). We prospectively measured urinary and bowel function of 237 men before brachytherapy and at 1, 3 and 12 months after treatment. Each symptom index is scored from 0 (no dysfunction) to 100 (maximum dysfunction). We report outcomes both as mean change in scale score from baseline and as the distribution of functional categories, grouped by pretreatment functional level: normal, intermediate, and poor (severe dysfunction). Results: Among all patients, MRB caused less urinary obstruction/irritation at 3 months after treatment than ultrasound-guided brachytherapy (mean score change 9.2 vs. 23.6, p<.001). Significant differences in outcome also existed between USB1 and USB2 (19.5 vs. 29.0, p=.01). When baseline function was normal, 15% of MRB patients reported severe 3-month dysfunction, compared to 50% of USB1 and 71% of USB2 patients ( Table ). Outcomes of patients with pretreatment urinary dysfunction differed less. Preliminary results documenting inferior outcomes prompted modification of the USB2 brachytherapy technique, producing a trend toward improved outcomes in small patient numbers (mean score change: 30.4 vs. 22.8, p=.25). Bowel symptom outcomes varied less. Conclusions: Patient-reported outcomes can provide sensitive and valid indicators of TA and QI that may contribute to optimal patient-centered care. [Table: see text] No significant financial relationships to disclose.

scholarly journals Design and feasibility of integrating personalized PRO dashboards into prostate cancer care

2015 ◽  
Vol 23 (1) ◽  
pp. 38-47 ◽  
Author(s):  
Andrea L Hartzler ◽  
Jason P Izard ◽  
Bruce L Dalkin ◽  
Sean P Mikles ◽  
John L Gore
Keyword(s):  
Prostate Cancer ◽  
Focus Groups ◽  
Cancer Care ◽  
Line Graphs ◽  
Patient Centered ◽  
Human Centered Design ◽  
Patient Reported ◽  
Related Quality ◽  
Centered Care ◽  
Health Related

Abstract Objective Patient-reported outcomes (PROs) are a valued source of health information, but prior work focuses largely on data capture without guidance on visual displays that promote effective PRO use in patient-centered care. We engaged patients, providers, and design experts in human-centered design of “PRO dashboards” that illustrate trends in health-related quality of life (HRQOL) reported by patients following prostate cancer treatment. Materials and Methods We designed and assessed the feasibility of integrating dashboards into care in 3 steps: (1) capture PRO needs of patients and providers through focus groups and interviews; (2) iteratively build and refine a prototype dashboard; and (3) pilot test dashboards with patients and their provider during follow-up care. Results Focus groups ( n = 60 patients) prioritized needs for dashboards that compared longitudinal trends in patients’ HRQOL with “men like me.” Of the candidate dashboard designs, 50 patients and 50 providers rated pictographs less helpful than bar charts, line graphs, or tables ( P &lt; .001) and preferred bar charts and line graphs most. Given these needs and the design recommendations from our Patient Advisory Board ( n = 7) and design experts ( n = 7), we built and refined a prototype that charts patients’ HRQOL compared with age- and treatment-matched patients in personalized dashboards. Pilot testing dashboard use ( n = 12 patients) improved compliance with quality indicators for prostate cancer care ( P &lt; .01). Conclusion PRO dashboards are a promising approach for integrating patient-generated data into prostate cancer care. Informed by human-centered design principles, this work establishes guidance on dashboard content, tailoring, and clinical use that patients and providers find meaningful.

Patient-reported outcomes for performance measurement: Multi-institution challenges.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 211-211
Author(s):  
Constance Barysauskas ◽  
Kristen K. McNiff ◽  
Stephen Flaherty ◽  
Mary Ellen Morba ◽  
Tracy E. Spinks ◽  
...  
Keyword(s):  
Performance Measurement ◽  
Patient Reported Outcomes ◽  
Quality Of Healthcare ◽  
Patient Centered ◽  
Aggregated Data ◽  
Cancer Centers ◽  
Care Experience ◽  
Patient Reported ◽  
Before And After ◽  
Centered Care

