Scaling and Spreading Electronic Capture of Patient-Reported Outcomes Using a National Surgical Quality Improvement Program

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ABSTRACT Patient-reported outcomes (PROs) in ambulatory (outpatient or 23-hour stay) surgery are particularly important to measure because these procedures are generally elective, have low complication rates, and are performed to improve quality of life. However, the evaluation of PROs in ambulatory surgery is infrequent and remains isolated to a few large academic medical centers. Measuring PROs is an important yet unrealized strategy that has the potential to improve the quality of surgical care throughout the US. This proposal aims to use the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) to scale the routine, health IT-enabled capture of PROs for quality improvement nationally by leveraging the ACS NSQIP network of hospital Collaboratives to spread its uptake. We propose the following aims: (1) to demonstrate feasibility of widespread adoption of the routine, health IT-enabled capture of PROs from ambulatory surgical patients to at least 30 ACS NSQIP hospitals for quality improvement; (2) to identify and understand common (program-wide) and unique (institutional) best practices to spread the health IT-enabled PRO implementation; and (3) to explore the potential to identify quality improvement gaps with aggregated PROs measured as part of the scale and spread processes. To achieve Aim 1, we will utilize a web-based portal linked to the ACS NSQIP registry to collect PROs using three validated measures that assess patients’ care experiences, quality of life, and the impact of pain on their recovery. We will leverage the ACS NSQIP network of Collaboratives to spread PRO implementation across ACS NSQIP hospitals in two cohorts, moving from 14 to at least 30 hospitals over the study period. During and at the end of each cohort, we will identify, understand, and document best practices for implementation to achieve Aim 2. The PROs data collected will then be examined to determine utility for quality improvement to achieve Aim 3. Specifically, we will determine whether performance variation exists, and we will determine the sample sizes needed to identify reliable differences between hospitals that may subsequently spark quality improvement projects. The Institute for Healthcare Improvement’s Framework for Spread and Model for Improvement will be used for implementation and evaluation. The results of this study will inform key questions: Is national implementation feasible? What strategies will best facilitate the effective implementation of health IT-enabled capture of PROs for surgical quality improvement? How will these strategies differ based upon the environments and contexts in which this implementation is introduced and used? Can PROs identify quality improvement opportunities in patients undergoing ambulatory surgery?