title: The development and acceptability of symptom management quality improvement reports based on patient-reported data: an overview of methods used in PROSSES.
abstract: Patient experiences with symptom care need to be assessed and documented to ensure successful management of cancer-related symptoms. This paper details one method for creating symptom management quality improvement (SMQI) reports, including case-mix adjustment of patient-reported measures. Qualitative data regarding the acceptability of these reports at participating cancer centers (CCs) are also provided.
  
  
  
  Data were collected from 2226 patients treated at 16 CCs via mailed/Web questionnaires. Twelve items assessing patient perceptions of symptom management-pain, fatigue, emotional distress-served as key quality indicators. Medico-demographic variables suitable for case-mix adjustment were selected using an index score combining predictive power and heterogeneity across CCs. SMQI reports were designed with staff feedback and produced for each CC, providing crude and adjusted CC-specific rates, along with study-wide rates for comparison purposes.
  
  
  
  Cancer type and participant educational level were selected for case-mix adjustment based upon high index scores. The Kendall rank correlation coefficient showed that case-mix adjustments changed the ranking of CCs on the key quality indicators (% Δ rank range: 5-22 %). The key quality indicators varied across CCs (all p < 0.02). SMQI reports were well received by CC staff, who described plans to share them with key personnel (e.g., cancer committee, navigator).
  
  
  
  This paper provides one method for creating hospital-level SMQI reports, including case-mix adjustment. Variation between CCs on key quality indicators, even after adjustment, suggested room for improvement. SMQI reports based on patient-reported data can inform and motivate efforts to improve care through professional/patient education and applying standards of care.
authors.affiliation: Intramural Research Department, American Cancer Society, 250 Williams Street, Atlanta, GA, 30301, USA.
authors.forename: Alyssa
authors.initials: A
authors.lastname: Troeschel
authors.affiliation: Intramural Research Department, American Cancer Society, 250 Williams Street, Atlanta, GA, 30301, USA. Tenbroeck.Smith@cancer.org.
authors.forename: Tenbroeck
authors.initials: T
authors.lastname: Smith
authors.affiliation: Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Castro
authors.affiliation: Research Triangle Institute, Research Triangle Park, Durham, NC, USA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Treiman
authors.affiliation: Rollins School of Public Health and Winship Cancer Institute, Emory University, Atlanta, GA, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Lipscomb
authors.affiliation: American College of Surgeons, Chicago, IL, USA.
authors.forename: Ryan M
authors.initials: RM
authors.lastname: McCabe
authors.affiliation: Patient-Centered Outcomes Research Institute, Washington, DC, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Clauser
authors.affiliation: Lehigh Valley Health Network, Allentown, PA, USA.
authors.forename: Eliot L
authors.initials: EL
authors.lastname: Friedman
authors.affiliation: Gibbs Cancer Center and Research Institute, Spartanburg, SC, USA.
authors.forename: Patricia D
authors.initials: PD
authors.lastname: Hegedus
authors.affiliation: Intramural Research Department, American Cancer Society, 250 Williams Street, Atlanta, GA, 30301, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Portier
mesh_terms: D000368:Aged; D006801:Humans; D008875:Middle Aged; D000071066:Patient Reported Outcome Measures; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires
keywords: Cancer; Case-mix adjustment; Patient-reported outcomes; Quality improvement reports; Symptom management