Ashley K. Vavra, MD, and Christopher J. Smolock, MD, talk to Vascular Specialist about why they decided to collect patient-reported outcomes (PROs), how they got started with them and the challenges they have faced. Vavra is a member and Smolock a recent member of the Society for Vascular Surgery (SVS) Performance Measures Committee.
Why did you decide to collect patient-reported outcomes?
AV: My feeling is that PROs are a way to help us as vascular surgeons better set expectations among the patients who we treat for how a vascular disease or treatment will affect their day-to-day life. As we learn more, I am hopeful that PROs will also help us learn how to better define the success of particular treatments or interventions.
CS: Seeing patients in long-term follow-up, it became apparent that a technically successful and complication-free intervention or operation did not always correlate positively with a patient’s quality of life (QOL) throughout recovery. A striking example of this paradox is in acute aortic dissection patients who are treated by means of percutaneous endografts.
How did you get started?
AV: I first looked at the literature on PROs in vascular surgery patients. However, the more I read, the more questions I had about which measures to collect and how to collect them. I found it helpful that the SVS released reporting guidelines for thoracic outlet syndrome that included two recommended PRO measures for collection; I used that as a starting point.
CS: We began using general QOL/ PRO surveys in retrospective research studies, one of which involved patients with total aortic replacement in multiple modalities over multiple stages. We began approaching extensive aortic repairs in this manner, presuming an advantage for the multi-stage, multi-modal approach in survival and QOL. Instead, we observed that patient QOL was not necessarily better than single-stage, open surgery.
How do you collect the PROs?
AV: I started collecting PROs prospectively using a paper form that is then entered in the electronic medical record (EMR). However, our institution has now set up a method of electronic collection for patients through the patient portal of our EMR.
CS: We started collecting prospectively and electronically for some patients during outpatient check-in but are still working through this process.
How do you use them with patients?
AV: So far, I have only used them on an individual patient basis and discussed trends if they are available.
CS: I use retrospective QOL data following aortic interventions to inform patients of potential challenges post-procedure that might seem counterintuitive. This has been especially helpful for our patients who experience weeks to months of malaise after a percutaneous intervention for aortic dissection, as it educates them on this expected outcome. The minimally invasive nature of such a procedure does not necessarily prepare the patient for a prolonged period of convalescence.
What challenges have you faced?
AV: The first challenge is response rates, and I have found that having an option to collect measures while patients are in the office is helpful. Another challenge is how to use the data. Since I have yet to analyze the data from our own experience and there aren’t benchmarks to help guide interpretation, I find it challenging to know exactly how to counsel patients on their results. Hopefully, this will improve as we learn more about how specific measures correlate with vascular disease and treatments.
CS: We are working on incorporating disease-specific PROs for each of the entities we treat. We also need to broaden the reach of this to the majority of our outpatient visits in a way that is not onerous to the patient or the provider.