211 Background: Patient-reported outcomes (PROs) are self-reported measures of a patient’s health or healthcare experience. PRO utilization is driven by the movement toward patient-centered care and emerging evidence which suggests patients (pts) more involved in their care experience better outcomes. The infrastructure to capture PROs is evolving and PROs are now used for performance measurement (PM). PRO-PMs assess the quality of healthcare for improvement and/or accountability; but implementation is challenging. Success of PRO-PM requires identification of pts, ongoing data collection and data aggregation across institutions. The Alliance of Dedicated Cancer Centers (ADCC) identified challenges of PRO use for PM. Methods: The validated tool, Expanded Prostate Cancer Index Composite, evaluating pt function and bother from treatment (trt), administered to new localized prostate pts at three independent cancer centers was retrospectively collected. Surveys administered before and after trt measured change from trt. Results: Institutions implementing PROs following local standards resulted in a high degree of variation. The aggregated data presented challenges in identifying eligible pt populations who received surveys before and after trt within a timeframe. We identified a pragmatic and meaningful pt population and survey implementation window. Pts were stratified by center and trt modality for analysis. Conclusions: The aggregation of dissimilar data sources led to the identification of institution implementation and data capture differences, however, the ADCC identified variation for PRO measure development. Clear guidance, policies and procedures are essential to ensure adequate homogeneity and reduced variability, to assure meaningful PM and reduce confounding by institution. [Table: see text]

Patient-reported outcomes after open radical prostatectomy, laparoscopic radical prostatectomy and permanent prostate brachytherapy

2019 ◽  
Vol 49 (11) ◽  
pp. 1037-1042
Author(s):  
Katsuyoshi Hashine ◽  
Toshio Kakuda ◽  
Shunsuke Iuchi ◽  
Ryotaro Tomida ◽  
Masafumi Matsumura
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Patient Reported Outcomes ◽  
Bowel Function ◽  
Laparoscopic Radical Prostatectomy ◽  
Postoperative Phase ◽  
Prostate Brachytherapy ◽  
Urinary Function ◽  
Open Radical Prostatectomy ◽  
Patient Reported

Abstract Objective To assess patient-reported outcomes after open radical prostatectomy, laparoscopic radical prostatectomy and permanent prostate brachytherapy. Methods patient-reported outcomes were evaluated using Expanded Prostate Cancer Index Composite scores at baseline and 1, 3, 6, 12 and 36 months after treatment, respectively, using differences from baseline scores. Results Urinary function was the same in the three groups at baseline, but worse after surgery than after permanent prostate brachytherapy until 12 months, and similar after open radical prostatectomy and permanent prostate brachytherapy and better than after laparoscopic radical prostatectomy at 36 months. Urinary bother was significantly worse at 1 month after surgery, but better after open radical prostatectomy than after permanent prostate brachytherapy and laparoscopic radical prostatectomy at 3 months, after which symptoms improved gradually in all groups. Obstructive/irritative symptoms were worse after permanent prostate brachytherapy than after open radical prostatectomy at 36 months, and worse after laparoscopic radical prostatectomy until 6 months. Urinary incontinence was worse after surgery, particularly after 1 month. This symptom returned to the baseline level at 12 months after open radical prostatectomy, but recovery after laparoscopic radical prostatectomy was slower. Bowel function after permanent prostate brachytherapy was significantly worse than after surgery at 1 month and this continued until 6 months. Bowel bother was slightly worse at 3 and 6 months after permanent prostate brachytherapy compared to these time points after surgery. Conclusion Urinary function and bother were worst after laparoscopic radical prostatectomy, especially in the early postoperative phase, whereas urinary obstructive/irritative symptom, bowel function and bother were worse after permanent prostate brachytherapy. These findings are useful and informative for the treatment of patients with prostate cancer.

scholarly journals Using Patient-Reported Outcomes to Assess Healthcare Quality: Toward Better Measurement of Patient-Centered Care in Cardiovascular Disease

2021 ◽  
pp. e1-e9
Author(s):  
Raul Angel Garcia ◽  
John A Spertus
Keyword(s):  
Health Status ◽  
Patient Reported Outcomes ◽  
Health Management ◽  
Clinical Care ◽  
Healthcare Quality ◽  
Patient Centered Care ◽  
Patient Centered ◽  
Patient Reported ◽  
Centered Care

