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Malapati SH, Edelen MO, Kaur MN, Zeng C, Ortega G, McCleary NJ, Hubbell H, Meyers P, Bryant AS, Sisodia RC, Pusic AL. Social Determinants of Health Needs and Health-related Quality of Life Among Surgical Patients: A Retrospective Analysis of 8512 Patients. Ann Surg 2024; 279:443-449. [PMID: 37800351 DOI: 10.1097/sla.0000000000006117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
OBJECTIVE To assess associations between social determinants of health (SDOH) needs and health-related quality of life (HRQOL) among surgical patients. BACKGROUND Despite the profound impact of SDOH on health outcomes, studies examining the effect of SDOH needs on HRQOL among surgical patients are limited. METHODS A retrospective study was conducted using responses from the SDOH needs assessment and the Patient-Reported Outcomes Measurement Information Systems Global Health instrument of adults seen in surgical clinics at a single institution. Patient characteristics including socioeconomic status (insurance type, education level, and employment status) were extracted. Stepwise multivariable logistic regression analyses were performed to identify independent predictors of global health scores. RESULTS A total of 8512 surgical patients (mean age: 55.6±15.8 years) were included. 25.2% of patients reported one or more SDOH needs. The likelihood of reporting at least one SDOH need varied by patient characteristics and socioeconomic status variables. In fully adjusted regression models, food insecurity [odds ratio (OR), 1.53; 95% CI, 1.38-1.70 and OR, 1.49; 95% CI, 1.22-1.81, respectively], housing instability (OR, 1.27; 95% CI, 1.12-1.43 and OR, 1.39; 95% CI, 1.13-1.70, respectively) lack of transportation (OR, 1.46; 95% CI, 1.27-1.68 and OR, 1.25; 95% CI, 1.00-1.57, respectively), and unmet medication needs (OR, 1.31; 95% CI, 1.13-1.52 and OR, 1.61; 95% CI, 1.28-2.03, respectively) were independent predictors of poor physical and mental health. CONCLUSIONS SDOH needs are independent predictors of poor patient-reported physical and mental health among surgical patients. Assessing and addressing SDOH needs should be prioritized in health care settings and by policymakers to improve HRQOL.
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Affiliation(s)
- Sri Harshini Malapati
- The Patient-Reported Outcome, Value and Experience Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Maria O Edelen
- The Patient-Reported Outcome, Value and Experience Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Manraj N Kaur
- The Patient-Reported Outcome, Value and Experience Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Chengbo Zeng
- The Patient-Reported Outcome, Value and Experience Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Gezzer Ortega
- The Patient-Reported Outcome, Value and Experience Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Nadine J McCleary
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Harrison Hubbell
- Office of the Chief Medical Officer, Mass General Brigham, Boston, MA
| | - Peter Meyers
- Office of the Chief Medical Officer, Mass General Brigham, Boston, MA
| | - Allison S Bryant
- Office of the Chief Medical Officer, Mass General Brigham, Boston, MA
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Rachel C Sisodia
- Office of the Chief Medical Officer, Mass General Brigham, Boston, MA
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Andrea L Pusic
- The Patient-Reported Outcome, Value and Experience Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Ortega MV, Hidrue MK, Lehrhoff SR, Ellis DB, Sisodia RC, Curry WT, del Carmen MG, Wasfy JH. Patterns in Physician Burnout in a Stable-Linked Cohort. JAMA Netw Open 2023; 6:e2336745. [PMID: 37801314 PMCID: PMC10559175 DOI: 10.1001/jamanetworkopen.2023.36745] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 08/21/2023] [Indexed: 10/07/2023] Open
Abstract
Importance Physician burnout is widely reported to be an increasing problem in the US. Although prior analyses suggest physician burnout is rising nationally, these analyses have substantial limitations, including different physicians joining and leaving clinical practice. Objective To examine the prevalence of burnout among physicians in a large multispecialty group over a 5-year period. Design, Setting, and Participants This survey study was conducted in 2017, 2019, and 2021 and involved physician faculty members of the Massachusetts General Physicians Organization. Participants represented different clinical specialties and a full range of career stages. The online survey instrument had 4 domains: physician career and compensation satisfaction, physician well-being, administrative workload on physicians, and leadership and diversity. Exposure Time. Main Outcomes and Measures Physician burnout, which was assessed with the Maslach Burnout Inventory. A binary burnout measure was used, which defined burnout as a high score in 2 of the 3 burnout subscales: Exhaustion, Cynicism, and Reduced Personal Efficacy. Results A total of 1373 physicians (72.9% of the original 2017 cohort) participated in all 3 surveys. The cohort included 690 (50.3%) male, 921 (67.1%) White, and 1189 (86.6%) non-Hispanic individuals. The response rates were 93.0% in 2017, 93.0% in 2019, and 92.0% in 2021. Concerning years of experience, the cohort was relatively well distributed, with the highest number and proportion of physicians (478 [34.8%]) reporting between 11 and 20 years of experience. Within this group, burnout declined from 44.4% (610 physicians) in 2017 to 41.9% (575) in 2019 (P = .18) before increasing to 50.4% (692) in 2021 (P < .001). Conclusions and Relevance Findings of this survey study suggest that the physician burnout rate in the US is increasing. This pattern represents a potential threat to the ability of the US health care system to care for patients and needs urgent solutions.
