Moving towards patient-reported outcomes in routine clinical practice: implementation lessons from the BREAST-Q

• DOI: 10.1007/s11136-022-03213-z
• Publication Date: 2022-08-16T14:05:04Z
• Authors: Jonas A. Nelson; Jacqueline J. Chu; Stefan Dabic; Elizabeth O. Kenw...; Meghana G. Shamsu...; Colleen M. McCarthy; Babak J. Mehrara; Andrea L. Pusic
• Keywords: 03 medical and health sciences; 0302 clinical medicine; Mammaplasty; Quality of Life; Humans; COVID-19; Patient Reported Outcome Measures; Pandemics; Article; 3. Good health

Longitudinal, routine utilization of patient-reported outcome measures (PROMs) in clinical care has been challenging. The purpose of this study is to describe a quality improvement initiative to improve patient engagement with the BREAST-Q, a gold-standard PROM for breast reconstruction.In 2011, we implemented the BREAST-Q as part of routine care. In 2018, we began a quality improvement initiative to increase BREAST-Q patient participation. The BREAST-Q was administered at every clinic visit via an institutional patient portal or an in-clinic tablet; digital dashboard technologies were used to improve workflow integration, real-time accountability, and immediate data availability at clinic visits. High clinical staff engagement was encouraged by assigning "BREAST-Q Champions." BREAST-Q completion data and patient characteristics were examined to understand non-response to the assessment.Following quality improvement, the average annual BREAST-Q completion rate increased from 42.8% in 2011-2017 to 87.6% in 2019, the last full year of our study period. High completion rates were maintained January-July 2020; however, a significantly larger proportion of BREAST-Qs were completed at home in 2020 versus the same period in 2019 (49.7 vs. 38.8%, p < 0.001), potentially due to the COVID-19 pandemic. Compared with non-responders, responders were younger (49.7 vs. 52.2 years, p < 0.001), more likely to be white (76.9 vs. 73.6%, p < 0.001), and had private insurance (79.4 vs. 69.8%, p < 0.001).Our quality improvement initiative successfully increased routine completion of the BREAST-Q. Similar implementation techniques may prove beneficial at other institutions interested in incorporating PROMs into routine care.