Division of Cardiothoracic Surgery, Washington University in St. Louis School of Medicine, St Louis, Missouri.
James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital, Cincinnati, Ohio.
Ann Thorac Surg. 2022 Jun;113(6):1845-1852. doi: 10.1016/j.athoracsur.2021.05.091. Epub 2021 Jul 2.
Patient-reported outcomes are critical for delivering high-quality surgical care, yet they are seldom collected in routine clinical practice. The objective of this quality improvement study was to improve routine patient-reported outcomes collection in a thoracic surgery clinic.
Thoracic surgery patients at a single academic institution were prospectively monitored from April 2019 to March 2020. The National Institutes of Health-validated Patient-Reported Outcomes Measurement Information System (PROMIS) was used. Using a Model for Improvement design and through multidisciplinary participant observation, we performed multiple plan-do-study-act cycles, an iterative, 4-stage model for rapidly testing interventions, to improve routine collection reliability.
During the study period, 2315 patient visits occurred. The baseline PROMIS assessment collection rate was 53%. After convening a multidisciplinary stakeholder team, the key drivers for PROMIS collection were having engaged staff, engaged patients, adequate technological capacity, and adequate time for survey completion, including when to complete the survey during the patient visits. Regular meetings between stakeholders were initiated to promote these key drivers. Several plan-do-study-act cycles were then used to test different interventions, resulting in several positive system shifts, as demonstrated on a statistical process control chart. Adherence to survey collection reached 91% of office visits by approximately 7 months, a 72% relative improvement, which was sustained.
Routine collection of patient-reported outcomes, such as PROMIS, are critical for improving thoracic surgical care. Our study shows that reliably collecting these data is possible in a clinical setting with minimal additional hospital resources.
患者报告的结果对于提供高质量的外科护理至关重要，但它们在常规临床实践中很少被收集。本质量改进研究的目的是提高胸外科诊所常规患者报告结果的收集。
从 2019 年 4 月到 2020 年 3 月，对一家学术机构的胸外科患者进行了前瞻性监测。使用了经过美国国立卫生研究院验证的患者报告结果测量信息系统（PROMIS）。通过使用改进模型设计和多学科参与者观察，我们进行了多次计划-执行-研究-行动循环，这是一种快速测试干预措施的迭代、四阶段模型，以提高常规收集的可靠性。
在研究期间，共发生了 2315 次就诊。PROMIS 评估收集率的基线为 53%。在召集一个多学科利益相关者团队后，PROMIS 收集的关键驱动因素是有敬业的员工、有参与意识的患者、足够的技术能力和足够的时间完成调查，包括在患者就诊期间何时完成调查。启动了利益相关者之间的定期会议，以促进这些关键驱动因素。然后使用了几个计划-执行-研究-行动循环来测试不同的干预措施，结果显示在统计过程控制图上有几个积极的系统转变。大约在 7 个月的时间里，通过定期会议，调查收集的依从性达到了 91%的门诊就诊率，相对提高了 72%，并持续保持。
常规收集患者报告的结果，如 PROMIS，对于改善胸外科护理至关重要。我们的研究表明，在不需要额外医院资源的情况下，在临床环境中可靠地收集这些数据是可行的。
