9 results on '"Sisodia, Rachel C."'
Search Results
2. The Surgeon's Perceived Value of Patient-reported Outcome Measures (PROMs): An Exploratory Qualitative Study of 5 Different Surgical Subspecialties.
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Mou D, Sisodia RC, Castillo-Angeles M, Ladin K, Bergmark RW, Pusic AL, Del Carmen MG, and Heng M
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- Humans, Qualitative Research, Attitude of Health Personnel, Patient Reported Outcome Measures, Specialties, Surgical, Surgeons psychology
- Abstract
Objective: To understand the surgeon's perceived value of PROMs in 5 different surgical subspecialties., Summary of Background Data: PROMs are validated questionnaires that assess the symptoms, function, and quality of life from the patient's perspective. Despite the increasing support for use of PROMs in the literature, there is limited uptake amongst surgeons. Furthermore, there is insufficient understanding of the surgeons' perceived value of PROMs. The aim of this study is to understand how surgeons perceive value in PROMs., Methods: We conducted an exploratory qualitative study to understand the perceived value of PROMs from the perspective of surgeons in various subspecialties. Per convenience sampling, we conducted semi-structured interviews with 30 surgeons from 5 subspecialties across 3 academic medical centers. The surgical subspecialties included bariatric surgery, breast oncologic surgery, orthopedic surgery, plastic and reconstructive surgery, and rhinology. Interviews were transcribed, coded, and evaluated with thematic analysis., Results: Surgeons endorsed that PROMs can be used to enhance clinical management, counsel patients in the preoperative and postoperative settings, and elicit sensitive information from patients that otherwise may go undetected. Obstacles to PROMs use include failure to generate actionable data, implementation obstacles, and inappropriate use of PROMs as a performance metric, with concerns regarding inadequate risk adjustment., Conclusions: Establishing an effective PROMs program requires an understanding of the surgeon's perspective of PROMs. Despite obstacles, different subspecialty surgeons find PROMs to be valuable in different settings, depending on the specialty and clinical context., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2022
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3. Initial findings from a prospective, large scale patient reported outcomes program in patients with gynecologic malignancy.
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Sisodia RC, Alimena S, Ferris W, Saini A, Philp L, Sullivan M, Dorney K, Bregar A, Eisenhauer E, Goodman A, Growdon W, Hubbell H, and Del Carmen M
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- Adult, Aged, Aged, 80 and over, Female, Humans, Massachusetts, Middle Aged, Prospective Studies, Surveys and Questionnaires, Genital Neoplasms, Female psychology, Patient Reported Outcome Measures, Psychometrics
- Abstract
Introduction: Patient reported outcome measures (PROMs) are associated with improved overall survival in patients with metastatic malignancy; however, routine collection of PROMs is nascent. Little is known about PROs in women with gynecologic malignancy outside of a trial setting, limiting our understanding of how routine populations experience treatment, disease and morbidity. The goal of this study was to prospectively collect and describe disease-specific PROs in a non-trial population of women with gynecologic malignancy., Methods: PROMs were assigned electronically to all patients presenting for care in our gynecologic oncology clinic. Patients received a general oncology questionnaire (EORTC QLQ C30) a disease specific questionnaire (FACT V, EORTC EN24, EORTC OV28, EORTC Cx 24), and questionnaires assessing support at home. Responses were mapped to relevant clinical variables. Descriptive statistics were performed, and comparisons made with parametric and nonparametric analyses. The association between support at home and perioperative complications was assessed via logistic regression., Results: In the study period, 3239 unique patients were evaluated at new patient visits, post-operative visits, chemotherapy visits and surveillance visits with a PROMs completion rate of 78.1% (n = 2530 women with 4402 completions). There was no difference in completion rates based on age or self-identified race. The EORTC QLQ C-30 questionnaire was able to adequately discern differences between disease sites. Overall, scores were lower than those obtained in trial populations. PROMs responses were not associated with perioperative complications., Conclusion: Systematic collection of PROMs is feasible and tech-enabled workflows result in high collection rates. Quality of life scores in our clinic population were lower than published data, indicating caution should be used when extrapolating quality of life data from clinical trials to counseling and decision making around routine patient populations., Competing Interests: Declaration of competing interest None., (Copyright © 2021 Elsevier Inc. All rights reserved.)
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- 2022
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4. Can the Knee Outcome and Osteoarthritis Score (KOOS) Function Subscale Be Linked to the PROMIS Physical Function to Crosswalk Equivalent Scores?
