American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Patient-Reported Outcomes in an Enhanced Recovery Pathway.
Abstract
Patient-reported outcomes (PROs) are measures of health status that come directly
from the patient. PROs are an underutilized tool in the perioperative setting. Enhanced
recovery pathways (ERPs) have primarily focused on traditional measures of health
care quality such as complications and hospital length of stay. These measures do
not capture postdischarge outcomes that are meaningful to patients such as function
or freedom from disability. PROs can be used to facilitate shared decisions between
patients and providers before surgery and establish benchmark recovery goals after
surgery. PROs can also be utilized in quality improvement initiatives and clinical
research studies. An expert panel, the Perioperative Quality Initiative (POQI) workgroup,
conducted an extensive literature review to determine best practices for the incorporation
of PROs in an ERP. This international group of experienced clinicians from North America
and Europe met at Stony Brook, NY, on December 2-3, 2016, to review the evidence supporting
the use of PROs in the context of surgical recovery. A modified Delphi method was
used to capture the collective expertise of a diverse group to answer clinical questions.
During 3 plenary sessions, the POQI PRO subgroup presented clinical questions based
on a literature review, presented evidenced-based answers to those questions, and
developed recommendations which represented a consensus opinion regarding the use
of PROs in the context of an ERP. The POQI workgroup identified key criteria to evaluate
patient-reported outcome measures (PROMs) for their incorporation in an ERP. The POQI
workgroup agreed on the following recommendations: (1) PROMs in the perioperative
setting should be collected in the framework of physical, mental, and social domains.
(2) These data should be collected preoperatively at baseline, during the immediate
postoperative time period, and after hospital discharge. (3) In the immediate postoperative
setting, we recommend using the Quality of Recovery-15 score. After discharge at 30
and 90 days, we recommend the use of the World Health Organization Disability Assessment
Scale 2.0, or a tailored use of the Patient-Reported Outcomes Measurement Information
System. (4) Future study that consistently applies PROMs in an ERP will define the
role these measures will have evaluating quality and guiding clinical care. Consensus
guidelines regarding the incorporation of PRO measures in an ERP were created by the
POQI workgroup. The inclusion of PROMs with traditional measures of health care quality
after surgery provides an opportunity to improve clinical care.
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https://hdl.handle.net/10161/17248Published Version (Please cite this version)
10.1213/ane.0000000000002758Publication Info
Abola, Ramon E; Bennett-Guerrero, Elliott; Kent, Michael L; Feldman, Liane S; Fiore,
Julio F; Shaw, Andrew D; ... Perioperative Quality Initiative (POQI) 2 Workgroup (2018). American Society for Enhanced Recovery and Perioperative Quality Initiative Joint
Consensus Statement on Patient-Reported Outcomes in an Enhanced Recovery Pathway.
Anesthesia and analgesia, 126(6). pp. 1874-1882. 10.1213/ane.0000000000002758. Retrieved from https://hdl.handle.net/10161/17248.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Michael Lewis Kent
Associate Professor of Anesthesiology
Timothy Ellis Miller
Professor of Anesthesiology
Clinical and research interests are Enhanced Recovery and Perioperative Medicine;
with particular interests in fluid management, and perioperative optimization of the
high-risk non-cardiac surgery patient.
Julie K. Marosky Thacker
Associate Professor of Surgery
Paul Edmund Wischmeyer
Professor of Anesthesiology
Paul Wischmeyer M.D., EDIC, FASPEN, FCCM is a critical care, perioperative, and nutrition
physician-researcher who specializes in enhancing preparation and recovery from surgery,
critical care and COVID-19. He serves as a Tenured Professor of Anesthesiology and
Surgery at Duke. He also serves as the Associate Vice Chair for Clinical Research
in the Dept. of Anesthesiology and Director of the TPN/Nutrition Team at Duke. Dr.
Wischmeyer earned his medical degree with honors at T
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