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Developing Patient-Centered Outcomes Metrics for Abdominal Surgery

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Abstract

As surgery enters the era of patient-centered care, it is advocated that postoperative recovery be measured using patient-reported outcome measures (PROMs) as they provide a means to incorporate patients’ perspectives and experiences into research and clinical decision-making. In comparison with traditional measures of surgical outcomes, such as length of hospital stay and complication rates, PROMs have the advantage of allowing a broad assessment of recovery across various health domains, engaging patients as the key stakeholders in the recovery process. In this chapter, we provide an overview about PROMs, how they are developed, and summarize current evidence- and consensus-based recommendations for the use of PROMs in surgical care. There is a great deal of research to be done before PROMs are fully embraced by all stakeholders in surgery; however, the integration of PROM data in research and in daily practice has a great potential to transform how we provide care for surgical patients.

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References

  1. Mayo NE. Dictionary of quality of life and health outcomes measurement. 1st ed. Milwaukee: ISOQOL; 2015.

    Google Scholar 

  2. Barry MJ, Edgman-Levitan S. Shared decision making — the pinnacle of patient-centered care. N Engl J Med. 2012;366(9):780–1.

    Article  CAS  PubMed  Google Scholar 

  3. Gabriel SE, Normand S-LT. Getting the methods right — the foundation of patient-centered outcomes research. N Engl J Med. 2012;367(9):787–90.

    Article  CAS  PubMed  Google Scholar 

  4. Greene J, Hibbard JH. Why does patient activation matter? An examination of the relationships between patient activation and health-related outcomes. J Gen Intern Med. 2012;27(5):520–6.

    Article  PubMed  Google Scholar 

  5. Marshall R, Beach MC, Saha S, et al. Patient activation and improved outcomes in HIV-infected patients. J Gen Intern Med. 2013;28(5):668–74.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Munson GW, Wallston KA, Dittus RS, Speroff T, Roumie CL. Activation and perceived expectancies: correlations with health outcomes among veterans with inflammatory bowel disease. J Gen Intern Med. 2009;24(7):809–15.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Gray M, Meakins JL. Evidence-based surgical practice and patient-centered care: inevitable. Surg Clin North Am. 2006;86(1):217–20.

    Article  PubMed  Google Scholar 

  8. Borza T, Oerline MK, Skolarus TA, et al. Association of the hospital readmissions reduction program with surgical readmissions. JAMA Surg. 2018;153(3):243–50.

    Article  PubMed  Google Scholar 

  9. Lee L, Tran T, Mayo NE, Carli F, Feldman LS. What does it really mean to “recover” from an operation? Surgery. 2014;155(2):211–6.

    Article  PubMed  Google Scholar 

  10. Desborough JP. The stress response to trauma and surgery. Br J Anaesth. 2000;85(1):109–17.

    Article  CAS  PubMed  Google Scholar 

  11. Wilmore DW. From Cuthbertson to fast-track surgery: 70 years of progress in reducing stress in surgical patients. Ann Surg. 2002;236(5):643–8.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Zhang LM, Hornor MA, Robinson T, Rosenthal RA, Ko CY, Russell MM. Evaluation of postoperative functional health status decline among older adults. JAMA Surg. 2020;155(10):950–8.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Stabenau HF, Becher RD, Gahbauer EA, Leo-Summers L, Allore HG, Gill TM. Functional trajectories before and after major surgery in older adults. Ann Surg. 2018;268(6):911–7.

    Article  PubMed  Google Scholar 

  14. Lawrence VA, Hazuda HP, Cornell JE, et al. Functional independence after major abdominal surgery in the elderly. J Am Coll Surg. 2004;199(5):762–72.

    Article  PubMed  Google Scholar 

  15. Lee L, Mata J, Ghitulescu GA, et al. Cost-effectiveness of enhanced recovery versus conventional perioperative management for colorectal surgery. Ann Surg. 2015;262(6):1026–33.

    Article  PubMed  Google Scholar 

  16. Berg K, Arestedt K, Kjellgren K. Postoperative recovery from the perspective of day surgery patients: a phenomenographic study. Int J Nurs Stud. 2013;50(12):1630–8.

