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Rothrock NE, Wilson SA, Heng M, Hodor A, Joeris A, Kaat AJ, McKelvey K, Schalet BD, Vrahas M. Using bookmarking methods with orthopedic clinicians and patients with fractures produces score interpretation labels for patient-reported outcome measures. Qual Life Res 2023; 32:2779-2787. [PMID: 37227662 PMCID: PMC10474193 DOI: 10.1007/s11136-023-03439-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The objective of this study was to determine the patient-reported outcome measure (PROM) score ranges associated with descriptive labels (i.e., within normal limits, mild, moderate, severe) by using bookmarking methods with orthopedic clinicians and patients who have experienced a bone fracture. STUDY DESIGN AND SETTING We created vignettes comprised of six items and responses from the Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity Function, Physical Function, and Pain Interference item banks reflecting different levels of severity. Two groups of patients with fractures (n = 11) and two groups of orthopedic clinicians (n = 16) reviewed the vignettes and assigned descriptive labels independently and then discussed as a group until reaching consensus via a videoconference platform. RESULTS PROMIS Physical Function and Pain Interference thresholds (T = 50, 40, 25/30 and T = 50/55, 60, 65/70, respectively) for patients with bone fractures were consistent with the results from other patient populations. Upper Extremity thresholds were about 10 points (1 SD) more severe (T = 40, 30, 25/20) compared to the other measures. Patient and clinician perspectives were similar. CONCLUSION Bookmarking methods generated meaningful score thresholds for PROMIS measures. These thresholds between severity categories varied by domain. Threshold values for severity represent important supplemental information to interpret PROMIS scores clinically.
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Affiliation(s)
- Nan E Rothrock
- Feinberg School of Medicine of Northwestern University, Chicago, IL, USA.
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave, Suite 2700, Chicago, IL, 60611, USA.
| | - Sandra A Wilson
- Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - Marilyn Heng
- Department of Orthopaedics, University of Miami Miller School of Medicine, Miami, FL, USA
- Orthopaedic Trauma Service, Ryder Trauma Center, Jackson Memorial Hospital, Miami, FL, USA
| | - Aleksandra Hodor
- AO Innovation Translation Center, AO Foundation, Dubendorf, Switzerland
| | - Alexander Joeris
- AO Innovation Translation Center, AO Foundation, Dubendorf, Switzerland
| | - Aaron J Kaat
- Feinberg School of Medicine of Northwestern University, Chicago, IL, USA
| | - Karma McKelvey
- Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Benjamin D Schalet
- Feinberg School of Medicine of Northwestern University, Chicago, IL, USA
| | - Mark Vrahas
- Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Scott HM, Braybrook D, Harðardóttir D, Ellis-Smith C, Harding R. Implementation of child-centred outcome measures in routine paediatric healthcare practice: a systematic review. Health Qual Life Outcomes 2023; 21:63. [PMID: 37394520 DOI: 10.1186/s12955-023-02143-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 06/04/2023] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND Person-centred outcome measures (PCOMs) are commonly used in routine adult healthcare to measure and improve outcomes, but less attention has been paid to PCOMs in children's services. The aim of this systematic review is to identify and synthesise existing evidence of the determinants, strategies, and mechanisms that influence the implementation of PCOMs into paediatric healthcare practice. METHODS The review was conducted and reported in accordance with PRISMA guidelines. Databased searched included CINAHL, Embase, Medline, and PsycInfo. Google scholar was also searched for grey literature on 25th March 2022. Studies were included if the setting was a children's healthcare service, investigating the implementation or use of an outcome measure or screening tool in healthcare practice, and reported outcomes relating to use of a measure. Data were tabulated and thematically analysed through deductive coding to the constructs of the adapted-Consolidated Framework for Implementation Research (CFIR). Results were presented as a narrative synthesis, and a logic model developed. RESULTS We retained 69 studies, conducted across primary (n = 14), secondary (n = 13), tertiary (n = 37), and community (n = 8) healthcare settings, including both child self-report (n = 46) and parent-proxy (n = 47) measures. The most frequently reported barriers to measure implementation included staff lack of knowledge about how the measure may improve care and outcomes; the complexity of using and implementing the measure; and a lack of resources to support implementation and its continued use including funding and staff. The most frequently reported facilitators of implementation and continued use include educating and training staff and families on: how to implement and use the measure; the advantages of using PCOMs over current practice; and the benefit their use has on patient care and outcomes. The resulting logic model presents the mechanisms through which strategies can reduce the barriers to implementation and support the use of PCOMs in practice. CONCLUSIONS These findings can be used to support the development of context-specific implementation plans through a combination of existing strategies. This will enable the implementation of PCOMs into routine paediatric healthcare practice to empower settings to better identify and improve child-centred outcomes. TRIAL REGISTRATION Prospero CRD 42022330013.
