Implementation and Effectiveness of Patient Reported Outcome Measures for Peripheral Arterial Disease

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ABSTRACT Peripheral artery disease (PAD) is the one of the most common causes of morbidity and mortality for adults in the United States. The number of patients needing surgical management for this condition is expected to nearly double over the next 30-years. Patients with symptomatic PAD are referred to vascular surgeons who have two potential treatment options: operative management via revascularization or non-operative management via supervised exercise therapy. Despite symptomatic relief as the primary goal for treatment, there are no objective outcomes used in PAD care to reflect patient’s perspective. Patient reported outcome measures (PROMs) are validated, robust tools that objectively measure patient outcomes from the patient perspective and help deliver patient-centered care. PROMs are used to monitor health changes across other medical conditions and contexts, the utility of PROMs in patients with PAD has not been well-established. Traditionally, vascular surgeons have used objective metrics, like ankle-brachial index (ABI) blood flow measurements, to evaluate progress and determine the success of an intervention. Despite the widespread availability of PROMs, it is presently unclear how these metrics can be used to in the clinic workflow and healthcare delivery of patients with PAD. The central goal of this research is to develop a successful implementation strategy for PROMs as a patient voice into routine clinical care for PAD. More specifically, we will examine how changes in physical function PROMs and ABI influence each other dynamically over time (Aim 1.1) and then compare PROM changes over time for physical function, depression, and social engagement in activities among operative and non-operative PAD patients (Aim 1.2). Next, we will obtain patient perceptions and value of PROMs in PAD care using semi- structured patient interviews (Aim 2). Finally, using a multilevel stakeholder advisory panel we will design a strategy for implementing PROMs into routine clinical workflow for PAD patients using a modified-Delphi approach (Aim 3). These data will provide essential contextual components (Aims 1 & 2) to help design a successful strategy for PROMs (Aim 3) into routine clinical practice for patients with PAD. This work will lay the foundation for future implementation efforts focused on use of PROMs at our institution and others. Our team is uniquely qualified to carry out this research. We have prospectively collected PROMs since 2016 for research and have the resources and clinical environment to implement changes in clinical practice. While executing these aims, I will gain valuable knowledge using qualitative research methods, trajectory analysis, and established implementation science frameworks. With the support of my mentorship team and the NRSA fellowship, I will attain a unique skillset at the intersection of implementation science, surgery, and patient care that will provide a solid foundation for future success as a vascular surgeon-scientist.