    Article  PubMed  Google Scholar 

  17. Nilsson U, Jaensson M, Hugelius K, Arakelian E, Dahlberg K. A journey to a new stable state—further development of the postoperative recovery concept from day surgical perspective: a qualitative study. BMJ Open. 2020;10(9):e037755.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Kleinbeck SVM, Hoffart N. Outpatient recovery after laparoscopic cholecystectomy. AORN J. 1994;60(3):394–8.

    Article  CAS  PubMed  Google Scholar 

  19. Lee L, Dumitra T, Fiore J Jr, Mayo N, Feldman L. How well are we measuring postoperative “recovery” after abdominal surgery? Qual Life Res. 2015;24:1–8.

    Google Scholar 

  20. Ljungqvist O, Rasmussen LS. Recovery after anaesthesia and surgery. Acta Anaesthesiol Scand. 2014;58(6):639–41.

    Article  CAS  PubMed  Google Scholar 

  21. Antonescu I, Mueller CL, Fried GM, Vassiliou MC, Mayo NE, Feldman LS. Outcomes reported in high-impact surgical journals. Br J Surg. 2014;101(5):582–9.

    Article  CAS  PubMed  Google Scholar 

  22. Miller T, Mythen M. Successful recovery after major surgery: moving beyond length of stay. Perioper Med. 2014;3(1):4.

    Article  Google Scholar 

  23. Davidson GH, Haukoos JS, Feldman LS. Practical guide to assessment of patient-reported outcomes. JAMA Surg. 2020;155(5):432–3.

    Article  PubMed  Google Scholar 

  24. U.S. Department of Health and Human Services Food and Drug Administration. Guidance for Industry. Patient-reported outcome measures: use in medical product development to support labeling claims. http://www.fda.gov/downloads/Drugs/Guidances/UCM193282.pdf. Published 2009. Accessed 23 Sept 2020.

  25. Olsen JA, Misajon R. A conceptual map of health-related quality of life dimensions: key lessons for a new instrument. Qual Life Res. 2020;29(3):733–43.

    Article  PubMed  Google Scholar 

  26. Ware JE Jr. SF-36 health survey. In: The use of psychological testing for treatment planning and outcomes assessment. 2nd ed. Mahwah: Lawrence Erlbaum Associates Publishers; 1999. p. 1227–46.

    Google Scholar 

  27. Ustün TB, Chatterji S, Kostanjsek N, et al. Developing the World Health Organization disability assessment schedule 2.0. Bull World Health Organ. 2010;88(11):815–23.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Black N. Patient reported outcome measures could help transform healthcare. BMJ. 2013;346:f167.

    Article  PubMed  Google Scholar 

  29. Rabin R, Charro F. EQ-SD: a measure of health status from the EuroQol Group. Ann Med. 2001;33(5):337–43.

    Article  CAS  PubMed  Google Scholar 

  30. Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. JNCI. 1993;85(5):365–76.

    Article  CAS  PubMed  Google Scholar 

  31. Myles PS. More than just morbidity and mortality – quality of recovery and long-term functional recovery after surgery. Anaesthesia. 2020;75(S1):e143–50.

    Article  PubMed  Google Scholar 

  32. Fiore JF Jr, Figueiredo S, Balvardi S, et al. How do we value postoperative recovery?: a systematic review of the measurement properties of patient-reported outcomes after abdominal surgery. Ann Surg. 2018;267(4):656–69.

    Article  PubMed  Google Scholar 

  33. Patrick DL, Burke LB, Gwaltney CJ, et al. Content validity—establishing and reporting the evidence in newly developed patient-reported outcomes (PRO) instruments for medical product evaluation: ISPOR PRO good research practices task force report: part 1—eliciting concepts for a new PRO instrument. Value Health. 2011;14(8):967–77.

    Article  PubMed  Google Scholar 

  34. Patrick DL, Burke LB, Gwaltney CJ, et al. Content validity—establishing and reporting the evidence in newly developed patient-reported outcomes (PRO) instruments for medical product evaluation: ISPOR PRO good research practices task force report: part 2—assessing respondent understanding. Value Health. 2011;14(8):978–88.

    Article  PubMed  Google Scholar 

  35. Mokkink LB, Terwee CB, Patrick DL, et al. The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes. J Clin Epidemiol. 2010;63(7):737–45.

    Article  PubMed  Google Scholar 

  36. Terwee CB, Prinsen CAC, Chiarotto A, et al. COSMIN methodology for evaluating the content validity of patient-reported outcome measures: a Delphi study. Qual Life Res. 2018;27(5):1159–70.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Alam R, Montanez J, Law S, et al. Development of a conceptual framework of recovery after abdominal surgery. Surg Endosc. 2020;34(6):2665–74.