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Affiliation(s)
- Hannah May Scott
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, Bessemer Rd, SE5 9RS, London, UK.
| | - Debbie Braybrook
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, Bessemer Rd, SE5 9RS, London, UK
| | - Daney Harðardóttir
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, Bessemer Rd, SE5 9RS, London, UK
| | - Clare Ellis-Smith
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, Bessemer Rd, SE5 9RS, London, UK
| | - Richard Harding
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, Bessemer Rd, SE5 9RS, London, UK
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McGee RG, Zhang EYB, Tan JJG, Cheung ACK, Garvey MP. A systematic review of patient-reported outcome measures in paediatric endocrinology. BMC Endocr Disord 2022; 22:177. [PMID: 35840922 PMCID: PMC9284786 DOI: 10.1186/s12902-022-01099-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/20/2022] [Indexed: 11/10/2022] Open
Abstract
CONTEXT Patient reported outcome measures (PROMs) are useful tools in paediatric endocrinology to gauge health status in children, especially since they are often unable to clearly communicate it themselves. We aimed to systematically search and appraise all available PROMs relevant to paediatric endocrinology and provide a curated resource for health professionals to utilise. EVIDENCE ACQUISITION We identified PROMs in paediatric endocrinology by systematically searching the Cochrane Library, MEDLINE, World Health Organisation International Clinical Trials Registry Platform, and the Cumulative Index to Nursing and Allied Health Literature on May 20, 2022. Additional studies were located through hand searching and content area expert contributions. We assessed the quality of each PROM using the COSMIN risk of bias checklist. EVIDENCE SYNTHESIS We identified 5003 papers in the initial search. After applying exclusion criteria we included seven PROMs in the review. Six PROMs were specific to Type I Diabetes and one to Hypothyroidism. We gave all studies an overall COSMIN score of 'inadequate' due to poorly detailed PROM development. CONCLUSION The scope and quality of PROMs in paediatric endocrinology is limited. Further research and development of PROM tools are required in paediatric endocrinology to allow for improved patient care.
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Affiliation(s)
- Richard G McGee
- Department of Paediatrics, Gosford Hospital, Holden St, Gosford, NSW, 2250, Australia.
- Central Coast Clinical School, The University of Newcastle, 77a Holden St, Gosford Hospital, Gosford, NSW, 2250, Australia.
