Protocol for implementation of the ‘AusPROM’ recommendations for elective surgery patients: a mixed-methods cohort study

Abstract

IntroductionIncorporating patient-reported outcome measures (PROMs) into usual care in hospitals can improve safety and quality. Gaps exist in electronic PROM (ePROM) implementation recommendations, including for elective surgery. The aims are to: (1) understand barriers and enablers to ePROM implementation in hospitals and develop Australian ePROM implementation recommendations (AusPROM); (2) test the feasibility and acceptability of the Quality of Recovery 15 item short-form (QoR-15) PROM for elective surgery patients applying the AusPROM and (3) establish if the QoR-15 PROM has concurrent validity with the EQ-5D-5L.Methods and analysisPhase I will identify staff barriers and facilitators for the implementation of the AusPROM recommendations using a Delphi technique. Phase II will determine QoR-15 acceptability for elective surgery patients across four pilot hospitals, using the AusPROM recommendations. For phase II, in addition to a consumer focus group, patients will complete brief acceptability surveys, incorporating the QoR-15, in the week prior to surgery, in the week following surgery and 4 weeks postsurgery. The primary endpoint will be 4 weeks postsurgery. Phase III will be the national implementation of the AusPROM (29 hospitals) and the concurrent validity of the QoR-15 and generic EQ-5D-5L. This protocol adopts the Guidelines for Inclusion of Patient-Reported Outcomes in Clinical Trials Protocols guidelines.Ethics and disseminationThe results will be disseminated via public forums, conferences and peer-reviewed journals. Ethics approval: La Trobe University (HEC20479).Trial registration numberACTRN12621000298819 (Phase I and II) and ACTRN12621000969864 (Phase III)

Patient Judgement of Change with Elective Surgery Correlates with Patient Reported Outcomes and Quality of Life

“…There are 71 items and this includes 35 common recommendations for all studies as well as an additional 36 recommendations for specific study types [ 20 ]. This study is part of a larger study to develop Australian ePROM implementation recommendations, called ‘AusPROM’ [ 6 ].…”

“…Participants were categorized as an overnight patient, or as a day surgery patient. The detailed inclusion and exclusion criteria and full methods have been published previously [ 6 ]. In summary, participants were aged 18+ and were scheduled to have, or had, elective surgery at one of the 29 included hospitals.…”

“…Sample size for the analysis was based on a sample of convenience, which had been reported for the broader study [ 6 ]. Patient participants provided written consent via a tick box, prior to commencing each of the PROM surveys.…”

“…Specific to elective surgery, the inclusion of PROMs, alongside other key outcomes such as hospital length of stay, re-admissions, complications and mortality, is important in measuring surgical risks and outcome [ 5 ]. However, much is unknown about how to streamline the PROM implementation process across complex health networks, to minimise the burden on the patient and the hospital [ 6 ], such as achieving a pre-surgery PROM score when it is not feasible to obtain this prior to surgery [ 7 ].…”

“…Both the 15-item Quality of Recovery 15 (QoR-15) and EuroQOL 5-Dimension 5-Level quality of life (EQ-5D) [ 13 , 14 ] tools are examples of PROMs that are frequently used with surgical patient cohorts in the short and longer-term [ 6 , 15 , 16 , 17 , 18 , 19 ]. Several questions relating to these two tools remain unanswered.…”