    Article  PubMed  Google Scholar 

  38. Petrillo J, Cano SJ, McLeod LD, Coon CD. Using classical test theory, item response theory, and Rasch measurement theory to evaluate patient-reported outcome measures: a comparison of worked examples. Value Health. 2015;18(1):25–34.

    Article  PubMed  Google Scholar 

  39. Pallant JF, Tennant A. An introduction to the Rasch measurement model: an example using the Hospital Anxiety and Depression Scale (HADS). Br J Clin Psychol. 2007;46(1):1–18.

    Article  PubMed  Google Scholar 

  40. Tennant A, Conaghan PG. The Rasch measurement model in rheumatology: what is it and why use it? When should it be applied, and what should one look for in a Rasch paper? Arthritis Care Res. 2007;57(8):1358–62.

    Article  Google Scholar 

  41. Hobart JC, Cano SJ, Zajicek JP, Thompson AJ. Rating scales as outcome measures for clinical trials in neurology: problems, solutions, and recommendations. Lancet Neurol. 2007;6(12):1094–105.

    Article  PubMed  Google Scholar 

  42. Hung M, Stuart AR, Higgins TF, Saltzman CL, Kubiak EN. Computerized adaptive testing using the PROMIS physical function item bank reduces test burden with less ceiling effects compared with the short musculoskeletal function assessment in orthopaedic trauma patients. J Orthop Trauma. 2014;28(8):439–43.

    Article  PubMed  Google Scholar 

  43. Gibbons RD, Weiss DJ, Kupfer DJ, et al. Using computerized adaptive testing to reduce the burden of mental health assessment. Psychiatr Serv. 2008;59(4):361–8.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Meijer RR, Nering ML. Computerized adaptive testing: overview and introduction. Appl Psychol Meas. 1999;23(3):187–94.

    Article  Google Scholar 

  45. Revicki DA, Cella DF. Health status assessment for the twenty-first century: item response theory, item banking and computer adaptive testing. Qual Life Res. 1997;6(6):595–600.

    Article  CAS  PubMed  Google Scholar 

  46. Mokkink LB, de Vet HCW, Prinsen CAC, et al. COSMIN risk of bias checklist for systematic reviews of patient-reported outcome measures. Qual Life Res. 2018;27(5):1171–9.

    Article  CAS  PubMed  Google Scholar 

  47. Mokkink LB, Terwee CB, Patrick DL, et al. The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study. Qual Life Res. 2010;19(4):539–49.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Reeve BB, Wyrwich KW, Wu AW, et al. ISOQOL recommends minimum standards for patient-reported outcome measures used in patient-centered outcomes and comparative effectiveness research. Qual Life Res. 2013;22(8):1889–905.

    Article  PubMed  Google Scholar 

  49. Alam R, Figueiredo SM, Balvardi S, et al. Development of a patient-reported outcome measure of recovery after abdominal surgery: a hypothesized conceptual framework. Surg Endosc. 2018;32(12):4874–85.

    Article  PubMed  Google Scholar 

  50. Stark PA, Myles PS, Burke JA. Development and psychometric evaluation of a postoperative quality of recovery score: the QoR-15. Anesthesiology. 2013;118(6):1332–40.

    Article  PubMed  Google Scholar 

  51. World Health Organization. Measuring health and disability: manual for WHO Disability Assessment Schedule (WHODAS 2.0). Geneva: World Health Organization; 2012.

    Google Scholar 

  52. Intro to PROMIS. https://www.healthmeasures.net/explore-measurement-systems/promis/intro-to-promis. Accessed 17 Nov 2020.

  53. Jammer I, Wickboldt N, Sander M, et al. Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European Perioperative Clinical Outcome (EPCO) definitions: a statement from the ESA-ESICM joint taskforce on perioperative outcome measures. Eur J Anaesthesiol. 2015;32(2):88–105.

    Article  PubMed  Google Scholar 

  54. Myles PS, Boney O, Botti M, et al. Systematic review and consensus definitions for the Standardised Endpoints in Perioperative Medicine (StEP) initiative: patient comfort. Br J Anaesth. 2018;120(4):705–11.

