Angela M Stover1,2, Benjamin Y Urick3, Allison M Deal2, Randall Teal2,4, Maihan B Vu2,4,5, Jessica Carda-Auten2,4, Jennifer Jansen2, Arlene E Chung2,6, Antonia V Bennett1,2, Anne Chiang7, Charles Cleeland8, Yehuda Deutsch9, Edmund Tai10, Dylan Zylla11, Loretta A Williams8, Collette Pitzen12, Claire Snyder13, Bryce Reeve14, Tenbroeck Smith15, Kristen McNiff16, David Cella17, Michael N Neuss18, Robert Miller19, Thomas M Atkinson20, Patricia A Spears2,21, Mary Lou Smith21,22, Cindy Geoghegan21,23, Ethan M Basch1,2,24. 1. Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC. 2. Lineberger Comprehensive Cancer Center, Chapel Hill, NC. 3. Department of Pharmacy, Center for Medication Optimization in the Division of Practice Advancement and Clinical Education, University of North Carolina at Chapel Hill, Chapel Hill, NC. 4. Connected Health Applications and Interventions (CHAI-Core), University of North Carolina at Chapel Hill, Chapel Hill, NC. 5. Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC. 6. Departments of Medicine and Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC. 7. Yale University and Smilow Cancer Center, Hartford, CT. 8. University of Texas MD Anderson Cancer Center, Houston, TX. 9. Memorial Cancer Center, Hollywood, FL. 10. Palo Alto Medical Foundation, Palo Alto, CA. 11. Park Nicollet Oncology Research, Frauenshuh Cancer Center, HealthPartners Institute, Minneapolis, MN. 12. MN Community Measurement, Minneapolis, MN. 13. Johns Hopkins University, Baltimore, MD. 14. Duke University, Durham, NC. 15. American Cancer Society, Atlanta, GA. 16. KM Healthcare Consulting, Atlanta, GA. 17. Northwestern University, Evanston, IL. 18. Vanderbilt University, Nashville, TN. 19. American Society of Clinical Oncology, Alexandria, VA. 20. Memorial Sloan Kettering Cancer Center, New York, NY. 21. Patient Advocate. 22. Research Advocacy Network, Naperville, IL. 23. Patients & Partners, LLC, Danbury, CT. 24. Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Abstract
PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
PURPOSE: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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
Authors: Saskia C C M Teunissen; Wendy Wesker; Cas Kruitwagen; Hanneke C J M de Haes; Emile E Voest; Alexander de Graeff Journal: J Pain Symptom Manage Date: 2007-05-23 Impact factor: 3.612
Authors: Kirsten K Ness; Melanie M Wall; J Michael Oakes; Leslie L Robison; James G Gurney Journal: Ann Epidemiol Date: 2005-08-30 Impact factor: 3.797
Authors: Angela M Stover; Carrie Tompkins Stricker; Karen Hammelef; Sydney Henson; Philip Carr; Jennifer Jansen; Allison M Deal; Antonia V Bennett; Ethan M Basch Journal: Med Care Date: 2019-05 Impact factor: 2.983
Authors: Michael N Neuss; Jennifer L Malin; Stephanie Chan; Pamela J Kadlubek; John L Adams; Joseph O Jacobson; Douglas W Blayney; Joseph V Simone Journal: J Clin Oncol Date: 2013-03-11 Impact factor: 44.544
Authors: Ronald C Chen; Peter Chang; Richard J Vetter; Himansu Lukka; William A Stokes; Martin G Sanda; Deborah Watkins-Bruner; Bryce B Reeve; Howard M Sandler Journal: J Natl Cancer Inst Date: 2014-07-08 Impact factor: 13.506
Authors: Christopher E Desch; Kristen K McNiff; Eric C Schneider; Deborah Schrag; Joan McClure; Eva Lepisto; Molla S Donaldson; Katherine L Kahn; Jane C Weeks; Clifford Y Ko; Andrew K Stewart; Stephen B Edge Journal: J Clin Oncol Date: 2008-07-20 Impact factor: 44.544
Authors: Angela Stover; Debra E Irwin; Ronald C Chen; Bhishamjit S Chera; Deborah K Mayer; Hyman B Muss; Donald L Rosenstein; Thomas C Shea; William A Wood; Jessica C Lyons; Bryce B Reeve Journal: EGEMS (Wash DC) Date: 2015-10-29
Authors: Angela M Stover; Rachel Kurtzman; Jennifer Walker Bissram; Jennifer Jansen; Philip Carr; Thomas Atkinson; C Tyler Ellis; Ashley T Freeman; Kea Turner; Ethan M Basch Journal: Cancers (Basel) Date: 2021-07-20 Impact factor: 6.575
Authors: Angela M Stover; Lotte Haverman; Hedy A van Oers; Joanne Greenhalgh; Caroline M Potter Journal: Qual Life Res Date: 2020-07-10 Impact factor: 4.147