Increasing Engagement in Patient Reported Outcome Measurement to Improve Breast Cancer Care using Health Information Technology in Community Cancer Settings

Despite compelling evidence that routine patient-reported outcome (PRO) measurement can improve outcomes and patient experiences in oncology, PRO reporting remains low among patients receiving care within community cancer care (CCC) settings. The goal of this proposed study is to increase breast cancer patient engagement in PRO reporting by establishing flexible and contextually aligned PRO implementation models in CCCs. Completing this work will set the stage to increase routine use of PROs in clinical care to improve health outcomes among patients in CCCs. In partnership with the Association of Community Cancer Centers (ACCC), we will develop models for successful implementation of PRO reporting in five CCCs in the ACCC network (Boston Medical Center, Boston, MA; Baptist Hospital, Memphis TN; Brooklyn Methodist, Brooklyn NY; University of Maryland, Baltimore, MD; Luminis Health, Lanham, MD). The HIT platform for this study will be imPROVE, an Epic-integrated PRO platform centered around the preferences, needs and values of breast cancer patients. In line with the priorities of the NCI, we will (Aim 1) identify challenges, barriers, and enablers to HIT-assisted PRO data collection among breast cancer patients receiving care in CCCs and develop PRO implementation models that address these factors; (Aim 2) conduct a phased implementation of the PRO data collection models in five CCCs using PDSA cycles to refine models and the RE-AIM framework to evaluate success; and (Aim 3) explore the potential of detecting differences in outcomes based on PRO data used in clinical care to inform future quality improvement efforts. Our expected outcomes are generalizable knowledge of the factors that trigger or deter breast cancer patient engagement, and models with training materials and tools for feasible, pragmatic, and sustainable PRO program implementation across the ACCC network. More than 80% of cancer patients nationwide receive their care at CCCs, and approximately 65% of the nation’s cancer patients are treated by a member of the ACCC network. The completion of this foundational work, with broad dissemination of lessons learned through the ACCC and beyond, will unlock the benefits of PRO reporting to a broader range of patients and advance cancer care. This work will also support a continued program of research to expand implementation and evaluation of PRO programs among other patient populations in oncology and further the use of PRO data for quality improvement.