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Affiliation(s)
- Marcus V. Ortega
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston
- Massachusetts General Physicians Organization, Boston
| | | | | | - Dan B. Ellis
- Massachusetts General Physicians Organization, Boston
- Department of Anesthesiology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Rachel C. Sisodia
- Massachusetts General Physicians Organization, Boston
- Division of Gynecology Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - William T. Curry
- Massachusetts General Physicians Organization, Boston
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Marcela G. del Carmen
- Massachusetts General Physicians Organization, Boston
- Division of Gynecology Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Jason H. Wasfy
- Massachusetts General Physicians Organization, Boston
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
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Sisodia RC, Del Carmen MG. Lesions of the Ovary and Fallopian Tube. Reply. N Engl J Med 2022; 387:1723-1724. [PMID: 36322863 DOI: 10.1056/nejmc2212426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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Affiliation(s)
- Rachel C Sisodia
- From Massachusetts General Hospital and Harvard Medical School - both in Boston
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Mou D, Mjaset C, Sokas CM, Virji A, Bokhour B, Heng M, Sisodia RC, Pusic AL, Rosenthal MB. Impetus of US hospital leaders to invest in patient-reported outcome measures (PROMs): a qualitative study. BMJ Open 2022; 12:e061761. [PMID: 35793919 PMCID: PMC9260769 DOI: 10.1136/bmjopen-2022-061761] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Though hospital leaders across the USA have invested significant resources in collection of patient-reported outcome measures (PROMs), there are very limited data on the impetus for hospital leadership to establish PROM programmes. In this qualitative study, we identify the drivers and motivators of PROM collection among hospital leaders in the USA. DESIGN Exploratory qualitative study. SETTING Thirty-seven hospital leaders representing seven different institutions with successful PROMs programs across twenty US states. METHODS Semistructured interviews conducted with hospital leaders. Transcripts were analysed using thematic analysis. RESULTS Leaders strongly believe that collecting PROMs is the 'right thing to do' and that the culture of the institution plays an important role in enabling PROMs. The study participants often believe that their institutions deliver superior care and that PROMs can be used to demonstrate the value of their services to payors and patients. Direct financial incentives are relatively weak motivators for collection of PROMs. Most hospital leaders have reservations about using PROMs in their current state as a meaningful performance metric. CONCLUSION These findings suggest that hospital leaders feel a strong moral imperative to collect PROMs, which is also supported by the culture of their institution. Although PROMs are used in negotiations with payors, direct financial return on investment is not a strong driver for the collection of PROMs. Understanding why leaders of major healthcare institutions invest in PROMs is critical to understanding the role that PROMs play in the US healthcare system.
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Affiliation(s)
- Danny Mou
- Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Physician Organization, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Christer Mjaset
- Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- Commonwealth Fund, New York, New York, USA
| | - Claire M Sokas
- Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Azan Virji
- Harvard Medical School, Boston, Massachusetts, USA
| | - Barbara Bokhour
- Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Marilyn Heng
- Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rachel C Sisodia
- Physician Organization, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Andrea L Pusic
- Division of Plastic and Reconstructive Surgery, Patient Reported Outcome Value and Experience (PROVE) Center, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Meredith B Rosenthal
- Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA
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Ortega G, Allar BG, Kaur MN, Edelen MO, Witt EE, Fayanju OM, Telem DA, Wagman LD, Sisodia RC, Powe NR, Pusic AL. Prioritizing Health Equity in Patient-reported Outcome Measurement to Improve Surgical Care. Ann Surg 2022; 275:488-491. [PMID: 34387209 DOI: 10.1097/sla.0000000000005169] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Gezzer Ortega
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Patient-Reported Outcomes, Value & Experience (PROVE) Center, Brigham and Women's Hospital, Boston, MA
| | - Benjamin G Allar
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA
- Harvard T.H. Chan School of Public Health, Boston, MA
| | - Manraj N Kaur
- Patient-Reported Outcomes, Value & Experience (PROVE) Center, Brigham and Women's Hospital, Boston, MA
| | - Maria O Edelen
- Patient-Reported Outcomes, Value & Experience (PROVE) Center, Brigham and Women's Hospital, Boston, MA
| | - Emily E Witt
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Harvard Medical School, Boston, MA
| | - Oluwadamilola M Fayanju
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Dana A Telem
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Lawrence D Wagman
- Department of Surgery, City of Hope National Medical Center, Duarte, CA
| | - Rachel C Sisodia
- Division of Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Mass General Brigham, Somerville, MA
| | - Neil R Powe
- Department of Medicine, Priscilla Chan and Mark Zuckerberg San Francisco General Hospital, University of California San Francisco School of Medicine, San Francisco, CA
| | - Andrea L Pusic
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Patient-Reported Outcomes, Value & Experience (PROVE) Center, Brigham and Women's Hospital, Boston, MA
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Philp L, Alimena S, Ferris W, Saini A, Bregar AJ, Del Carmen MG, Eisenhauer EL, Growdon WB, Goodman A, Dorney K, Mazina V, Sisodia RC. Patient reported outcomes after risk-reducing surgery in patients at increased risk of ovarian cancer. Gynecol Oncol 2021; 164:421-427. [PMID: 34953629 DOI: 10.1016/j.ygyno.2021.12.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/12/2021] [Accepted: 12/12/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To describe the quality of life of women at an increased risk of ovarian cancer undergoing risk-reducing bilateral salpingo-oophorectomy (RRBSO). METHODS Patients evaluated in our gynecologic oncology ambulatory practice between January 2018-December 2019 for an increased risk of ovarian cancer were included. Patients received the EORTC QLQ-C30 and PROMIS emotional and instrumental support questionnaires along with a disease-specific measure (PROM). First and last and pre- and post-surgical PROM responses in each group were compared as were PROMs between at-risk patients and patients with other ovarian diseases. RESULTS 195 patients with an increased risk of ovarian cancer were identified, 155 completed PROMs (79.5%). BRCA1 or BRCA2 mutations were noted in 52.8%. Also included were 469 patients with benign ovarian disease and 455 with ovarian neoplasms. Seventy-two at-risk patients (46.5%) had surgery and 36 had both pre- and post-operative PROMs. Post-operatively, these patients reported significantly less tension (p = 0.011) and health-related worry (p = 0.021) but also decreased levels of health (p = 0.018) and quality of life <7d (0.001), less interest in sex (p = 0.014) and feeling less physically attractive (p = 0.046). No differences in body image or physical/sexual health were noted in at-risk patients who did not have surgery. When compared to patients with ovarian neoplasms, at-risk patients reported lower levels of disease-related life interference and treatment burden, less worry, and better overall health. CONCLUSIONS In patients with an increased risk of ovarian cancer, RRBSO is associated with decreased health-related worry and tension, increased sexual dysfunction and poorer short-term quality of life. Patients with ovarian neoplasms suffer to a greater extent than at-risk patients and report higher levels of treatment burden and disease-related anxiety.