    Article  CAS  PubMed  Google Scholar 

  55. Moonesinghe SR, Jackson AIR, Boney O, et al. Systematic review and consensus definitions for the Standardised Endpoints in Perioperative Medicine initiative: patient-centred outcomes. Br J Anaesth. 2019;123(5):664–70.

    Article  CAS  PubMed  Google Scholar 

  56. Loftus TJ, Tighe PJ, Filiberto AC, et al. Artificial intelligence and surgical decision-making. JAMA Surg. 2020;155(2):148–58.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Coons SJ, Eremenco S, Lundy JJ, O’Donohoe P, O’Gorman H, Malizia W. Capturing patient-reported outcome (PRO) data electronically: the past, present, and promise of ePRO measurement in clinical trials. Patient. 2015;8(4):301–9.

    Article  PubMed  Google Scholar 

  58. Ganser AL, Raymond SA, Pearson JD. Data quality and power in clinical trials: a comparison of ePRO and paper in a randomized trial. In: ePRO: electronic solutions for patient-reporteddata. Surray: Gower; 2010. p. 49–78.

    Google Scholar 

  59. Cook KF, O’Malley KJ, Roddey TS. Dynamic assessment of health outcomes: time to let the CAT out of the bag? Health Serv Res. 2005;40(5p2):1694–711.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Ross J, Holzbaur E, Wade M, Rothrock T. Patient preferences: pro mixed modes – Epro versus paper. Value Health. 2014;17(7):A515.

    Article  CAS  PubMed  Google Scholar 

  61. Coons SJ, Gwaltney CJ, Hays RD, et al. Recommendations on evidence needed to support measurement equivalence between electronic and paper-based patient-reported outcome (PRO) measures: ISPOR ePRO good research practices task force report. Value Health. 2009;12(4):419–29.

    Article  PubMed  Google Scholar 

  62. Gwaltney CJ, Shields AL, Shiffman S. Equivalence of electronic and paper-and-pencil administration of patient-reported outcome measures: a meta-analytic review. Value Health. 2008;11(2):322–33.

    Article  PubMed  Google Scholar 

  63. Harniss M, Amtmann D, Cook D, Johnson K. Considerations for developing interfaces for collecting patient-reported outcomes that allow the inclusion of individuals with disabilities. Med Care. 2007;45(5):S48–54.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Wu AW, Kharrazi H, Boulware LE, Snyder CF. Measure once, cut twice—adding patient-reported outcome measures to the electronic health record for comparative effectiveness research. J Clin Epidemiol. 2013;66(8, Supplement):S12–20.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Flum DR, Alfonso-Cristancho R, Devine EB, et al. Implementation of a “real-world” learning health care system: Washington state’s comparative effectiveness research translation network (CERTAIN). Surgery. 2014;155(5):860–6.

    Article  PubMed  Google Scholar 

  66. Medicine Io. Patients charting the course: citizen engagement and the learning health system: workshop summary. Washington, DC: The National Academies Press; 2011.

    Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Surgery, McGill University, Montreal, QC, Canada

    Julio F. Fiore & Liane S. Feldman

  2. Department of Systems and Computer Engineering, Carleton University, Ottawa, ON, Canada

    Fateme Rajabiyazdi

Authors
  1. Julio F. Fiore
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  2. Fateme Rajabiyazdi
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  3. Liane S. Feldman
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Corresponding author

Correspondence to Julio F. Fiore .

Editor information

Editors and Affiliations

  1. Department of Surgery, University of Massachusetts Chan Medical School - Baystate, Medical Center, Springfield, MA, USA

    John R. Romanelli

  2. Department of Surgery, Inova Fairfax Medical Campus, Falls Church, VA, USA

    Jonathan M. Dort

  3. Department of Surgery, Lenox Hill Hospital, New York, NY, USA

    Rebecca B. Kowalski

  4. Department of Surgery, NYU Langone Medical Center, Brooklyn, NY, USA

    Prashant Sinha

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Fiore, J.F., Rajabiyazdi, F., Feldman, L.S. (2022). Developing Patient-Centered Outcomes Metrics for Abdominal Surgery. In: Romanelli, J.R., Dort, J.M., Kowalski, R.B., Sinha, P. (eds) The SAGES Manual of Quality, Outcomes and Patient Safety. Springer, Cham. https://doi.org/10.1007/978-3-030-94610-4_14

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  • DOI: https://doi.org/10.1007/978-3-030-94610-4_14

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