Abstract P3-11-03: Use of real-time patient reported outcomes to improve performance in breast surgery
Authors: Whitacre EB , Moore MN 
Published: March 2017

Background: Patient reported outcomes (PRO's) are important to the new health care delivery system but can be difficult to obtain, especially in real-time. The purpose of this project was to demonstrate that 1) An office based iPad patient survey mechanism can obtain PRO's effectively and efficiently; 2) Real time reporting of outcomes to a national database can identify potential gaps in care compared to a peer group of surgeons; 3) Rapid reporting can be used to assess the impact of changes in clinical practice.

Methods: The American Society of Breast Surgeons has a HIPAA secure quality-reporting program for breast surgery which has a parallel secure web site to collect PRO's for patients undergoing breast surgical procedures. Based on patient responses, the physician site reports aggregate PRO's for mastectomy, lumpectomy and breast biopsy, comparing each physicians results with his/her peers. The existing patient survey site utilizes an email invitation and response system, but has only a 34% response rate.

Review of the existing data before beginning the project showed that the lowest score for the participating surgeon (EBW) was in response to the question following mastectomy: "During your office visit, did your surgeon or your surgeon's staff discuss what to expect with care and recovery after surgery?" with an 83% positive response compared to 88% for the aggregate in 2014. To address this, the following clinical changes were made beginning in 2016: 1) Additional emphasis on the expected post op course during initial cancer talk with the patient, 2) a phone call by the surgeon 1-2 days before mastectomy to address any additional questions, 3) a phone call by the surgeon 1-2 days after surgery. In addition, in order to improve the patient response rate, the patient survey was adapted to an iPad, allowing patients to complete the survey in the office at the time of their post operative visit.

Results: The iPad system resulted in a 98% response rate compared to 34% for the email based system. Median time to complete the survey was less than 2 minutes and required no additional staff time, office space, or equipment (other than the iPad itself.) Most patients were very pleased with the iPad platform, although some older patients had difficulty seeing the screen or navigating the touch screen. The high response rate resulted in a very rapid change in the reported PRO's, showing within less than 4 months, that the clinical changes focusing on patient concerns over post operative mastectomy care were successfully addressed, with and increase from 83% to 94% satisfaction for that particular outcome measure.

Conclusion: This study demonstrates that an office based iPad patient survey, linked to a national quality database reporting surgical care, can be used to identify gaps in care, and can then be used to rapidly assess the impact of implemented clinical changes. This is not possible with other national web sites attempting to report quality (e.g. Physician Compare, Health Grades, Vitals), and should be considered for future programs to improve reporting and actionability of PRO's.Background: Patient reported outcomes (PRO's) are important to the new health care delivery system but can be difficult to obtain, especially in real-time. The purpose of this project was to demonstrate that 1) An office based iPad patient survey mechanism can obtain PRO's effectively and efficiently; 2) Real time reporting of outcomes to a national database can identify potential gaps in care compared to a peer group of surgeons; 3) Rapid reporting can be used to assess the impact of changes in clinical practice.

Methods: The American Society of Breast Surgeons has a HIPAA secure quality-reporting program for breast surgery which has a parallel secure web site to collect PRO's for patients undergoing breast surgical procedures. Based on patient responses, the physician site reports aggregate PRO's for mastectomy, lumpectomy and breast biopsy, comparing each physicians results with his/her peers. The existing patient survey site utilizes an email invitation and response system, but has only a 34% response rate.

Review of the existing data before beginning the project showed that the lowest score for the participating surgeon (EBW) was in response to the question following mastectomy: "During your office visit, did your surgeon or your surgeon's staff discuss what to expect with care and recovery after surgery?" with an 83% positive response compared to 88% for the aggregate in 2014. To address this, the following clinical changes were made beginning in 2016: 1) Additional emphasis on the expected post op course during initial cancer talk with the patient, 2) a phone call by the surgeon 1-2 days before mastectomy to address any additional questions, 3) a phone call by the surgeon 1-2 days after surgery. In addition, in order to improve the patient response rate, the patient survey was adapted to an iPad, allowing patients to complete the survey in the office at the time of their post operative visit.

Results: The iPad system resulted in a 98% response rate compared to 34% for the email based system. Median time to complete the survey was less than 2 minutes and required no additional staff time, office space, or equipment (other than the iPad itself.) Most patients were very pleased with the iPad platform, although some older patients had difficulty seeing the screen or navigating the touch screen. The high response rate resulted in a very rapid change in the reported PRO's, showing within less than 4 months, that the clinical changes focusing on patient concerns over post operative mastectomy care were successfully addressed, with and increase from 83% to 94% satisfaction for that particular outcome measure.

Conclusion: This study demonstrates that an office based iPad patient survey, linked to a national quality database reporting surgical care, can be used to identify gaps in care, and can then be used to rapidly assess the impact of implemented clinical changes. This is not possible with other national web sites attempting to report quality (e.g. Physician Compare, Health Grades, Vitals), and should be considered for future programs to improve reporting and actionability of PRO's.

Citation Format: Whitacre EB, Moore MN. Use of real-time patient reported outcomes to improve performance in breast surgery [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-11-03.