ABSTRACT
Objectives: When pandemic events arise, there are complex decisions to take under pressure, such as the prioritization of cases. While there are international examples of using PROMs to organize waiting lists, there are no such experiences in Italy. Italy was the first European country to be hit hard by the COVID-19 outbreak, and a selection of patients was necessary. Could PROMs be used in a prioritization process? Methods: We focused on robotic oncological surgery for prostate cancer in three different surgical units (SU) in Tuscany (Italy). We selected all patients who replied to the baseline PROMs questionnaire (EORTC-QLQ-C30) and received surgery during the COVID-19 crisis (March-May 2020) (n=86). We comparatively analyzed, for each SU, their baseline score with their position both in the real weekly surgical list and the simulation of an optimized list by using the PROMs, considering ±3 positions of tolerance. We discussed the findings with healthcare professionals. Results: More than 65.7% of cases were not operated accordingly to the severity perceived by patients. In one SU, the two surgical lists did not significantly differ. In the others, those who underwent later the surgery reported a worse condition (mean PROMs score 69/100;mean n. positions in surgical list SU1 +16 on 40). Healthcare professionals discussed the limits and potential of integrating PROMs-scores among the prioritization criteria, reaching a consensus on specific PROMs indicators to be tested to this eds. Conclusions: PROMs may represent a key tool to prioritize patients in oncological surgery. Surgical activities are still organized from a provider perspective. We proposed the use of PROMs as a tool to consider patient-reported needs to prioritize procedures. Further analysis should be done to estimate the value of using PROMs for the prioritization of most severe cases.
ABSTRACT
BACKGROUND: The COVID-19 pandemic is a complex global public health crisis presenting clinical, organisational and system-wide challenges. Different research perspectives on health are needed in order to manage and monitor this crisis. Performance intelligence is an approach that emphasises the need for different research perspectives in supporting health systems' decision-makers to determine policies based on well-informed choices. In this paper, we present the viewpoint of the Innovative Training Network for Healthcare Performance Intelligence Professionals (HealthPros) on how performance intelligence can be used during and after the COVID-19 pandemic. DISCUSSION: A lack of standardised information, paired with limited discussion and alignment between countries contribute to uncertainty in decision-making in all countries. Consequently, a plethora of different non-data-driven and uncoordinated approaches to address the outbreak are noted worldwide. Comparative health system research is needed to help countries shape their response models in social care, public health, primary care, hospital care and long-term care through the different phases of the pandemic. There is a need in each phase to compare context-specific bundles of measures where the impact on health outcomes can be modelled using targeted data and advanced statistical methods. Performance intelligence can be pursued to compare data, construct indicators and identify optimal strategies. Embracing a system perspective will allow countries to take coordinated strategic decisions while mitigating the risk of system collapse.A framework for the development and implementation of performance intelligence has been outlined by the HealthPros Network and is of pertinence. Health systems need better and more timely data to govern through a pandemic-induced transition period where tensions between care needs, demand and capacity are exceptionally high worldwide. Health systems are challenged to ensure essential levels of healthcare towards all patients, including those who need routine assistance. CONCLUSION: Performance intelligence plays an essential role as part of a broader public health strategy in guiding the decisions of health system actors on the implementation of contextualised measures to tackle COVID-19 or any future epidemic as well as their effect on the health system at large. This should be based on commonly agreed-upon standardised data and fit-for-purpose indicators, making optimal use of existing health information infrastructures. The HealthPros Network can make a meaningful contribution.