Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Lineberger Comprehensive Cancer Center, Chapel Hill, NC.
JCO Oncol Pract. 2020 Mar;16(3):e234-e250. doi: 10.1200/JOP.19.00784. Epub 2020 Feb 19.
Patient-reported outcome measures (PROMs) that assess how patients feel and function have potential for evaluating quality of care. Stakeholder recommendations for PRO-based performance measures (PMs) were elicited, and feasibility testing was conducted at six cancer centers.
Interviews were conducted with 124 stakeholders to determine priority symptoms and risk adjustment variables for PRO-PMs and perceived acceptability. Stakeholders included patients and advocates, caregivers, clinicians, administrators, and thought leaders. Feasibility testing was conducted in six cancer centers. Patients completed PROMs at home 5-15 days into a chemotherapy cycle. Feasibility was operationalized as ≥ 75% completed PROMs and ≥ 75% patient acceptability.
Stakeholder priority PRO-PMs for systemic therapy were GI symptoms (diarrhea, constipation, nausea, vomiting), depression/anxiety, pain, insomnia, fatigue, dyspnea, physical function, and neuropathy. Recommended risk adjusters included demographics, insurance type, cancer type, comorbidities, emetic risk, and difficulty paying bills. In feasibility testing, 653 patients enrolled (approximately 110 per site), and 607 (93%) completed PROMs, which indicated high feasibility for home collection. The majority of patients (470 of 607; 77%) completed PROMs without a reminder call, and 137 (23%) of 607 completed them after a reminder call. Most patients (72%) completed PROMs through web, 17% paper, or 2% interactive voice response (automated call that verbally asked patient questions). For acceptability, > 95% of patients found PROM items to be easy to understand and complete.
Clinicians, patients, and other stakeholders agree that PMs that are based on how patients feel and function would be an important addition to quality measurement. This study also shows that PRO-PMs can be feasibly captured at home during systemic therapy and are acceptable to patients. PRO-PMs may add value to the portfolio of PMs as oncology transitions from fee-for-service payment models to performance-based care that emphasizes outcome measures.
评估患者感受和功能的患者报告结局测量（PROM）有可能用于评估护理质量。本研究旨在确定基于患者报告结果的绩效测量（PM）的优先症状和风险调整变量，并在六个癌症中心进行可行性测试。
对 124 名利益相关者进行了访谈，以确定用于 PRO-PM 的优先症状和风险调整变量，以及对其的可接受性的看法。利益相关者包括患者和患者代言人、护理人员、临床医生、管理人员和思想领袖。在六个癌症中心进行了可行性测试。患者在化疗周期的第 5-15 天在家中完成 PROM。将可行性定义为≥75%的患者完成了 PROM，且≥75%的患者认可。
系统治疗的利益相关者优先考虑的 PRO-PM 是胃肠道症状（腹泻、便秘、恶心、呕吐）、抑郁/焦虑、疼痛、失眠、疲劳、呼吸困难、身体功能和周围神经病变。建议的风险调整因素包括人口统计学特征、保险类型、癌症类型、合并症、催吐风险和支付账单的困难。在可行性测试中，共有 653 名患者入组（每个中心约 110 名），其中 607 名（93%）完成了 PROM，这表明在家中收集数据具有很高的可行性。大多数患者（470/607；77%）无需提醒电话即可完成 PROM，而 137 名（23%）患者在收到提醒电话后完成了 PROM。大多数患者（72%）通过网络完成 PROM，17%通过纸质完成，2%通过交互式语音应答（自动电话，以口头询问患者问题）完成。对于可接受性，超过 95%的患者认为 PROM 项目易于理解和完成。
临床医生、患者和其他利益相关者一致认为，基于患者感受和功能的 PM 将是质量测量的重要补充。本研究还表明，在系统治疗期间，患者可以在家中方便地完成 PRO-PM，且患者易于接受。随着肿瘤学从按服务收费的支付模式向强调结果测量的基于绩效的护理模式转变，PRO-PM 可能会增加 PM 组合的价值。
