Brigham & Women's Hospital: Using Patient Reported Outcomes to Improve Breast Cancer Care

Dr. Andrea Pusic, breast cancer reconstruction surgeon, wants to extend outcomes measurement beyond traditional surgical metrics of infections, complications, and survival rates. The case describes her development of a new mobile phone app, which collects patients’ responses to questions about their post-surgical outcomes and experiences using BREAST-Q, a statistically-validated patient-reported outcomes survey instrument she helped develop. The app provides patients with immediate feedback about their progress, and access to resources customized to their recovery needs. Dr. Pusic also leads a time-driven activity-based costing study to measure the cost of treating patients for all disease stages and across all stages of care and treatment modalities, including psychosocial oncology and physical therapy services. The case describes several care decisions based on the new information on patient outcomes and preferences, and the costs of care. The case ends with Dr. Pusic deciding whether to undertake a project that would adapt the new app for community cancer care centers, which have limited resources, more diverse patient populations, and worse outcome than urban academic medical centers.