Scaling and Spreading Electronic Capture of Patient-Reported Outcomes Using a National Surgical Quality Improvement Program

使用国家手术质量改进计划扩大和传播患者报告结果的电子捕获

• 批准号: 9793541
• 负责人: CLIFFORD KO
• 金额: $ 49.91万
• 依托单位: AMERICAN COLLEGE OF SURGEONS
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-01 至 2022-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9793541
• 关键词: Scaling; Spreading; Electronic; Capture; Patient

ABSTRACT Patient-reported outcomes (PROs) in ambulatory (outpatient or 23-hour stay) surgery are particularly important to measure because these procedures are generally elective, have low complication rates, and are performed to improve quality of life. However, the evaluation of PROs in ambulatory surgery is infrequent and remains isolated to a few large academic medical centers. Measuring PROs is an important yet unrealized strategy that has the potential to improve the quality of surgical care throughout the US. This proposal aims to use the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) to scale the routine, health IT-enabled capture of PROs for quality improvement nationally by leveraging the ACS NSQIP network of hospital Collaboratives to spread its uptake. We propose the following aims: (1) to demonstrate feasibility of widespread adoption of the routine, health IT-enabled capture of PROs from ambulatory surgical patients to at least 30 ACS NSQIP hospitals for quality improvement; (2) to identify and understand common (program-wide) and unique (institutional) best practices to spread the health IT-enabled PRO implementation; and (3) to explore the potential to identify quality improvement gaps with aggregated PROs measured as part of the scale and spread processes. To achieve Aim 1, we will utilize a web-based portal linked to the ACS NSQIP registry to collect PROs using three validated measures that assess patients’ care experiences, quality of life, and the impact of pain on their recovery. We will leverage the ACS NSQIP network of Collaboratives to spread PRO implementation across ACS NSQIP hospitals in two cohorts, moving from 14 to at least 30 hospitals over the study period. During and at the end of each cohort, we will identify, understand, and document best practices for implementation to achieve Aim 2. The PROs data collected will then be examined to determine utility for quality improvement to achieve Aim 3. Specifically, we will determine whether performance variation exists, and we will determine the sample sizes needed to identify reliable differences between hospitals that may subsequently spark quality improvement projects. The Institute for Healthcare Improvement’s Framework for Spread and Model for Improvement will be used for implementation and evaluation. The results of this study will inform key questions: Is national implementation feasible? What strategies will best facilitate the effective implementation of health IT-enabled capture of PROs for surgical quality improvement? How will these strategies differ based upon the environments and contexts in which this implementation is introduced and used? Can PROs identify quality improvement opportunities in patients undergoing ambulatory surgery?

抽象的 门诊（门诊或 23 小时住院）手术中的患者报告结果 (PRO) 尤为重要 进行测量，因为这些手术通常是选择性的，并发症发生率低，并且是进行的 然而，对门诊手术中 PRO 的评估很少且仍然存在。 孤立于几个大型学术医疗中心是一项重要但尚未实现的策略。 有潜力提高整个美国的外科护理质量。 美国外科医生学会 (ACS) 国家外科质量改进计划 (NSQIP) 旨在扩大 通过利用 ACS NSQIP，常规、卫生 IT 支持的 PRO 捕获，以提高全国质量 我们提出以下目标：（1）展示。 广泛采用常规的、卫生信息技术支持的从门诊手术中捕获 PRO 的可行性 患者到至少 30 家 ACS NSQIP 医院进行质量改进 (2) 识别和了解常见问题； （计划范围内）和独特（机构）最佳实践，以传播卫生信息技术支持的 PRO 实施； (3) 探索通过衡量总体 PRO 来确定质量改进差距的潜力 为了实现目标 1，我们将利用链接到 ACS 的基于网络的门户。 NSQIP 登记处使用三种经过验证的措施来收集 PRO，这些措施可评估患者的护理体验、质量 我们将利用 ACS NSQIP 协作网络来了解疼痛对他们的康复的影响。 将 PRO 实施分散到 ACS NSQIP 医院，分为两组，从 14 家增加到至少 30 家 在研究期间和每个队列结束时，我们将识别、了解和了解医院的情况。 记录实现目标 2 的最佳实践。然后将检查收集的 PRO 数据 确定质量改进实现目标 3 的效用。具体来说，我们将确定是否 存在性能差异，我们将确定识别可靠差异所需的样本量 医院之间的合作可能会引发医疗保健研究所的质量改进项目。 改进的传播框架和改进模型将用于实施和 这项研究的结果将揭示关键问题：国家实施是否可行？ 战略将最有利于有效实施卫生信息技术支持的手术 PRO 捕获 质量改进这些策略将如何根据其所处的环境和背景而有所不同？ PRO 是否可以识别患者的质量改进机会？ 正在进行门诊手术？