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Affiliation(s)
- L Philp
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, USA.
| | - S Alimena
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Brigham and Women's Hospital, Boston, USA
| | - W Ferris
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, USA
| | - A Saini
- University of Massachusetts School of Medicine, Worcester, USA
| | - A J Bregar
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, USA
| | - M G Del Carmen
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, USA
| | - E L Eisenhauer
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, USA
| | - W B Growdon
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, USA
| | - A Goodman
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, USA
| | - K Dorney
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, USA
| | - V Mazina
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, USA
| | - R C Sisodia
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, USA
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Heng M, Tang X, Schalet BD, Collins AK, Chen AF, Melnic CM, O’Brien TM, Sisodia RC, Franklin PD, Cella D. Can the Knee Outcome and Osteoarthritis Score (KOOS) Function Subscale Be Linked to the PROMIS Physical Function to Crosswalk Equivalent Scores? Clin Orthop Relat Res 2021; 479:2653-2664. [PMID: 34114974 PMCID: PMC8726566 DOI: 10.1097/corr.0000000000001857] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/19/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND An increased focus on patient-reported outcome measures (PROMs) has led to a proliferation of these measures in orthopaedic surgery. Mandating a single PROM in clinical and research orthopaedics is not feasible given the breadth of data already collected with older measures and the emergence of psychometrically superior measures. Creating crosswalk tables for scores between measures allows providers to maintain control of measure choice. Furthermore, crosswalk tables permit providers to compare scores collected with older outcome measures with newly collected ones. Given the widespread use of the newer Patient-reported Outcome Measure Information System Physical Function (PROMIS PF) and the established Knee Outcome and Osteoarthritis Score (KOOS), it would be clinically useful to link these two measures. QUESTION/PURPOSE Can the KOOS Function in Activities of Daily Living (ADL) subscale be robustly linked to the PROMIS PF to create a crosswalk table of equivalent scores that accurately reflects a patient's reported physical function level on both scales? METHODS We sought to establish a common standardized metric for collected responses to the PROMIS PF and the KOOS ADL to develop equations for converting a PROMIS PF score to a score for the KOOS-ADL subscale and vice versa. To do this, we performed a retrospective, observational study at two academic medical centers and two community hospitals in an urban and suburban healthcare system. Patients 18 years and older who underwent TKA were identified. Between January 2017 and July 2020, we treated 8165 patients with a TKA, 93% of whom had a diagnosis of primary osteoarthritis. Of those, we considered patients who had completed a full KOOS and PROMIS PF 10a on the same date as potentially eligible. Twenty-one percent (1708 of 8165) of patients were excluded because no PROMs were collected at any point, and another 67% (5454 of 8165) were excluded because they completed only one of the required PROMs, leaving 12% (1003 of 8165) for analysis here. PROMs were collected each time they visited the health system before and after their TKAs. Physical function was measured by the PROMIS PF version 1.0 SF 10a and KOOS ADL scale. Analyses to accurately create a crosswalk of equivalent scores between the measures were performed using the equipercentile linking method with both unsmoothed and log linear smoothed score distributions. RESULTS Crosswalks were created, and adequate validation results supported their validity; we also created tables to allow clinicians and clinician scientists to convert individual patients' scores easily. The mean difference between the observed PROMIS PF scores and the scores converted by the crosswalk from the KOOS-ADL scores was -0.08 ± 4.82. A sensitivity analysis was conducted, confirming the effectiveness of these crosswalks to link the scores of two measures from patients both before and after surgery. CONCLUSION The PROMIS PF 10a can be robustly linked to the KOOS ADL measure. The developed crosswalk table can be used to convert PROMIS PF scores from KOOS ADL and vice versa. CLINICAL RELEVANCE The creation of a crosswalk table between the KOOS Function in ADL subscale and PROMIS PF allows clinicians and researchers to easily convert scores between the measures, thus permitting greater choice in PROM selection while preserving comparability between patient cohorts and PROM data collected from older outcome measures. Creating a crosswalk, or concordance table, between the two scales will facilitate this comparison, especially when pooling data for meta-analyses.
