Implementing PROMS for elective surgery patients: feasibility, response rate, degree of recovery and patient acceptability

 Background: Patient reported outcome measures (PROMs) engage patients in co-evaluation of their health and  wellbeing outcomes. This study aimed to determine the feasibility, response rate, degree of recovery and patient  acceptability of a PROM survey for elective surgery. Methods: We sampled patients with a broad range of elective surgeries from four major Australian hospitals to evaluate (1) feasibility of the technology used to implement the PROMs across geographically dispersed sites, (2) response  rates for automated short message service (SMS) versus email survey delivery formats, (3) the degree of recovery at  one and four weeks post-surgery as measured by the Quality of Recovery 15 Item PROM (QoR-15), and (4) patient  acceptability of PROMS based on survey and focus group results. Feasibility and acceptability recommendations were  then co-designed with stakeholders, based on the data. Results: Over three months there were 5985 surveys responses from 20,052 surveys (30% response rate). Feasibility  testing revealed minor and infrequent technical difculties in automated email and SMS administration of PROMs  prior to surgery. The response rate for the QoR-15 was 34.8% (n=3108/8919) for SMS and 25.8% (n=2877/11,133)  for email. Mean QoR-15 scores were 122.1 (SD 25.2; n=1021); 113.1 (SD 27.7; n=1906) and 123.4 (SD 26.84; n=1051)  for pre-surgery and one and four weeks post-surgery, respectively. One week after surgery, 825 of the 1906 responses  (43%) exceeded 122.6 (pre-surgery average), and at four weeks post-surgery, 676 of the 1051 responses (64%)  exceeded 122.6 (pre-surgery average). The PROM survey was highly acceptable with 76% (n=2830/3739) of patients  rating 8/10 or above for acceptability. Fourteen patient driven recommendations were then co-developed. Conclusion: Administering PROMS electronically for elective surgery hospital patients was feasible, acceptable and  discriminated changes in surgical recovery over time. Patient co-design and involvement provided innovative and  practical solutions to implementation and new recommendations for implementation. Trial Registration and Ethical Approval ACTRN12621000298819 (Phase I and II) and ACTRN12621000969864 (Phase  III). Ethics approval has been obtained from La Trobe University (Australia) Human Research Ethics Committee  (HEC20479).