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Heng M, Tang X, Schalet BD, Collins AK, Chen AF, Melnic CM, O'Brien TM, Sisodia RC, Franklin PD, and Cella D
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- Activities of Daily Living, Aged, Correlation of Data, Female, Humans, Male, Middle Aged, Psychometrics, Reproducibility of Results, Retrospective Studies, Surveys and Questionnaires, Treatment Outcome, Arthroplasty, Replacement, Knee statistics & numerical data, Disability Evaluation, Health Status Indicators, Osteoarthritis, Knee surgery, Patient Reported Outcome Measures
- Abstract
Background: An increased focus on patient-reported outcome measures (PROMs) has led to a proliferation of these measures in orthopaedic surgery. Mandating a single PROM in clinical and research orthopaedics is not feasible given the breadth of data already collected with older measures and the emergence of psychometrically superior measures. Creating crosswalk tables for scores between measures allows providers to maintain control of measure choice. Furthermore, crosswalk tables permit providers to compare scores collected with older outcome measures with newly collected ones. Given the widespread use of the newer Patient-reported Outcome Measure Information System Physical Function (PROMIS PF) and the established Knee Outcome and Osteoarthritis Score (KOOS), it would be clinically useful to link these two measures., Question/purpose: Can the KOOS Function in Activities of Daily Living (ADL) subscale be robustly linked to the PROMIS PF to create a crosswalk table of equivalent scores that accurately reflects a patient's reported physical function level on both scales?, Methods: We sought to establish a common standardized metric for collected responses to the PROMIS PF and the KOOS ADL to develop equations for converting a PROMIS PF score to a score for the KOOS-ADL subscale and vice versa. To do this, we performed a retrospective, observational study at two academic medical centers and two community hospitals in an urban and suburban healthcare system. Patients 18 years and older who underwent TKA were identified. Between January 2017 and July 2020, we treated 8165 patients with a TKA, 93% of whom had a diagnosis of primary osteoarthritis. Of those, we considered patients who had completed a full KOOS and PROMIS PF 10a on the same date as potentially eligible. Twenty-one percent (1708 of 8165) of patients were excluded because no PROMs were collected at any point, and another 67% (5454 of 8165) were excluded because they completed only one of the required PROMs, leaving 12% (1003 of 8165) for analysis here. PROMs were collected each time they visited the health system before and after their TKAs. Physical function was measured by the PROMIS PF version 1.0 SF 10a and KOOS ADL scale. Analyses to accurately create a crosswalk of equivalent scores between the measures were performed using the equipercentile linking method with both unsmoothed and log linear smoothed score distributions., Results: Crosswalks were created, and adequate validation results supported their validity; we also created tables to allow clinicians and clinician scientists to convert individual patients' scores easily. The mean difference between the observed PROMIS PF scores and the scores converted by the crosswalk from the KOOS-ADL scores was -0.08 ± 4.82. A sensitivity analysis was conducted, confirming the effectiveness of these crosswalks to link the scores of two measures from patients both before and after surgery., Conclusion: The PROMIS PF 10a can be robustly linked to the KOOS ADL measure. The developed crosswalk table can be used to convert PROMIS PF scores from KOOS ADL and vice versa., Clinical Relevance: The creation of a crosswalk table between the KOOS Function in ADL subscale and PROMIS PF allows clinicians and researchers to easily convert scores between the measures, thus permitting greater choice in PROM selection while preserving comparability between patient cohorts and PROM data collected from older outcome measures. Creating a crosswalk, or concordance table, between the two scales will facilitate this comparison, especially when pooling data for meta-analyses., Competing Interests: All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members., (Copyright © 2021 by the Association of Bone and Joint Surgeons.)
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- 2021
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5. Digital disparities: lessons learned from a patient reported outcomes program during the COVID-19 pandemic.
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Sisodia RC, Rodriguez JA, and Sequist TD
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- Digital Divide, Healthcare Disparities, Humans, SARS-CoV-2, COVID-19, Electronic Health Records, Pandemics, Patient Reported Outcome Measures
- Abstract
The collection of patient reported outcomes (PROs) allows us to incorporate the patient's voice into their care in a quantifiable, validated manner. Large-scale collection of PROs is facilitated by the electronic health record and its portal, though, historically, patients have eschewed the portal and completed patient-reported outcome measures in the clinic via tablet. Furthermore, access and use of the portal is associated with known racial inequities. Our institution oversees the largest clinical PRO program in the world, and has a long history of racially equitable PRO completion rates via tablet. However, when the COVID-19 pandemic forced us to remove tablets from clinics and rely exclusively on portal use for PRO completion, profound racial disparities resulted immediately. Our experience quantifiably demonstrates the magnitude of inequity that the portal, in its current configuration, generates and serves as a cautionary tale to other health care systems and electronic health records., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Medical Informatics Association.)
