Background: Patient-reported outcomes (PROs) are used increasingly in routine clinical care and inform policies, reimbursements, and quality improvement. Less is known regarding PRO implementation in routine clinical care for diverse and underrepresented patient populations. Objective: This review aims to identify studies of PRO implementation in diverse and underrepresented patient populations, elucidate representation of clinical specialties, assess implementation outcomes, and synthesize patient needs, concerns, and preferences. Methods: MEDLINE, Embase, Web of Science, CINAHL, and PsycINFO were searched September 2021 for studies aiming to study PRO implementation in diverse and underrepresented patient populations within the United States. Studies were screened and data extracted by three independent reviewers. Implementation outcomes were assessed according to Proctor et al. taxonomy. A descriptive analysis of data was conducted. Results: The search yielded 8,687 records, and 28 studies met inclusion criteria. The majority were observational cohort studies (n = 21, 75%) and conducted in primary care (n = 10, 36%). Most studies included majority female (n = 19, 68%) and non-White populations (n = 15, 54%), while fewer reported socioeconomic (n = 11, 39%) or insurance status (n = 9, 32.1%). Most studies assessed implementation outcomes of feasibility (n = 27, 96%) and acceptability (n = 19, 68%); costs (n = 3, 11%), penetration (n = 1, 4%), and sustainability (n = 1, 4%) were infrequently assessed. Conclusion: PRO implementation in routine clinical care for diverse and underrepresented patient populations is generally feasible and acceptable. Research is lacking in key clinical specialties. Further work is needed to understand how health disparities drive PRO implementation outcomes.

Delivering high-quality surgical care requires knowing how best to define and measure quality in surgery. Patient-reported outcomes (PROs) enable surgeons, health care systems, and payers to understand meaningful health outcomes from the patient's perspective and can be measured using patient-reported outcome measures (PROMs). As a result, there is much interest in using PROMs in routine surgical care, to guide quality improvement and to inform reimbursement pay structures. This chapter defines PROs and PROMs, differentiates PROMs from other quality measures such as patient-reported experience measures, describes PROMs in the context of routine clinical care, and provides an overview of interpreting PROM data. This chapter also describes how PROMs may be applied to quality improvement and value-based reimbursement in surgery.

Background: With efforts underway globally to scale up access to surgical care for the billions who lack it, understanding the impact of climate change on surgical care delivery is critical for clinicians and policymakers. We aimed to assess the current state of knowledge regarding the impact of climate change on the Lancet Commission on Global Surgery Bellwether Procedures: laparotomy, caesarean delivery and treatment of an open fracture. Methods: Adhering to PRISMA guidelines, we performed a systematic review of PubMed, Embase, CINAHL and Web of Science. We included studies that incorporated at least one of each of our two sets of search terms: (1) a specific Bellwether Procedure or its directly related pathophysiology, and (2) a climate change pressure (e.g. extreme heat, major storm, etc.). We excluded studies published before January 1, 2000; in languages outside coauthors’ fluency; and those without primary data (e.g. meta-analyses). Two co-authors screened each abstract and then the qualifying full articles for inclusion and data extraction. Our study is registered in PROSPERO (#CRD42021271933). Results: We initially identified 4,618 references, narrowed to 32 for final analysis. Most studies (n=18, 56.3%) were conducted in high income countries. Only one study was conducted in Africa; none were conducted in South America or the Western Pacific. Caesarean section was the most studied procedure (n=20, 54.1%) and major storms were the most studied climate change pressure (n=14, 37.8%). Conclusion: Overall, the impact of climate change on surgery is understudied. Major specific content gaps include laparotomy procedures; long-term climate pressures (e.g. heat, air pollution); geographic regions in South America, the Western Pacific and Africa; and low income country contexts. Though the existing body of literature is small, current trends can inform future research and policy initiatives in global surgery.