A Review of PROM Implementation in Surgical Practice

Abstract

Objective: To synthesize the current state of PROM implementation and collection in routine surgical practice through a review of the literature.

Summary of background data: Patient-reported outcomes (PROs) are increasingly relevant in the delivery of high quality, individualized patient care. For surgeons, PROMs can provide valuable insight into changes in patient quality of life before and after surgical interventions. Despite consensus within the surgical community regarding the promise of PROMs, little is known about their real-world implementation.

Methods: The literature search was conducted in MEDLINE and Embase for studies published after 2012. We conducted a scoping review to synthesize the current state of implementation of PROs across all sizes and types of surgical practices. Studies were included if they met the following inclusion criteria: (1) patients ≥18 years 2) routine surgical practice, (3) use of a validated PRO instrument in the peri-operative period to report on general or disease-specific health-related quality of life, (4) primary or secondary outcome was implementation. Two independent reviewers screened 1524 titles and abstracts.

Findings: 16 studies were identified that reported on the implementation of PROMs for surgical patients. Sample size ranged from 41 patients in a single-center pilot study to 1324 patients in a study across 17 institutions. PROs were collected pre-operatively in 3 studies, post-operatively in 10, and at unspecified times in 4. The most commonly reported implementation outcomes were fidelity (12) and feasibility (11). Less than half of studies analyzed nonrespondents. All studies concluded that collection of PROMs was successful based on outcomes measured.

Conclusions: The identified studies suggest that implementation metrics including minimum standards of collection pre- and postintervention, reporting for response rates in the context of patient eligibility and analysis of respondents and nonrespondents, in addition to transparency regarding the resources utilized and cost, can facilitate adoption of PROMs in clinical care and accountability for surgical outcomes.