Electronic Patient Reported Outcomes (ePROs) have become fundamental in evaluating quality of life; however, there is not one common definition. One way of approaching a definition is that an ePRO represents the patients’ individual assessment of their health status electronically without the health care provider’s interpretation. In this light, ePRO measures can be useful in assisting surgeons to improve the quality of care. One ePRO measure was integrated into the American College of Surgeons (ACS) Surgeon Specific Registry (SSR) in September 2018 as part of the ACS Surgical Phases—Qualified Clinical Data Registry (QCDR), a Centers for Medicare & Medicaid Services (CMS) Merit-based Incentive Payment System (MIPS) Quality Reporting Option for 2018. For other MIPS 2018 participation options, visit the SSR MIPS 2018 Participation web page.
Using ePROs
A variety of Quality Measures Reporting Options are available for general surgeons, trauma surgeons (specifically, Trauma Quality Improvement Program participants), and other surgical specialties. One of these options includes an ePRO measure based on the Consumer Assessment of Healthcare Providers and Systems Surgical Care Survey, commonly known as S-CAHPS.
Once a provider decides to use ePRO for a particular case, e-mails are sent directly to patients for them to complete an assessment 90–180 days after the procedure date. The system will send the patient follow-up e-mail notifications every two weeks until a final reminder is sent six months after the operation. The patient may opt out of those e-mails at any time using an option within the message. If a patient has submitted survey responses for the ePRO, the results can be reviewed in the SSR.
“Getting the patient’s voice [as a component of] evaluating the quality of care is very important, and ePRO integration into the SSR is a first step in doing that. Because the patient voice offers perhaps the truest sense of how the patient is doing and feeling, their perceptions are essential for evaluating and therefore improving our quality of patient care,” said Clifford Y. Ko, MD, MS, MSHS, FACS, Director, ACS National Surgical Quality Improvement Program (ACS NSQIP®), and Director, ACS Division of Research and Optimal Patient Care. “The longer-term goal is to get the patient’s voice into all of our registries, whether it’s cancer or trauma or NSQIP, and to have the patient’s perspective in all of our evaluations of quality.”
NSQIP pilot
In addition to the work in the SSR, the ACS has launched a pilot in ACS NSQIP Adult. According to Dr. Ko, the PROs pilot in ACS NSQIP Adult launched in 2017, with participation from 18 hospitals in the U.S. and Canada. “We were able to get their PROs on a number of areas such as pain and function and overall quality of life. We were able to start linking it to their NSQIP data so we could get yet another perspective into quality,” Dr. Ko said. “So, over the ensuing 12 months, we will advance it within that program and into others as well.”
As part of the College’s commitment to measuring surgical outcomes to improve care, specifically through its Quality Programs, the ACS has started merging all of its clinical databases into one common platform, with an end goal of integrating ePROs feedback into clinical outcomes data. With ePRO integration into the registries, these assessments are anticipated to foster patient engagement, promote performance improvement, and enhance patient-centered care.
