title: Using Quality Improvement Principles to Enhance Long-Term Completion of Patient-Reported Outcomes after Ventral Hernia Repair.
abstract: BACKGROUND
  Ventral hernia repair (VHR) is a commonly performed surgical procedure. Unfortunately, long-term prospective information about quality of life and outcomes after VHR has been challenging to obtain. Decoupling follow-up from clinical visits via patient-reported outcomes (PROs) has been proposed as a means of achieving better long-term assessments after VHR. The Americas Hernia Society Quality Collaborative (AHSQC) is a national quality improvement (QI) effort in hernia repair that uses PROs to obtain long-term follow-up. However, the modality of PRO engagement to maximize participation has not been well established. A formal QI initiative was undertaken to determine if long-term PRO follow-up could be increased at a single AHSQC site by adding telephone communication to email communication for long-term postoperative VHR assessment.
  
  
  METHODS
  Between September 2015 and July 2016, the long-term (greater than 1 year) AHSQC PRO completion rates after VHR at our institution were analyzed using plan-do-study-act cycles. Two interventions were implemented: contacting patients by telephone and changing timing of telephone calls.
  
  
  RESULTS
  Two hundred thirty-two patients were identified, of whom 99 (42.7%) met eligibility criteria. Before this initiative, the long-term PRO completion rate was 16.3% in postoperative VHR patients. The completion rate after introducing telephone calls (intervention 1) was 35.7% and after changing the timing of telephone calls (intervention 2), was 55.1%. The mean participation rate was 45.4% (± 9.7%).
  
  
  CONCLUSIONS
  A telephone-based approach markedly improved long-term PRO participation rates in postoperative VHR patients. Ultimately, a combination of email and telephone communication may be necessary to achieve higher levels of PRO follow-up in the VHR population.
authors: Division of General Surgery, Vanderbilt University School of Medicine, Nashville, TN. Electronic address: nishant.ganesh.kumar@vanderbilt.edu.
authors: Nishant
authors: N
authors: Ganesh Kumar
authors: Division of General Surgery, Vanderbilt University School of Medicine, Nashville, TN.
authors: Adil A
authors: AA
authors: Faqih
authors: Division of General Surgery, Vanderbilt University School of Medicine, Nashville, TN.
authors: Michael P
authors: MP
authors: Feng
authors: Division of General Surgery, Vanderbilt University School of Medicine, Nashville, TN.
authors: Richard S
authors: RS
authors: Miller
authors: Division of General Surgery, Vanderbilt University School of Medicine, Nashville, TN.
authors: Richard A
authors: RA
authors: Pierce
authors: Division of General Surgery, Vanderbilt University School of Medicine, Nashville, TN.
authors: Kenneth W
authors: KW
authors: Sharp
authors: Division of General Surgery, Vanderbilt University School of Medicine, Nashville, TN.
authors: Michael D
authors: MD
authors: Holzman
authors: Division of General Surgery, Vanderbilt University School of Medicine, Nashville, TN.
authors: Benjamin K
authors: BK
authors: Poulose
mesh_terms: D000359:Aftercare / Q000379:methods*; D034742:Electronic Mail; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy; D006801:Humans; D000071066:Patient Reported Outcome Measures; D058996:Quality Improvement; D017216:Telemedicine / Q000379:methods*; D013689:Telephone