Patient-reported outcomes (PROs) are elicited directly from patients so they can describe their overall health status, including their symptoms, function, and quality of life. While commonly used as end points in clinical trials, PROs can play an important role in routine clinical care, population health management, and as a means for quantifying the quality of patient care. In this review, we propose that PROs be used to improve patient-centered care in the treatment of cardiovascular diseases given their importance to patients and society and their ability to improve doctor- provider communication. Furthermore, given the current variability in patients’ health status across different clinics and the fact that PROs can be improved by titrating therapy, we contend that PROs have a key opportunity to serve as measures of healthcare quality.

scholarly journals Exploring Pediatric Tele-Rheumatology Practices During COVID-19: A Survey of the PRCOIN Network

2021 ◽  
Vol 9 ◽  
Author(s):  
Y. Ingrid Goh ◽  
Danielle R. Bullock ◽  
Janalee Taylor ◽  
Rajdeep Pooni ◽  
Tzielan C. Lee ◽  
...  
Keyword(s):  
Pediatric Rheumatology ◽  
Patient Reported Outcomes ◽  
Healthcare Providers ◽  
Patient Centered ◽  
Patient Reported ◽  
Hands On ◽  
Centered Care ◽  
Virtual Visits ◽  
Continued Use

Healthcare providers were rapidly forced to modify the way they practiced medicine during the coronavirus disease 2019 (COVID-19) pandemic. Many providers transitioned from seeing their patients in person to virtually using telemedicine platforms with limited training and experience using this medium. In pediatric rheumatology, this was further complicated as musculoskeletal exams typically require hands-on assessment of patients. The objective of this study was to examine the adoption of telemedicine into pediatric rheumatology practices, to assess its benefits and challenges, and to gather opinions on its continued use. A survey was sent to the lead representatives of each Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN) site to collect data about their center's experience with telemedicine during the COVID-19 pandemic. Quantitative data were analyzed using descriptive statistics, and qualitative data were thematically analyzed. Responses were received from the majority [19/21 (90%)] of PR-COIN sites. All respondents reported transitioning from in-person to primarily virtual patient visits during the COVID-19 pandemic. All centers reported seeing both new consultations and follow-up patients over telemedicine. Most centers reported using both audio and video conferencing systems to conduct their telemedicine visits. The majority of respondents [13/19 (68%)] indicated that at least 50% of their site's providers consistently used pediatric Gait Arms Legs and Spine (pGALS) to perform active joint count assessments over telemedicine. Over half of the centers [11/19 (58%)] reported collecting patient-reported outcomes (PROs), but the rate of reliably documenting clinical components varied. A few sites [7/19 (37%)] reported performing research-related activity during telemedicine visits. All centers thought that telemedicine visits were able to meet providers' needs and support their continued use when the pandemic ends. Benefits reported with telemedicine visits included convenience and continuity of care for families. Conversely, challenges included limited ability to perform physical exams and varying access to technology. Pediatric rheumatology providers were able to transition to conducting virtual visits during the COVID-19 pandemic. Healthcare providers recognize how telemedicine can enhance their practice, but challenges need to be overcome in order to ensure equitable, sustainable delivery of quality and patient-centered care.

scholarly journals Imaging-based patient-reported outcomes (PROs) database: How we do it

2020 ◽  
Author(s):  
Soterios Gyftopoulos ◽  
Adam Jacobs ◽  
Mohammad Samim
Keyword(s):  
Patient Reported Outcomes ◽  
Treatment Guidelines ◽  
Evidence Base ◽  
National Standards ◽  
Medical Decision ◽  
Standards Of Care ◽  
Patient Centered ◽  
Patient Reported ◽  
Centered Care ◽  
The Impact

Abstract Patient-reported outcomes (PROs) provide an essential understanding of the impact a condition or treatment has on a patient, while complementing other, more traditional outcomes information like survival and time to symptom resolution. PROs have become increasingly important in medicine with the push toward patient-centered care. The creation of a PROs database within an institution or practice provides a way to collect, understand, and use this kind of patient feedback to inform quality improvement and develop the evidence base for medical decision-making and on a larger scale could potentially help determine national standards of care and treatment guidelines. This paper provides a first-hand account of our experience setting up an imaging-based PROs database at our institution and is organized into steps the reader can follow for creating a PROs database of their own. Given the limited use of PROs within both diagnostic and interventional radiology, we hope our paper stimulates a new interest among radiologists who may have never considered outcomes work in the past.

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