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- 2021
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6. Patient reported outcomes measures in gynecologic oncology: A primer for clinical use, part I.
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Sisodia RC, Dewdney SB, Fader AN, Wethington SL, Melamed A, Von Gruenigen VE, Zivanovic O, Carter J, Cohn DE, Huh W, Wenzel L, Doll K, Cella D, and Dowdy SC
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- Electronic Health Records, Female, Genital Neoplasms, Female therapy, Humans, Quality of Life, Surveys and Questionnaires, Genital Neoplasms, Female diagnosis, Patient Reported Outcome Measures
- Abstract
Competing Interests: Declaration of competing interest The authors report no conflict of interest.
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- 2020
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7. Factors Associated With Increased Collection of Patient-Reported Outcomes Within a Large Health Care System.
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Sisodia RC, Dankers C, Orav J, Joseph B, Meyers P, Wright P, St Amand D, Del Carmen M, Ferris T, Heng M, Licurse A, Meyer G, and Sequist TD
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- Adult, Aged, Aged, 80 and over, Cohort Studies, Female, Humans, Male, Massachusetts, Middle Aged, Surveys and Questionnaires, Data Collection statistics & numerical data, Delivery of Health Care statistics & numerical data, Patient Reported Outcome Measures
- Abstract
Importance: The collection of patient-reported outcomes (PROs) has garnered intense interest, but dissemination of PRO programs has been limited, as have analyses of the factors associated with successful programs., Objective: To identify factors associated with improving PRO collection rates within a large health care system using a centralized PRO infrastructure., Design, Setting, and Participants: This cohort study included 205 medical and surgical clinics in the Partners Healthcare system in Massachusetts that implemented a PRO program between March 15, 2014, and December 31, 2018, using a standardized centralized infrastructure. Data were analyzed from March to April 2019., Exposures: Relevant clinical characteristics were recorded for each clinic launching a PRO program., Main Outcomes and Measures: The primary outcome was the mean PRO collection rate during each clinic's most recent 6 months of collection prior to January 2019. Data were analyzed using a linear regression model with the 6-month PRO collection rate as the dependent variable and clinic characteristics as independent variables. Secondary analysis used a logistic regression model to assess clinical factors associated with successful clinics, defined as those that collected PROs at a rate greater than 50%., Results: Between March 2014 and December 2018, 205 Partners Healthcare clinics were available for analysis, and 4 061 205 PRO measures from 745 028 encounters were collected. Among these, 103 clinics (50.2%) collected at a rate greater than 50%. Increased collection rates were associated with more than 50% of physicians in a clinic trained on PROs (change, 19.6% [95% CI, 9.9%-29.4%]; P < .001), routine administrative oversight of collection rates (change, 16.0% [95% CI, 6.6%-25.5%]; P = .001), previous collection of PROs on paper (change, 12.5% [95% CI, 4.7%-20.3%]; P = .002), presence of a clinical champion (change, 11.2% [95% CI, 2.5%-20.0%]; P = .01) and payer incentive (change, 10.5% [95% CI, 2.0%-18.9%]; P = .02)., Conclusions and Relevance: These findings suggest that training physicians on the use of PROs, administrative surveillance of collection rates, and the presence of a local clinical champion may be promising interventions for increasing PRO collection. Clinics that have previously collected PROs may have greater success in increasing collections. Payer incentive for collection was associated with improved collections, but not associated with successful programs.