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Affiliation(s)
- Marilyn Heng
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Physicians Organization, Boston, MA, USA
| | - Xiaodan Tang
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Benjamin D. Schalet
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Austin K. Collins
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Antonia F. Chen
- Harvard Medical School, Boston, MA, USA
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Christopher M. Melnic
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
- Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Boston, MA, USA
| | - Todd M. O’Brien
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
- Department of Orthopaedic Surgery, North Shore Medical Center, Salem, MA, USA
| | - Rachel C. Sisodia
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Physicians Organization, Boston, MA, USA
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA
| | - Patricia D. Franklin
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Sisodia RC, Alimena S, Ferris W, Saini A, Philp L, Sullivan M, Dorney K, Bregar A, Eisenhauer E, Goodman A, Growdon W, Hubbell H, Del Carmen M. Initial findings from a prospective, large scale patient reported outcomes program in patients with gynecologic malignancy. Gynecol Oncol 2021; 164:113-119. [PMID: 34763938 DOI: 10.1016/j.ygyno.2021.10.084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/20/2021] [Accepted: 10/20/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Patient reported outcome measures (PROMs) are associated with improved overall survival in patients with metastatic malignancy; however, routine collection of PROMs is nascent. Little is known about PROs in women with gynecologic malignancy outside of a trial setting, limiting our understanding of how routine populations experience treatment, disease and morbidity. The goal of this study was to prospectively collect and describe disease-specific PROs in a non-trial population of women with gynecologic malignancy. METHODS PROMs were assigned electronically to all patients presenting for care in our gynecologic oncology clinic. Patients received a general oncology questionnaire (EORTC QLQ C30) a disease specific questionnaire (FACT V, EORTC EN24, EORTC OV28, EORTC Cx 24), and questionnaires assessing support at home. Responses were mapped to relevant clinical variables. Descriptive statistics were performed, and comparisons made with parametric and nonparametric analyses. The association between support at home and perioperative complications was assessed via logistic regression. RESULTS In the study period, 3239 unique patients were evaluated at new patient visits, post-operative visits, chemotherapy visits and surveillance visits with a PROMs completion rate of 78.1% (n = 2530 women with 4402 completions). There was no difference in completion rates based on age or self-identified race. The EORTC QLQ C-30 questionnaire was able to adequately discern differences between disease sites. Overall, scores were lower than those obtained in trial populations. PROMs responses were not associated with perioperative complications. CONCLUSION Systematic collection of PROMs is feasible and tech-enabled workflows result in high collection rates. Quality of life scores in our clinic population were lower than published data, indicating caution should be used when extrapolating quality of life data from clinical trials to counseling and decision making around routine patient populations.
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Affiliation(s)
- Rachel C Sisodia
- Mass General Brigham, 399 Revolution Drive, Somerville, MA 02145, USA; Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
| | - Stephanie Alimena
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Winslow Ferris
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | | | - Lauren Philp
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Mackenzie Sullivan
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Katelyn Dorney
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Amy Bregar
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Eric Eisenhauer
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Annekathryn Goodman
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Whitfield Growdon
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Harrison Hubbell
- Mass General Brigham, 399 Revolution Drive, Somerville, MA 02145, USA
| | - Marcela Del Carmen
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Harvard T.H.Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
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Sisodia RC, Ellis D, Hidrue M, Linov P, Cavallo E, Bryant AS, Wakamatsu M, del Carmen MG. Cohort study of impact on length of stay of individual enhanced recovery after surgery protocol components. BMJ Surg Interv Health Technologies 2021; 3:e000087. [PMID: 35047804 PMCID: PMC8749327 DOI: 10.1136/bmjsit-2021-000087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/09/2021] [Indexed: 11/05/2022] Open
Abstract
Objective The goal of this study was to explore which enhanced recovery after surgery (ERAS) bundle items were most associated with decreased length of stay after surgery, most likely associated with decreased length of stay after surgery. Design A cohort study. Setting Large tertiary academic medical centre. Participants The study included 1318 women undergoing hysterectomy as part of our ERAS pathway between 1 February 2018 and 30 January 2020 and a matched historical cohort of all hysterectomies performed at our institution between 3 October 2016 and 30 January 2018 (n=1063). Intervention The addition of ERAS to perioperative care. This is a cohort study of all patients undergoing hysterectomy at an academic medical centre after ERAS implementation on 1 February 2018. Compliance and outcomes after ERAS roll out were monitored and managed by a centralised team. Descriptive statistics, multivariate regression, interrupted time series analysis were used as indicated. Main outcome measures Impact of ERAS process measure adherence on length of stay. Results After initiation of ERAS pathway, 1318 women underwent hysterectomy. There were more open surgeries after ERAS implementation, but cohorts were otherwise balanced. The impact of process measure adherence on length of stay varied based on surgical approach (minimally invasive vs open). For open surgery, compliance with intraoperative antiemetics (−30%, 95% CI −18% to 40%) and decreased postoperative fluid administration (−12%, 95% CI −1% to 21%) were significantly associated with reduced length of stay. For minimally invasive surgery, ambulation within 8 hours of surgery was associated with reduced length of stay (−53%, 95% CI −55% to 52%). Conclusions While adherence to overall ERAS protocols decreases length of stay, the specific components of the bundle most significantly impacting this outcome remain elusive. Our data identify early ambulation, use of antiemetics and decreasing postoperative fluid administration to be associated with decreased length of stay.
