For the past nine years, the Surgical Outcomes and Applied Research (SOAR) group at the University of Colorado School of Medicine has been conducting research on health services within the Department of Surgery. A large part of that research has to do with clinical outcomes for surgery patients and how patients fare — in the short term and the long term — after an operation. Members of SOAR recently published a paper looking at how patient-reported outcomes (PROs) can help surgeons keep tabs on how patients are recovering after a surgical procedure.
“Patient-reported outcomes give patients a voice in their care,” says Robert Meguid, MD, MPH, FACS, who published the study along with CU School of Medicine faculty members William Henderson, MPH, PhD, Anne Lambert-Kerzner, PhD, MSPH, Michael Bronsert, PhD MS, and Karl Hammermeister, MD. “I see it as furthering the partnership between patients and providers in those patients’ care. We are getting improved buy-in from the patients in the care delivered to them, and getting improved engagement from the providers, that the care they’re delivering is what the patients truly want.”
Information gathering
To gather the data, SOAR researchers interviewed patients just before a surgery to get a baseline score on 13 different measures, including cognitive function, pain level, fatigue, depression, and general life satisfaction. The 13 categories were drawn from a larger list of 60 measures, created by the National Institutes of Health, called the Patient-Reported Outcome Measurement Information System (PROMIS). A follow-up survey was mailed to the patients four weeks after the surgery to see how their scores had changed.
A total of 393 patients completed the preoperative survey, and 239 completed the survey that was sent to them weeks after their surgery. SOAR researchers found that postoperative scores for physical function, pain, and cognitive function worsened significantly, but mental scores did not. Those results are expected, Meguid says, but what he didn’t expect is how interested patients would be in sharing their feedback.
“That response rate is much higher than we expect from typical survey data where you typically get 15% to 20% of people responding, not over 60%,” he says. “That tells me that patients want their voice to be heard by their providers. It prompts us to say, ‘Why don’t we collect data over longer periods of time on patients after their operation so we can make sure patients get back to the baseline they want and we want them to be at?’”
Encouraging the use of PROs
The researchers shared their findings in the Journal of Surgical Research in hopes that other surgeons will start to use PROs to keep track of patients’ progress after surgery. Ideally, Meguid says, postoperative surveys would be sent at several time points after a surgery, and a surgeon would be alerted if a patient’s scores worsen significantly or fail to rise to an expected level in a certain period of time. Based on the SOAR group’s results, he advises that surgeons pay attention to access issues, such as creating a version of the survey in Spanish for Hispanic patients and designing delivery methods that don’t rely on computer access.
“With patients who have limited and underrepresented access to health care, it goes to show that there is a continued need for their access and engagement to be improved so they can have as optimal outcomes as we want them to,” he says.
Meguid also advises using a small number of measures to ease the burden on patients, and to pick measures that are significantly different from one another to optimize the spectrum of data being collected.
“This study changed my personal practice of patient care,” he says. “I now follow patients sooner after they go home, and I follow them longer. When patients feel heard, they’re more engaged in their care and they know we are more engaged in their care as providers, so that synergistically improves their desire to continue to recover. We suspected this before, but now we better understand this.”
