Real-World Adherence to Patient-Reported Outcome Monitoring as a Cancer Care Quality Metric

Abstract

PURPOSE: Routine collection of patient-reported outcomes (PROs) for patients with advanced solid malignancies is an evidence-based practice and critical component of high-quality cancer care, but real-world adherence is poorly characterized. We sought to describe real-world adherence to PRO monitoring and its potential predictors. METHODS: We conducted a retrospective cross-sectional study using deidentified electronic health record data from a National Cancer Institute Cancer Center, encompassing one academic and two community sites. Participants included individuals with lung cancer receiving systemic therapy from January 1 to December 31, 2019. The primary outcome was patient-level adherence, defined as the proportion of treatment visits during which a PRO questionnaire (spanning symptoms, functional status, and global quality-of-life domains) was completed within 30 days. Practice-level performance was calculated as unadjusted mean patient-level adherence. We modeled patient-level adherence using multivariable ordinary least squares regression and identified covariates associated with adherence using a significance threshold of P < .05. RESULTS: In 2019, there were 18,604 encounters for 1,105 patients with lung cancer (mean [standard deviation] age 65.8 [10.2] years; 621 [56.2%] female; 216 [19.6%] Black) receiving systemic therapy. The mean patient-level PRO adherence ranged from 27.2% to 70.0% across sites and was 49.4% overall. Advanced age (≥ 65 years) and Black or African American race were negatively associated with PRO adherence ( P < .01). CONCLUSION: Across this real-world cohort of patients undergoing treatment for lung cancer, adherence to PRO monitoring lagged that achieved in seminal clinical trials, with potential age- and race-based disparities, demonstrating an implementation gap that could be addressed with standardized reporting of an adherence-based quality metric.

Evaluation of remote digital postoperative wound monitoring in routine surgical practice

“…While the focus of this intervention was on surgical wounds, there is increasing interest in broader perioperative monitoring in the literature 24 , particularly how these can be used within “virtual ward” pathways to prevent admission and facilitate discharge 25 . While this may further reduce health service utilisation and present an avenue for future development, these potential benefits must be balanced with the burden on patients to complete a more complex series of patient-reported outcomes 26 , and on health services to review and respond 27 .…”

The Effects of Patient-Reported Outcome Screening on the Survival of People with Cancer: A Systematic Review and Meta-Analysis

“…The systematic introduction of PRO monitoring into clinical practice is often difficult due to operational and financial barriers to the implementation of these complex interventions, as well as the uncertainty among physicians regarding their usefulness in actual practice [ 3 , 40 ]. Therefore, it is important to identify the categories of patients who are most likely to benefit and consequently focus efforts on these populations [ 41 ].…”

Clinical Impact of Routine Assessment of Patient-Reported Health Status in Heart Failure Clinic: The PRO-HF Trial

“…2,[6][7][8][9][10] To that extent, multiple organizations, including the American Heart Association and the Centers for Medicare and Medicaid Services, have introduced quality measures promoting routine PRO assessment in clinical care, including for patients with heart failure (HF). [11][12][13] The HF community has shown increasing interest in incorporating PROs into clinical care. 14 The 2022 American College of Cardiology/American Heart Association/ Heart Failure Society of America Heart Failure Clinical Practice Guidelines included a new class-IIA recommendation to capture patient-reported health status as part of HF care.…”