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Affiliation(s)
- Rachel C. Sisodia
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Massachusetts General Hospital Physicians Organization, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Dan Ellis
- Massachusetts General Hospital Physicians Organization, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Anesthesia, Critical Care & Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael Hidrue
- Massachusetts General Hospital Physicians Organization, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Pamela Linov
- Massachusetts General Hospital Physicians Organization, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Elena Cavallo
- Massachusetts General Hospital Physicians Organization, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Allison S. Bryant
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - May Wakamatsu
- Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Marcela G. del Carmen
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Massachusetts General Hospital Physicians Organization, Massachusetts General Hospital, Boston, Massachusetts, USA
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11
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Sullivan MW, Philp L, Kanbergs AN, Safdar N, Oliva E, Bregar A, Del Carmen MG, Eisenhauer EL, Goodman A, Muto M, Sisodia RC, Growdon WB. Lymph node assessment at the time of hysterectomy has limited clinical utility for patients with pre-cancerous endometrial lesions. Gynecol Oncol 2021; 162:613-618. [PMID: 34247769 DOI: 10.1016/j.ygyno.2021.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/30/2021] [Accepted: 07/03/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to determine the proportion of patients with a pre-invasive endometrial lesion who meet Mayo criteria for lymph node dissection on final pathology to determine if the use of sentinel lymph node biopsy in patients with pre-invasive lesions would be warranted. METHODS All women who underwent hysterectomy for a pre-invasive endometrial lesion (atypical hyperplasia or endometrial intra-epithelial neoplasia) between 2009 and 2019 were included for analysis. Relevant statistical tests were utilized to test the associations between patient, operative, and pathologic characteristics. RESULTS 141 patients met inclusion criteria. 51 patients (36%) had a final diagnosis of cancer, the majority (96%) of which were Stage IA grade 1 endometrioid carcinomas. Seven patients (5%) met Mayo criteria on final pathology (one grade 3, seven size >2 cm, one >50% myoinvasive). Three of these seven patients had lymph nodes assessed of which 0% had metastases. Six of these patients had frozen section performed, and 2 met (33%) Mayo criteria intraoperatively. Of the seven patients in the overall cohort that had lymph node sampling, six had a final diagnosis of cancer and none had positive lymph nodes. Of the 51 patients with cancer, only 10 had cancer diagnosed using frozen section, and only two met intra-operative Mayo criteria. Age > 55 was predictive of meeting Mayo criteria on final pathology (p = 0.007). No patients experienced a cancer recurrence across a median follow up of 24.3 months. CONCLUSIONS Atypical hyperplasia and endometrial intra-epithelial neoplasia portend low risk disease and universal nodal assessment is of limited value.
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Affiliation(s)
- Mackenzie W Sullivan
- Division of Gynecologic Oncology, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Lauren Philp
- Division of Gynecologic Oncology, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alexa N Kanbergs
- Division of Gynecologic Oncology, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nida Safdar
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Esther Oliva
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Amy Bregar
- Division of Gynecologic Oncology, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Marcela G Del Carmen
- Division of Gynecologic Oncology, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Eric L Eisenhauer
- Division of Gynecologic Oncology, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Annekathryn Goodman
- Division of Gynecologic Oncology, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael Muto
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rachel C Sisodia
- Division of Gynecologic Oncology, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Whitfield B Growdon
- Division of Gynecologic Oncology, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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12
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Sisodia RC, Rodriguez JA, Sequist TD. Digital Disparities: Lessons learned from a Patient Reported Outcomes Program During the COVID-19 Pandemic. J Am Med Inform Assoc 2021; 28:2265-2268. [PMID: 34244760 PMCID: PMC8344913 DOI: 10.1093/jamia/ocab138] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/15/2021] [Accepted: 07/08/2021] [Indexed: 11/14/2022] Open
Abstract
The collection of patient reported outcomes (PROs) allows us to incorporate the patient's voice within their care in a quantifiable, validated manner. Large scale collection of PROs is facilitated by the electronic health record (EHR) and its portal, though historically patients have eschewed the portal and completed patient reported outcome measures (PROMS) in clinic via tablet. Furthermore, access to and use of the portal is associated with known racial inequities. Our institution oversees the largest clinical PRO program in the world, and has a long history of racially equitable PRO completion rates via tablet. However, when the COVID-19 pandemic forced us to remove tablets from clinics and rely exclusively on portal use for PRO completion, profound racial disparities resulted immediately. Our experience quantifiably demonstrates the magnitude of inequity that the portal, in its current configuration, generates and serves as a cautionary tale to other health care systems and EHRs.