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- 2020
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8. Linking the KOOS-PS to PROMIS Physical Function in Knee Patients Evaluated for Surgery
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Tang, Xiaodan, Schalet, Benjamin D, Heng, Marilyn, Lange, Jeffrey K, Bedair, Hany S, O'Brien, Todd M, Sisodia, Rachel C, Franklin, Patricia D, Cella, David, and Epidemiology and Data Science
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Knee Joint ,Lower Extremity ,Humans ,Orthopedics and Sports Medicine ,Surgery ,Patient Reported Outcome Measures ,Postoperative Period ,Osteoarthritis, Knee ,Arthroplasty, Replacement, Knee - Abstract
INTRODUCTION: The Knee Injury and Osteoarthritis Outcome Score-Physical Function Short-form and the Patient-Reported Outcomes Measurement Information System Physical Function are widely used patient-reported outcome measures in orthopaedic practice and research. It would be helpful for clinicians and researchers to compare scores obtained on one instrument with those collected on another. To achieve this goal, this study conducted a linking analysis and computed a crosswalk table between these two scales.DATA: The data of this study were collected as part of the clinical care of total knee arthroplasty patients in a large urban and suburban health system. The sample was a mix of responses from nonsurgical (no surgery performed), preoperative (before surgical intervention), and postoperative (after surgical intervention) groups.METHODS: This study applied five linking methods: the item response theory (IRT)-based linking methods including fixed-parameter calibration, separate-parameter calibration with Stocking-Lord constants, and calibrated projection; and the equipercentile methods with log-linear smoothing and nonsmoothing approaches. Before conducting the linking analysis, we checked the linking assumptions including the similar content of the two scales, the unidimensionality of the combined scales, and the population invariance. The results of the five linking methods were evaluated by mean difference, SD, root-mean-squared deviation, intraclass correlation coefficient of the observed T scores and the crosswalk-derived T scores.RESULTS: The linking assumptions were all met. T scores generated from the Stocking-Lord crosswalk had the smallest mean difference (= -0.03) and relatively small SD (= 4.91) and root-mean-squared deviation (= 4.91) among the five linking methods. We validated this crosswalk in a larger sample with the nonsurgical, preoperative, and postoperative groups and in an external sample.DISCUSSION: This study provides clinicians and researchers a practical tool (ie, a crosswalk table) to link scores from two popular physical function measures. Given the diversity of patient-reported outcome measures in use for knee conditions, these crosswalk tables would accelerate clinical and research interpretation of aggregating functional outcomes among the patients evaluated for knee surgery each year.
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- 2021
9. Surgeon-level variance in achieving clinical improvement after lumbar decompression: the importance of adequate risk adjustment.
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Karhade, Aditya V., Sisodia, Rachel C., Bono, Christopher M., Fogel, Harold A., Hershman, Stuart H., Cha, Thomas D., Doorly, Terence P., Kang, James D., Schwab, Joseph H., and Tobert, Daniel G.
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SPINAL stenosis , *ACADEMIC medical centers , *BIVARIATE analysis , *BODY mass index , *PATIENT reported outcome measures - Abstract
Background Context: Patient-Reported Outcome Measurement Information System (PROMIS) scores are increasingly utilized in clinical care. However, it is unclear if PROMIS can discriminate surgeon performance on an individual level.Purpose: The purpose of this study was to examine surgeon-level variance in rates of achieving minimal clinically important difference (MCID) after lumbar decompression.Patient Sample: This is a prospective, observational cohort study performed across a healthcare enterprise (two academic medical centers and three community centers). Patients 18 years or older undergoing one- to two-level primary decompression for lumbar disc herniation (LDH) or lumbar spinal stenosis (LSS) were included.Outcome Measures: The primary outcome was achievement of MCID, using a distribution-based method, on paired PROMIS physical function scores.Methods: Descriptive statistics were generated to examine the baseline characteristics of the study cohort. Bivariate analyses were used to examine the impact of surgeon-level variance on rates of MCID. Multivariable analyses were used to examine the risk-adjusted impact of surgeon-level variance on rates of MCID.Results: Overall, 636 patients treated by nine surgeons were included. The median patient age was 58 [interquartile range (IQR): 46-70] and 62.3% (n=396) were female. Among all patients, 56.9% (n=362) underwent surgery for LDH. The overall rate of achieving MCID was 75.8% (n=482). Of the surgeons, the median years in practice were 12 (range 4-31) and 55.6% (n=5) were in academic practice settings. On bivariate analysis, patients treated by one of the surgeons had lower rates of achieving MICD (odds ratio=0.37, 95% confidence interval: 0.15-0.91, p=.03). However, on multivariable analysis adjusting for operative indication (LDH vs. LSS), body mass index, number of comorbidities, percent unemployment in patient zip code, and preoperative PROMIS physical function scores, all surgeons were equally likely to obtain MCID.Conclusions: In this cohort, variance in PROMIS scores after primary lumbar decompression is influenced by patient-related factors and not by individual surgeon. Adequate risk adjustment is needed if ascertaining clinical improvement on an individual surgeon basis.Level Of Evidence: 2. [ABSTRACT FROM AUTHOR]- Published
- 2021
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