Presented by: Deb Bulych, Director Supportive Care Patient Reported Outcomes (PRO)
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Transcript of Presented by: Deb Bulych, Director Supportive Care Patient Reported Outcomes (PRO)
Presented by:Deb Bulych, Director Supportive Care
Patient Reported Outcomes (PRO)
What We’ll Learn Today
What are Patient Reported Outcomes (Pro’s)
Benefits of PRO’s SCA Implementation 2 PRO’s chosen, Screening for Distress
and the Ambulatory Outpatient Satisfaction Survey (AOPSS)
Progress to date Lessons learned
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Patient/Family Centered Care
What is Patient/Family Centered Care? Is the “Provision of care that is respectful
of and responsive to individual patient/family preferences, needs and values and ensures that these values guide all clinical decisions.
It is “working with patients and families rather than doing things “to” or “for them”.
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Patient/Family Centered Care
It is making an intentional effort to start with what is important (what matters) to the patient.
To improve the patient's cancer experience by; Increase quality of life for those living with
and after being diagnosed with cancer. Reduce the burden of suffering throughout
the cancer experience.
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Person-Centered Care
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Patients want to be involved in the decisions that affect the
care they receive
Care organized “WITH” patients and their families to meet their needs and wants
Person-Centred Care
Care that incorporates patient needs, but is still doing “TO” and “FOR” patients
Patient-Focused CareCare organized for the
system and those who work in it
System-Centred Care
Demand for increased transparency and
accountability from institutionsSlide courtesy of CCO
Canadian Partnership Against Cancer (CPAC)Patient Experience Outcomes Initiatives GOAL: to improve the patient experience across
the cancer journey through standardized measurement that accelerates optimal care and health related outcomes across Canada
EXPECTED RESULT: By 2017, all jurisdictions should have established a measurement and reporting cycle for patient experience that facilitates action to drive improvement through use of standardized, validated screening and patient-reported outcome assessment tools and programmatic interventions
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Project Background
Three year (2014 to 2017) project funded by the Canadian Partnership against Cancer (CPAC)
Involves the three prairie provinces; MB, SK and AB.
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What are Patient Reported Outcomes (PROs)
PROs are outcomes that meet the following criteria: 1) Are reported by the patient
2) Matter to the patient
3) Are distinct from disease-focused outcomes
Examples: Pain, fatigue, anxiety, depression Patient experience/satisfaction Quality of care, Quality of life
Slide courtesy of AHS 8
What are Patient Reported Outcomes? (PROs) Tools that are used to gain insight from the
patient’s perspective into the perceived effects that the impact of the disease and treatments have on aspects of their health, their lifestyle and subsequently their quality of life.
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Why are PROs important?
Routine and proper use of patient reported outcomes;
Improves over all patient health outcome Improves process of care Standardizes cancer care Enhances patient/Family Centered Care
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Using the Evidence:Purpose to our Work
Patient engagement is recognized as a key component of achieving high quality healthcare
In order to do this we need to have a system that regularly collects feedback from patients and has the mechanisms in place to utilize this feedback to drive care at multiple levels
Goal: Harness Patient Reported Outcomes to improve system effectiveness and patient experience
Slide courtesy of AHS
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Using the Evidence:Initiative Objectives
1) Create a comprehensive and integrated tri-provincial approach to the collection, analysis, and reporting of PROs
2) Utilize and leverage existing information technology infrastructure and electronic medical records to facilitate PRO collection while minimizing patient and clinician burden
3) Facilitate a systematic process for reporting, sharing and utilizing PRO data at the various levels
4) Facilitate inter and intra-provincial collaboration around quality improvement (QI) initiatives
5) Create a culture of continual learning through QI that can be evaluated through subsequent PROs
Slide courtesy of AHS
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Enhance Person-Centred Care
Gather PROs and Conduct Focused QI
Improve Patient
Experience
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Scope
Patient Reported Outcomes Screening for Distress Tool (ESAS & CPC) AOPSS Satisfaction Survey Data
Development a clear process for data review and patient engagement/feedback about priorities for action
Collect PROs electronically where possible Maximize the use of ARIA and electronic reporting Connect PRO with clinical response Building capacity for tailored data to program level and
provincial
Two Quality Improvement Initiatives in response to provincial data
Slide courtesy of AHS14
Screening for Distress
Why? Thorough multi-symptom screen directly
from the patient Enhances provision of person-centered
care Providing right care for the right person at
the right time Cost and quality implications Evidence informed
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How does Distress Screening Improve Person-Centered Cancer Care?
