Otolaryngologist Steven S. Chang, MD, was confident that his 40-year-old patient, an avid racquetball player and runner, was recovering well from surgery.
“I talked with him, and he looked great. He was healing wonderfully, and I was very happy with myself,” said Dr. Chang, a head-and-neck cancer surgeon at Henry Ford Health in Detroit.
A health score logged as part of a patient-reported outcomes initiative, however, told a different story.
As he left the room, a medical assistant alerted Dr. Chang that the patient’s physical function score was very poor. The assistant pointed to a wheelchair and said, "That's his wheelchair.” Dr. Chang found out the patient had missed all his physical therapy appointments and was severely debilitated. “When I walked in the room, he was already sitting in the examination chair. I didn't realize how debilitated he was,” he said.
In a recent AMA Insight Network webinar, Dr. Chang elaborated on the patient-reported outcomes effort and how it alerts physicians to severe health problems in cancer patients. This initiative “has augmented my practice and has changed and humbled me in the way I approach speaking with my patients,” said Dr. Chang, Henry Ford’s chair of otolaryngology—head and neck surgery. He is also the medical director of Henry Ford Health and Michigan State University’s Center for Patient Reported Outcomes.
Henry Ford Health is a member of the AMA Health System Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Leadership identifies reporting need
During the AMA webinar, Dr. Chang fielded questions from moderator Suja Mathew, MD, the executive vice president and chief clinical officer at another AMA Health System Program member, Atlantic Health System.
Among other benefits, members of the AMA Health System Program have access to the AMA Insight Network’s Quality, Safety and Equity community. This virtual forum provides an opportunity for like-minded leaders from across the country to hear more examples of how leading health systems are finding innovative ways to address health care inequities in their communities.
Patient-centered outcomes research helps people and their caregivers make informed decisions, Dr. Chang noted. Patients learn what they can do to improve outcomes, and physicians and care delivery systems are better equipped to make optimal decisions about health care, he explained.
Assessments conducted by Dr. Chang and other cancer leaders identified a need for a coordinated patient-reported outcomes program at Henry Ford Health.
Several clinical trials helped guide the program’s design. The research found that patient-reported quality of life was predictive of overall survival, “which shows that there’s something unique about the patient and the patient voice,” he added.
The program, implemented across Henry Ford’s 50 outpatient clinics, monitors cancer patients’ reported quality of life in real time. It predicts cancer mortality and unplanned health care use such as emergency department and urgent-care visits, even when controlling for other variables.
Survey an easy experience for patients
Henry Ford Health uses the Patient Reported Outcomes Measurement Information System Computer Adaptive Test, instrumentation developed by the National Institutes of Health, to collect data on cancer patients.
Based on patient responses, it adapts the next response, crafting a “patient choose-your-own adventure type of experience.” While it encompasses a battery of 300 questions, patients only answer a few questions at a time—they aren’t forced to complete the entire survey every time. The survey collects information from four domains: depression, physical function, pain interference and fatigue.
Data goes through Henry Ford’s EHR.
“The way we deploy the instrument is, one week prior to your visit, if you have a cancer diagnosis within your electronic medical record, the instrument is sent to you via MyChart. If it's completed, then you're done and it's available for review,” explained Dr. Chang. Patients that don’t complete the questionnaire before their visit can do so on an iPad when they check in.
The score is immediately available. “It's used through a SmartPhrase within the notes,” he added. Medical assistants can see vital signs, blood pressure and quality of life scores when they're rooming the patients.
Reports can be generated for a specific physician, physician practice or physician location.
Scores identify severe cases
Dr. Chang and his colleagues discovered that the scores could help them predict mortality. “If patients were going to die three to six months out, we could see a signal.”
The scores also signaled when patients had unplanned hospitalizations or ED or urgent-care visits. “We have our cancer urgent-care monitoring really severe scores as a safety net and acting upon it as needed,” he said.
Physicians and patients alike have been receptive. “It’s really showed us the value of predicting overall survival and utilization,” and patients have found value in being heard, he said.