| | - Edward Y B Zhang
- Central Coast Clinical School, The University of Newcastle, 77a Holden St, Gosford Hospital, Gosford, NSW, 2250, Australia
| | - Jennifer J G Tan
- Central Coast Clinical School, The University of Newcastle, 77a Holden St, Gosford Hospital, Gosford, NSW, 2250, Australia
| | - Aiden C K Cheung
- Central Coast Clinical School, The University of Newcastle, 77a Holden St, Gosford Hospital, Gosford, NSW, 2250, Australia
| | - Matthew P Garvey
- Central Coast Clinical School, The University of Newcastle, 77a Holden St, Gosford Hospital, Gosford, NSW, 2250, Australia
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Chen M, Jones CM, Bauer HE, Osakwe O, Ketheeswaran P, Baker JN, Huang IC. Barriers and Opportunities for Patient-Reported Outcome Implementation: A National Pediatrician Survey in the United States. CHILDREN 2022; 9:children9020185. [PMID: 35204906 PMCID: PMC8870373 DOI: 10.3390/children9020185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 11/16/2022]
Abstract
Purpose: To characterize pediatricians’ perceived barriers and areas of confidence in assessing patient-reported outcomes (PROs) in the U.S., and to test associations of these factors with implementing PRO assessment. Methods: Using a random sample from the members of American Medical Association, we recruited general pediatricians and pediatric subspecialists to complete a survey (July 2011 to December 2013). Perceived barriers and confidence in PRO assessment were compared by age, pediatric specialty (general pediatrics, seven subspecialties), practice settings (academic, private), and region of practice. Multivariable logistic regressions tested associations of demographic factors, barriers, and confidence factors with the implementation of PRO assessment. Findings: The survey was completed by 458 participants (response rate 48.5%); of these, 40.4%, 15.9%, 15.5%, and 8.1% were general pediatricians, cardiology, hematology/oncology, and pulmonary specialists, respectively. PRO assessment was implemented by 29.0% of the pediatricians. The top five barriers for PRO assessment included limited time/manpower (79.0%), limited training (77.4%), lengthy PRO instruments (76%), lack of meaningful cut-offs on PRO scores (75.5%), and unavailable PRO instruments (75.0%). Limited knowledge of PROs (OR 4.10; 95% CI 2.21, 7.60) and unavailability of PRO instruments (OR 1.87; 95% CI 1.01, 3.49) increased the odds of not implementing the assessment, whereas confidence in PRO assessments compatible with norms (OR 0.41; 95% CI 0.23, 0.72) and perceived benefit over clinical judgment alone (OR 0.53; 95% CI 0.31, 0.93) decreased the odds of not implementing the assessment. Interpretation: significant barriers to PRO assessment in pediatric settings suggest the need for providing training, resources, and practical guidance toward implementation. Patient or Public Contribution: healthcare service users contributed to this study by completing a survey and providing feedback about the barriers and areas of confidence in assessing PROs for pediatric populations.
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Affiliation(s)
- Ming Chen
- College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA;
| | - Conor M. Jones
- Weill Medical College, Cornell University, New York, NY 10021, USA;
| | - Hailey E. Bauer
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA;
| | | | | | - Justin N. Baker
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA;
| | - I-Chan Huang
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA;
- Correspondence: ; Tel.: +1-901-595-8369
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Austin EJ, LeRouge C, Lee JR, Segal C, Sangameswaran S, Heim J, Lober WB, Hartzler AL, Lavallee DC. A learning health systems approach to integrating electronic patient-reported outcomes across the health care organization. Learn Health Syst 2021; 5:e10263. [PMID: 34667879 PMCID: PMC8512814 DOI: 10.1002/lrh2.10263] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/20/2021] [Accepted: 02/15/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Foundational to a learning health system (LHS) is the presence of a data infrastructure that can support continuous learning and improve patient outcomes. To advance their capacity to drive patient-centered care, health systems are increasingly looking to expand the electronic capture of patient data, such as electronic patient-reported outcome (ePRO) measures. Yet ePROs bring unique considerations around workflow, measurement, and technology that health systems may not be poised to navigate. We report on our effort to develop generalizable learnings that can support the integration of ePROs into clinical practice within an LHS framework. METHODS Guided by action research methodology, we engaged in iterative cycles of planning, acting, observing, and reflecting around ePRO use with two primary goals: (1) mobilize an ePRO community of practice to facilitate knowledge sharing, and (2) establish guidelines for ePRO use in the context of LHS practice. Multiple, emergent data collection activities generated generalizable guidelines that document the tangible best practices for ePRO use in clinical care. We organized guidelines around thematic areas that reflect LHS structures and stakeholders. RESULTS Three core thematic areas (and 24 guidelines) emerged. The theme of governance reflects the importance of leadership, knowledge management, and facilitating organizational learning around best practice models for ePRO use. The theme of integration considers the intersection of workflow, technology, and human factors for ePROs across areas of care delivery. Lastly, the theme of reporting reflects critical considerations for curating data and information, designing system functions and interactions, and presentation of ePRO data to support the translation of knowledge to action. CONCLUSIONS The guidelines produced from this work highlight the complex, multidisciplinary nature of implementing change within LHS contexts, and the value of action research approaches to enable rapid, iterative learning that leverages the knowledge and experience of communities of practice.
