Bringing the patient voice into quality assessment: National stakeholder perceptions of facilitators and barriers for the use of PROs as performance measures.

Abstract

61 Background: An emerging trend in quality improvement is to incorporate the patient voice into performance metrics for routine care delivery using patient-reported outcomes (PRO). For instance, patients may complete a questionnaire about how well their symptoms are controlled (e.g., nausea). High-quality care is then determined by adjusting scores and comparing similar practices on symptom control. However, stakeholder (clinicians, administrators, and researchers) perspectives of facilitators and barriers are not well characterized because PRO performance measures are an emerging concept. Methods: Key informant interviews were conducted with 35 stakeholders (9 medical oncology clinicians, 13 administrators, and 13 health services researchers) from 5 healthcare systems across the U.S. Interview guides were used to elicit perceptions of barriers, facilitators, and acceptability for using PROs as performance measures. Transcripts were content analyzed by stakeholder group using standard methodology. Results: Clinicians reported barriers that were structural (e.g., complexity of programming electronic health record [EHR] changes) and process-oriented (e.g., changing clinic workflow to accommodate PRO review and alerts). Clinicians noted concerns about appropriate adjustments to ensure fair quality comparisons across practices. Clinicians and administrators reported structural barriers such as reimbursement and staff training, and outcome barriers such as choosing symptoms that have clear treatment guidelines. Facilitators included dashboards to visually display results that are intuitive and easily accessible in the EHR. Researchers focused on standardization and selecting thresholds for symptom alerts. Conclusions: Clinicians, administrators, and researchers reported barriers to the integration of PROs as quality measures. These barriers are mainly structural- and process-oriented but generally did not focus on acceptability. Facilitators focused on presenting PRO scores in an easily interpretable and accessible way within the EHR. Results will inform multi-site feasibility testing of PROs as quality metrics.