Patient-Reported Outcomes, a Central Component to Value and Rapid-Learning Systems


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Reshma Jagsi, MD, DPhil

With the passage of the Patient Protection and Affordable Care Act in 2010, value became the operative word in assessing the success of health care, from outcomes to cost. To drive more value, the Affordable Care Act seeks to implement initiatives such as comparative effectiveness research that will inform system-wide health-care decisions by providing evidence on the effectiveness, benefits, and harms of different treatment options. While comparative effectiveness research might be a relatively new concept on the macro health-care landscape, the oncology community has long been engaged in introspective methods of deriving more value out of care.

Capturing Quality Data

The concept of a rapid-learning system, which provides a continuous cycle of learning by capturing evidence-based guidelines and creating insights through analysis of data from every patient experience is gaining traction in oncology organizations. ASCO, for one, is committed to making a health information–driven rapid-learning system a reality. One of the keys to establishing a rapid-learning system is capturing the bidirectional information exchanges among patients and providers.

Naturally, the ultimate aim is to encourage patients to provide information that can be used to inform shared decision-making, which leads to timely interventions and improved patient outcomes. To that end, there is growing interest in the systematic collection of patient-reported outcomes, which can directly contribute to the larger scheme of developing a rapid-learning health-care model. Research has shown that collecting and using patient-reported outcomes in oncology can identify issues of concern to patients and improve communication and outcomes.

Although there is growing interest in incorporating routine patient-reported outcomes into clinical practice, there are few data that capture how oncologists view the use of patient-reported outcomes in daily clinical practice. A recent study published in the Journal of Oncology Practice (JOP) shed light on this important issue.1

In the JOP study, Reshma Jagsi, MD, DPhil, Associate Professor in the Department of Radiation Oncology at the University of Michigan Health System, Ann Arbor, and colleagues used the Quality Oncology Practice Initiative (QOPI) and a minority-based Community Clinical Oncology Program (MB-CCOP) to identify potential interview candidates. The researchers conducted 45-minute semistructured interviews of practicing oncologists to identify the critical features that ensure ease of collection of patient-reported outcomes in a busy oncology practice.

For the study, the investigators identified a diverse group of physicians identified through their affiliation with MB-CCOPs or QOPI. They ultimately conducted and thematically coded transcripts of interviews with 17 of these physicians for their qualitative analysis. The interview participants came from both academic and community practices around the country.

Value of Patient-Reported Outcomes

At the onset of the study, there was varied ability to define a patient-reported outcome among the participants. To ensure consistent interpretations, the authors gave clear definitions prior to continuing the interviews.

Many of the participants said that implementing patient-reported outcomes improved the quality and thoroughness of their patient interactions. Several benefits perceived by the participants included increased efficiency and better accuracy in identifying patient concerns prior to the office visit.

The authors concluded that the consensus among doctors could be captured fairly accurately by the following response: “Something like this would clearly improve … the quality of care of our patients because I think a lot of times in our hectic and busy day, a lot of these things slip through the cracks.”

Common Concerns

Although most of the participants saw benefits in adopting patient-reported outcomes, many of the respondents shared concerns about the effects of receiving an excessive amount of information. Another major concern, not surprisingly, was cost of implementation and the impact on clinic flow and efficiency. The following statements captured these concerns about information overload and costs:

  • “If somebody came in and filled out an entire review of systems, it would … be a little bit overwhelming in terms of trying to deal with all the symptoms they may check off.”
  • “The number-one thing is that the burden to the practice in terms of implementing—whether that’s financial, technical, or personnel—is not too onerous that it becomes problematic.”

Another concern was about how the information would be used, given the potential to penalize providers by divulging measures of patient satisfaction that were negative. “If this is a tool that we will eventually make public in any fashion, you will have a lot of resistance … if you are sincere about improving care, you don’t put it out in the public domain,” said one participant.

Results and Conclusions

The authors concluded that their study complemented other work in this area, which have all suggested that, in general, physicians and patients have a positive view on the feasibility and worth of patient-reported outcomes. Most participants saw an improvement in efficiency and quality of patient encounters when using patient-reported outcomes.

In particular, community oncologists noted the value of patient-reported outcomes in adding more ability to identify, track, and document their patients’ most important symptoms, which has the added value of helping providers prevent underreported symptoms that lead to unnecessary procedures.

The main concerns expressed by participants were the costs and feasibility of implementation and the potential information overload that could hamper the efficiencies of a busy community practice. However, the participant responses indicated that most community oncologists felt that the potential benefits of implementing patient-reported outcomes greatly outweighed the concerns over cost and workflow issues.

The authors also observed that quality assessment measures like patient-reported outcomes are part of oncology’s future, so it behooves them to keep ahead of the curve.

Given the general acceptance and enthusiasm among physicians and patients, the authors concluded, “The time is right to begin pilot testing such measures with community oncologists so they can lend their expertise to national discussions on which measures to use and how best to use them.” This added knowledge on how to harvest patient-related data will serve the greater goal of making the dream of a rapid-learning system a reality in the clinical oncology care model. ■

Disclosure: Dr. Jagsi reported no potential conflicts of interest. For full disclosures of the study authors, visit jop.ascopubs.org.

Reference

1. Jagsi R, Chiang A, Polite BN, et al: Qualitative analysis of practicing oncologists’ attitudes and experiences regarding collection of patient-reported outcomes. J Oncol Pract. August 6, 2013 (early release online).



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