For the last 18 years, Andrea Pusic, MD, MHS, FACS, FRCSC, has focused her research on patient-reported outcomes — the aspects of outcomes that only patients can know and share.

“Often, the clinical outcomes that we use to measure success are not the outcomes that matter most to our patients,” said Pusic, founding director of the Patient-Reported Outcomes, Value and Experience (PROVE) Center at the Brigham and chief of Plastic Surgery. “Traditional metrics do not take into account patient symptoms — pain, functional status, mobility – although improvement in these areas is what so many patients seek in their care.”

Historically, research in plastic surgery, including breast reconstructive surgery, has focused on rates of complications and survival data, but these statistics only tell one piece of the story. Patients have options when it comes to breast reconstruction, and while rates of complications may be comparable for different surgical techniques, there can be differences in quality of life and patient satisfaction.

“We wanted to understand how successful our approaches had been for patients and if one approach may be more successful compared to another,” said Pusic. “That’s where the idea of patient-reported outcomes comes in.”

Prompted by PROMs

In the last 15 years, new tools have been developed to rigorously quantify what patients think about their outcomes. As the field of evolved, Pusic recognized the opportunity to develop patient-reported outcomes measures (PROMs) for patients who had experienced breast cancer. While at Memorial Sloan Kettering Cancer Center, Pusic’s team developed Breast-Q, a tool that measured satisfaction with breast surgery overall, followed by other questionnaires for different areas of plastic surgery.

Pusic brought this PROMs-based approach with her when she joined the Brigham in 2018. Since launching the imPROVE app 4 months ago, over 900 patients have been enrolled across Brigham and Women’s Hospital, Brigham and Women’s Faulkner Hospital and Dana-Farber Cancer Institute.

An App to Meet Patients’ Needs

“Our patients told us that they don’t want to just fill out a survey about what they are experiencing and then wait until their next appointment to speak with their doctor,” said Pusic. “They wanted reassurance or resources and guidance in that moment.”

To create the imPROVE app, Pusic solicited input from patients, patient advocates and clinicians from many areas, including anesthesiologists, nurses, radiation oncologists, medical oncologists and breast surgeons. Her team also contracted with the software company ADK to develop the mobile app and make it convenient for patients to both submit responses to surveys and access treatment information relevant to them. With the help of the Brigham Digital Innovation Hub (iHub), the team was able to navigate the information security, privacy, legal, and governance guidelines, ensuring this new digital innovation is compliant with our institutional policies.  The app includes links to resources to help patients manage their symptoms and guidance for what to do and when to call their physician.

“The app is not meant to replace conversations with health care providers, but to offer patients something right there and then — to give feedback right away as they are providing us with key data,” said Pusic.

The imPROVE app is currently available for patients in plastic surgery and is being piloted with patients of the Brigham’s breast cancer surgeons. Pusic and her team hope to expand the offering to patients treated in other surgical areas, including gynecological oncology.



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