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Affiliation(s)
- Rachel C Sisodia
- Massachusetts General Hospital, 55 Fruit Street Boston MA, 02114.,Mass General Brigham, 399 Revolution Dr, Somerville, MA, 02145
| | | | - Thomas D Sequist
- Mass General Brigham, 399 Revolution Dr, Somerville, MA, 02145.,Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115
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13
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Mou D, Horn DM, Heng M, Castillo-Angeles M, Ladin K, Frendl D, Kaur M, Del Carmen M, Sequist TD, Sisodia RC. Primary care physician's (PCP) perceived value of patient-reported outcomes (PROs) in clinical practice: a mixed methods study. BMJ Qual Saf 2021; 31:221-229. [PMID: 34016689 DOI: 10.1136/bmjqs-2020-012206] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 03/20/2021] [Accepted: 05/01/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND Patient-reported outcomes (PROs) can promote patient engagement, shared-decision making and improve the overall experience of care. However, PRO integration in the primary care clinical setting is limited. Exploring the perspectives of primary care physicians (PCPs) on PROs is key to understanding how they are being used in the clinical setting. We sought to elucidate this clinical perspective at one of the largest US health systems that has integrated a wide range of PROs into routine primary care. METHODS Mixed methods study with both anonymous online surveys and in-person qualitative semistructured interviews conducted with PCPs to understand their clinical perspectives on the applications of the existing PROs. PCPs from the 19 affiliated clinics were prompted to complete the survey. Interviewed PCPs were selected via a combination of random and purposive selection from the PCP directory. RESULTS Of 172 PCPs, 117 (68%) completed the online survey and 28 completed semistructured interviews. Most PCPs (77%) reviewed PRO responses with their patients. PCPs endorsed that PROs improve clinic efficiency and clinical management. However, PCPs have heterogeneous perspectives on the relevance of PROs in clinical practice, likely due to variations in clinic practice. For specific PRO instruments, PCPs reported anxiety and depression screening PROs to be most helpful. PCPs felt that PROs assisted with completing screening questions that are required by regulatory bodies. Barriers to using PROs include poor user-interface for both clinicians and patients and inadequate training. CONCLUSIONS Most PCPs regularly use PRO data though there are mixed opinions about their clinical relevance. An adaptable, user-friendly PRO system has the potential to have meaningful clinical applications in primary care.
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Affiliation(s)
- Danny Mou
- Physician Organization, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daniel M Horn
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marilyn Heng
- Massachusetts General Hospital Department of Orthopaedic Surgery, Boston, Massachusetts, USA
| | - Manuel Castillo-Angeles
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Keren Ladin
- Occupational Therapy and Community Health, Tufts University, Medford, Massachusetts, USA
| | - Daniel Frendl
- Urology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Manraj Kaur
- Patient Reported Outcomes, Value, and Experience (PROVE) Center, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Marcela Del Carmen
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Rachel C Sisodia
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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14
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Melnic CM, Paschalidis A, Katakam A, Bedair HS, Heng M, O’Brien TM, Sisodia RC. Patient-Reported Mental Health Score Influences Physical Function After Primary Total Knee Arthroplasty. J Arthroplasty 2021; 36:1277-1283. [PMID: 33189495 DOI: 10.1016/j.arth.2020.10.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/15/2020] [Accepted: 10/19/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Despite the effectiveness of total knee arthroplasty (TKA), patients often have lingering pain and dysfunction. Recent studies have raised concerns that preoperative mental health may negatively affect outcomes after TKA. The primary aim of this study investigates the relationship between patient-reported mental health and postoperative physical function following TKA. METHODS A retrospective study of 1392 primary TKA patients was performed. Mental health and physical function scores were measured using the Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health, and PROMIS Physical Function 10a and Knee injury and Osteoarthritis Outcome Score Physical Function (KOOS-PS) short forms. These assessments were completed preoperatively and up to 1-year postoperatively. Patients were stratified based on preoperative mental health scores into five distinct categories ranging from "Poor" to "Excellent." Locally estimated scatter plot smoothing curves (LOESS) were fit to the data examining physical function score trends over time. RESULTS Patients with higher mental health scores before surgery demonstrated better preoperative and postoperative physical function scores. However, all patients experienced similar gains in physical function following surgery. Despite this early improvement, patients with the worst mental health scores experienced a sharp decline in physical function approximately a year after surgery and did not appear to recover. CONCLUSIONS Poor mental health should not be a contraindication for performing TKA. For patients with the lowest mental health scores, physicians should account for the possibility that physical function scores may deteriorate a year after surgery. Tighter follow-up guidelines, more frequent physical therapy visits, or treatment for mental health issues may be considered to counter such deterioration.
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Affiliation(s)
- Christopher M Melnic
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA
| | - Aris Paschalidis
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Akhil Katakam
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA
| | - Hany S Bedair
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA
| | - Marilyn Heng
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Massachusetts General Physician Organization, Boston, MA
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15
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Karhade AV, Sisodia RC, Bono CM, Fogel HA, Hershman SH, Cha TD, Doorly TP, Kang JD, Schwab JH, Tobert DG. Surgeon-level variance in achieving clinical improvement after lumbar decompression: the importance of adequate risk adjustment. Spine J 2021; 21:405-410. [PMID: 33039548 DOI: 10.1016/j.spinee.2020.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/23/2020] [Accepted: 10/05/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Patient-Reported Outcome Measurement Information System (PROMIS) scores are increasingly utilized in clinical care. However, it is unclear if PROMIS can discriminate surgeon performance on an individual level. PURPOSE The purpose of this study was to examine surgeon-level variance in rates of achieving minimal clinically important difference (MCID) after lumbar decompression. PATIENT SAMPLE This is a prospective, observational cohort study performed across a healthcare enterprise (two academic medical centers and three community centers). Patients 18 years or older undergoing one- to two-level primary decompression for lumbar disc herniation (LDH) or lumbar spinal stenosis (LSS) were included. OUTCOME MEASURES The primary outcome was achievement of MCID, using a distribution-based method, on paired PROMIS physical function scores. METHODS Descriptive statistics were generated to examine the baseline characteristics of the study cohort. Bivariate analyses were used to examine the impact of surgeon-level variance on rates of MCID. Multivariable analyses were used to examine the risk-adjusted impact of surgeon-level variance on rates of MCID. RESULTS Overall, 636 patients treated by nine surgeons were included. The median patient age was 58 [interquartile range (IQR): 46-70] and 62.3% (n=396) were female. Among all patients, 56.9% (n=362) underwent surgery for LDH. The overall rate of achieving MCID was 75.8% (n=482). Of the surgeons, the median years in practice were 12 (range 4-31) and 55.6% (n=5) were in academic practice settings. On bivariate analysis, patients treated by one of the surgeons had lower rates of achieving MICD (odds ratio=0.37, 95% confidence interval: 0.15-0.91, p=.03). However, on multivariable analysis adjusting for operative indication (LDH vs. LSS), body mass index, number of comorbidities, percent unemployment in patient zip code, and preoperative PROMIS physical function scores, all surgeons were equally likely to obtain MCID. CONCLUSIONS In this cohort, variance in PROMIS scores after primary lumbar decompression is influenced by patient-related factors and not by individual surgeon. Adequate risk adjustment is needed if ascertaining clinical improvement on an individual surgeon basis. LEVEL OF EVIDENCE 2.
