Brigham and Woman's Hospital, Center for Surgery and Public Health, Boston, Massachusetts.
Brigham and Woman's Hospital, Patient Reported Outcomes, Value and Experience Center, Boston, Massachusetts.
Ann Surg. 2022 Jan 1;275(1):85-90. doi: 10.1097/SLA.0000000000005029.
To synthesize the current state of PROM implementation and collection in routine surgical practice through a review of the literature.
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.
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.
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.
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.
通过文献回顾，综合目前常规外科实践中实施和收集患者报告结局（PROM）的现状。
患者报告的结果（PROM）在提供高质量、个体化患者护理方面越来越重要。对于外科医生来说，PROM 可以提供有价值的信息，了解患者在手术干预前后生活质量的变化。尽管外科医生群体对 PROM 的前景达成共识，但对其实际应用知之甚少。
在 MEDLINE 和 Embase 中进行了 2012 年后发表的文献检索。我们进行了范围综述，以综合所有规模和类型的外科实践中实施 PROM 的现状。如果研究符合以下纳入标准，则将其纳入：（1）患者年龄≥18 岁；（2）常规外科实践；（3）在围手术期使用经过验证的 PROM 工具报告一般或疾病特异性健康相关生活质量；（4）主要或次要结局为实施。两名独立的审查员筛选了 1524 篇标题和摘要。
确定了 16 项研究报告了外科患者 PROM 的实施情况。样本量从单个中心的试点研究中的 41 例到 17 个机构的研究中的 1324 例不等。3 项研究在术前收集 PROM，10 项研究在术后收集，4 项研究在未指定时间收集。报告最多的实施结果是保真度（12）和可行性（11）。不到一半的研究分析了无应答者。所有研究都根据测量的结果得出结论，认为收集 PROM 是成功的。
确定的研究表明，实施指标包括在干预前后进行最低限度的收集标准，在患者资格范围内报告反应率，并分析应答者和无应答者，以及关于利用资源和成本的透明度，可以促进 PROM 在临床护理中的采用，并对手术结果负责。