Facilitates a shift in focus from tumor focus discussion to: Comprehensive discussions between
clinicians, patients and families Foster therapeutic relationships Facilitate information exchange Respond to emotions and uncertainty Supportive decision making Enable patient/family self-management
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Demographic and clinical characteristics of patients participating in distress screening
Slide courtesy of SCA Epidemiology and Performance Measurement Department18
ESAS scores frequency distribution
Slide courtesy of SCA Epidemiology and Performance Measurement Department19
Distribution of patient responses to CPC
Slide courtesy of SCA Epidemiology and Performance Measurement Department20
Referral status of patients by ESAS symptom for scores between 5 and 10
Slide courtesy of SCA Epidemiology and Performance Measurement Department21
Frequency distribution of referrals, by clinic site
Slide courtesy of SCA Epidemiology and Performance Measurement Department22
Using the Evidence: S4D Reporting: Inputs & Ideas S4D
ESASScores
By domain
Domain compare
Managed By
ReferralDeclined
CPCDomain items
Managed by
ReferralDeclined
OtherProvided By
ReferralsBy groups
Not completed
Priority Concern
Not Reviewed
- What- When- Why- Who- How
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The Future of S4D
Electronic data entry and reporting Real time data leads to analysis and
quality improvement work Increase patient quality of life and improve
the patient experience
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AOPSS – What the evidence says?
Why? AOPSS was completed in 2004, 2006, 2008 and 2013, and the
analysis from 2013 has identified key patient experience needs for consideration The three dimensions of care most in need of improvement,
based on 2013 survey results were: Physical comfort Information, communication and education Coordination and continuity of care
The three targeted initiatives we have been working to meet those needs are:
Journal for cancer patients The Peer Navigation Program Palliative Care Pain and Symptom Management
Program25
Utilizing PROs to drive care at various levels
National
Core set of indicators that can be reported at a national level
Provincial
Aggregate data for AdministratorsTargeted QI to impact areas of high symptom burden
Program Level
Point of Care
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Slide courtesy of AHS
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Province Specific Indicators
Secondary PRO collection; specific to QI project
Secondary PRO collection; specific to QI project
Analyze DataAnalyze Data
Quality Improvement Selection•Select QI/bolster efforts on previous QI
Quality Improvement Selection•Select QI/bolster efforts on previous QI
Primary PRO Collection•Screening Tool, EQ5D, AOPSS
Primary PRO Collection•Screening Tool, EQ5D, AOPSS
ImplementImplement
•QI specific Evaluation•Additional PROs used by each Province
Slide courtesy of AHS27
Progress to Date:Initiative Timeline
20142017
20162015
Phase 1: Planning and Initiation March 2014 to December 1, 2014 Tri-provincial initiative plan AB charter and implementation plan
Phase 2: PRO Collection and AnalysisDecember 2014 to September 30, 2015Establishing and implementing IT approachWorking with early adopters
Phase 3: Knowledge MobilizationOctober 1, 2015 to October 31, 2016Develop structures to utilize the data to drive QI Implement 2 QI projects
Phase 4: Evaluation and Reporting
November 1, 2016 to January 31, 2017
Slide courtesy of AHS
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Lessons Learned
1. Strong desire to use evidence to improve patient/family experience
2. Culture shift to patient reported outcomes from disease focused out comes
3. Use of technology to gather evidence is welcome once reports generated prove useful
4. Utilizing existing technology adds to sustainability
5. Must consider burden to IT as infrastructure is built
6. Repeated PDSA cycles are required in all quality improvement work
7. Remain flexible and never stop asking why? – let the evidence speak and inform!
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