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Affiliation(s)
- Aditya V Karhade
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Rachel C Sisodia
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Christopher M Bono
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Harold A Fogel
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; Department of Orthopaedic Surgery, Newton Wellesley Hospital, Newton, MA 02462, USA
| | - Stuart H Hershman
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Thomas D Cha
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; Department of Orthopaedic Surgery, Newton Wellesley Hospital, Newton, MA 02462, USA
| | - Terence P Doorly
- Department of Neurosurgery, North Shore Medical Center, Boston, MA 01923, USA
| | - James D Kang
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02114, USA; Department of Orthopaedic Surgery, Brigham and Women's Faulkner Hospital, Boston, MA 02130, USA
| | - Joseph H Schwab
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; Department of Orthopaedic Surgery, Newton Wellesley Hospital, Newton, MA 02462, USA
| | - Daniel G Tobert
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; Department of Orthopaedic Surgery, Newton Wellesley Hospital, Newton, MA 02462, USA.
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16
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Sisodia RC, Dewdney SB, Fader AN, Wethington SL, Melamed A, Von Gruenigen VE, Zivanovic O, Carter J, Cohn DE, Huh W, Wenzel L, Doll K, Cella D, Dowdy SC. Patient reported outcomes measures in gynecologic oncology: A primer for clinical use, part I. Gynecol Oncol 2021; 158:194-200. [PMID: 32580886 DOI: 10.1016/j.ygyno.2020.04.696] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 04/18/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Rachel C Sisodia
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, United States of America.
| | - Summer B Dewdney
- Division of Gynecologic Oncology, Rush University Medical Center, Chicago, IL, United States of America
| | - Amanda N Fader
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, United States of America
| | - Stephanie L Wethington
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, United States of America
| | - Alexander Melamed
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America
| | - Vivian E Von Gruenigen
- Department of Obstetrics and Gynecology, University Hospitals of Cleveland, United States of America
| | - Oliver Zivanovic
- Memorial Sloan Kettering Cancer Center, 300 East 66th Street, 8th Floor, New York, NY, 10065, United States of America
| | - Jeanne Carter
- Memorial Sloan Kettering Cancer Center, 300 East 66th Street, 8th Floor, New York, NY, 10065, United States of America
| | - David E Cohn
- Department of Obstetrics and Gynecology, Ohio State University College of Medicine, Columbus, OH 43210, United States of America
| | - Warner Huh
- Department of Obstetrics and Gynecology, University and Alabama, Birmingham, AL, United States of America
| | - Lari Wenzel
- Universtiy of California, Irvine, United States of America
| | - Kemi Doll
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States of America
| | - David Cella
- Department of Medical Social Sciences and Robert H Lurie Comprehensive Cancer Center, Northwestern University, United States of America
| | - Sean C Dowdy
- Division of Gynecologic Oncology, Mayo Clinic, Rochester, MN 55905, United States of America
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17
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Sisodia RC, Dewdney SB, Fader AN, Wethington SL, Melamed A, Von Gruenigen VE, Zivanovic O, Carter J, Cohn DE, Huh W, Wenzel L, Doll K, Cella D, Dowdy SC. Patient reported outcomes measures in gynecologic oncology: A primer for clinical use, Part II. Gynecol Oncol 2020; 158:201-207. [DOI: 10.1016/j.ygyno.2020.03.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/16/2020] [Indexed: 11/28/2022]
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18
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Li S, Manning-Geist B, Gockley A, Ramos A, Sisodia RC, Del Carmen M, Growdon WB, Horowitz N, Berkowitz R, Worley M. Use of ablation and ultrasonic aspiration at primary debulking surgery in advanced stage ovarian, fallopian tube, and primary peritoneal cancer. Int J Gynecol Cancer 2020; 30:1052-1057. [PMID: 32487686 DOI: 10.1136/ijgc-2020-001466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/10/2020] [Accepted: 05/12/2020] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES Ovarian cancer patients with miliary disease have the lowest rates of complete surgical resection and poorest survival. Adjunct surgical techniques may potentially increase rates of complete surgical resection. No studies have evaluated the use of these techniques in primary debulking surgery for ovarian cancer patients with miliary disease. The aim of this study was to examine the use of adjunct surgical techniques during primary debulking surgery for patients with advanced epithelial ovarian, fallopian tube, and primary peritoneal cancer with miliary disease. METHODS Medical records of patients with International Federation of Gynecology and Obstetrics (FIGO) stages IIIC-IVB epithelial ovarian, fallopian tube, or primary peritoneal cancer with miliary disease undergoing primary debulking surgery from January 2010 to December 2014 were reviewed. Adjunct surgical techniques were defined as ultrasonic surgical aspiration, argon enhanced electrocautery, thermal plasma energy, and traditional electrocautery ablation. Patients undergoing surgery with and without these devices were compared with respect to demographics, operative characteristics, postoperative complications, residual disease, progression free survival and overall survival. RESULTS A total of 135 patients with miliary disease underwent primary debulking surgery, of which 30 (22.2%) patients used adjunct surgical techniques. The most common devices were ultrasonic surgical aspiration (40%) and argon enhanced electrocautery (36.7%). The most common sites of use were diaphragm (63.3%), pelvic peritoneum (30%), bowel mesentery (20%), and large bowel serosa (20%). There were no differences in age, stage, primary site, histology, operative time, surgical complexity, or postoperative complications for patients operated on with or without these devices. Volume of residual disease was similar (0.1-1 cm: 60% with adjunct techniques versus 68.6% without; complete surgical resection: 16.7% with adjunct techniques versus 13.3% without; p=0.67). For patients with ≤1 cm residual disease, median progression free survival (15 versus 15 months, p=0.65) and median overall survival (40 versus 55 months, p=0.38) were also similar. CONCLUSION Adjunct surgical techniques may be incorporated during primary debulking surgery for patients with advanced epithelial ovarian, fallopian tube, or primary peritoneal cancer with miliary disease; however, these do not improve the rate of optimal cytoreduction.
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Affiliation(s)
- Sue Li
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA .,Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Beryl Manning-Geist
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Allison Gockley
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Dana-Farber Cancer Institute, Boston, MA, USA
| | - Amanda Ramos
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rachel C Sisodia
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Marcela Del Carmen
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Whitfield B Growdon
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Neil Horowitz
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ross Berkowitz
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Dana-Farber Cancer Institute, Boston, MA, USA
| | - Michael Worley
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Dana-Farber Cancer Institute, Boston, MA, USA
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19
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Sisodia RC, Dankers C, Orav J, Joseph B, Meyers P, Wright P, St. Amand D, del Carmen M, Ferris T, Heng M, Licurse A, Meyer G, Sequist TD. Factors Associated With Increased Collection of Patient-Reported Outcomes Within a Large Health Care System. JAMA Netw Open 2020; 3:e202764. [PMID: 32286657 PMCID: PMC7156989 DOI: 10.1001/jamanetworkopen.2020.2764] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The collection of patient-reported outcomes (PROs) has garnered intense interest, but dissemination of PRO programs has been limited, as have analyses of the factors associated with successful programs. OBJECTIVE To identify factors associated with improving PRO collection rates within a large health care system using a centralized PRO infrastructure. DESIGN, SETTING, AND PARTICIPANTS This cohort study included 205 medical and surgical clinics in the Partners Healthcare system in Massachusetts that implemented a PRO program between March 15, 2014, and December 31, 2018, using a standardized centralized infrastructure. Data were analyzed from March to April 2019. EXPOSURES Relevant clinical characteristics were recorded for each clinic launching a PRO program. MAIN OUTCOMES AND MEASURES The primary outcome was the mean PRO collection rate during each clinic's most recent 6 months of collection prior to January 2019. Data were analyzed using a linear regression model with the 6-month PRO collection rate as the dependent variable and clinic characteristics as independent variables. Secondary analysis used a logistic regression model to assess clinical factors associated with successful clinics, defined as those that collected PROs at a rate greater than 50%. RESULTS Between March 2014 and December 2018, 205 Partners Healthcare clinics were available for analysis, and 4 061 205 PRO measures from 745 028 encounters were collected. Among these, 103 clinics (50.2%) collected at a rate greater than 50%. Increased collection rates were associated with more than 50% of physicians in a clinic trained on PROs (change, 19.6% [95% CI, 9.9%-29.4%]; P < .001), routine administrative oversight of collection rates (change, 16.0% [95% CI, 6.6%-25.5%]; P = .001), previous collection of PROs on paper (change, 12.5% [95% CI, 4.7%-20.3%]; P = .002), presence of a clinical champion (change, 11.2% [95% CI, 2.5%-20.0%]; P = .01) and payer incentive (change, 10.5% [95% CI, 2.0%-18.9%]; P = .02). CONCLUSIONS AND RELEVANCE These findings suggest that training physicians on the use of PROs, administrative surveillance of collection rates, and the presence of a local clinical champion may be promising interventions for increasing PRO collection. Clinics that have previously collected PROs may have greater success in increasing collections. Payer incentive for collection was associated with improved collections, but not associated with successful programs.
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Affiliation(s)
- Rachel C. Sisodia
- Partners Healthcare, Somerville, Massachusetts
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Christian Dankers
- Partners Healthcare, Somerville, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Brigham and Women’s Hospital, Boston, Massachusetts
| | - John Orav
- Harvard Medical School, Boston, Massachusetts
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | | | | | | | | | - Marcela del Carmen
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Tim Ferris
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | | | - Adam Licurse
- Harvard Medical School, Boston, Massachusetts
- Brigham and Women’s Hospital, Boston, Massachusetts
| | - Gregg Meyer
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Thomas D. Sequist
- Partners Healthcare, Somerville, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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