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Affiliation(s)
- Elizabeth J. Austin
- Surgical Outcomes Research Center, Department of SurgeryUniversity of WashingtonSeattleWashingtonUSA
- Department of Health ServicesUniversity of WashingtonSeattleWashingtonUSA
| | - Cynthia LeRouge
- Department of Health ServicesUniversity of WashingtonSeattleWashingtonUSA
- Information Systems and Business AnalyticsFlorida International UniversityMiamiFloridaUSA
| | - Jenney R. Lee
- Surgical Outcomes Research Center, Department of SurgeryUniversity of WashingtonSeattleWashingtonUSA
| | - Courtney Segal
- Surgical Outcomes Research Center, Department of SurgeryUniversity of WashingtonSeattleWashingtonUSA
- Department of Health ServicesUniversity of WashingtonSeattleWashingtonUSA
| | - Savitha Sangameswaran
- Surgical Outcomes Research Center, Department of SurgeryUniversity of WashingtonSeattleWashingtonUSA
- Department of Biomedical Informatics and Medical EducationUniversity of WashingtonSeattleWashingtonUSA
| | - Joseph Heim
- Department of Health ServicesUniversity of WashingtonSeattleWashingtonUSA
- Department of Industrial & Systems Engineering, College of EngineeringUniversity of WashingtonSeattleWashingtonUSA
| | - William B. Lober
- Department of Health ServicesUniversity of WashingtonSeattleWashingtonUSA
- Department of Biomedical Informatics and Medical EducationUniversity of WashingtonSeattleWashingtonUSA
- Biobehavioral Nursing and Health InformaticsUniversity of WashingtonSeattleWashingtonUSA
| | - Andrea L. Hartzler
- Department of Biomedical Informatics and Medical EducationUniversity of WashingtonSeattleWashingtonUSA
| | - Danielle C. Lavallee
- Surgical Outcomes Research Center, Department of SurgeryUniversity of WashingtonSeattleWashingtonUSA
- Department of Health ServicesUniversity of WashingtonSeattleWashingtonUSA
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Ratnayake I, Ahern S, Ruseckaite R. Acceptability of patient reported outcome measures (PROMs) in a cystic fibrosis data registry. BMJ Open Respir Res 2021; 8:8/1/e000927. [PMID: 34281916 PMCID: PMC8291302 DOI: 10.1136/bmjresp-2021-000927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/27/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Improvements in the treatment of cystic fibrosis (CF) have resulted in longer survival and an increased focus on optimising daily functioning with the condition. Patient-reported outcome measures (PROMs) are valuable tools in evaluating the health-related quality of life of persons with chronic diseases. PROMs may be incorporated into clinical registries to assess and provide feedback regarding the health-related quality of life of the affected population. This study uses qualitative methodology to describe the views of patients with CF, caregivers and clinicians on the usefulness and practicality of incorporating a PROM in the Australian Cystic Fibrosis Data Registry (ACFDR). Methods We conducted semistructured interviews with a convenience sample of patients with CF (n=5), caregivers (n=7) and clinicians (n=13) on their opinions on incorporating the Cystic Fibrosis Questionnaire-Revised or the Cystic Fibrosis Quality of Life Questionnaire into the ACFDR. We analysed data into topics and subtopics using conventional content analysis. Results Participants believed that PROMs could generate useful aggregate health-related quality of life data to support better understanding of the experiences of the modern CF population. Participants emphasised that implementation must be supported by processes to feedback data to patients and clinicians. Most participants preferred electronic PROMs administration for easy integration into existing systems and the potential to support feedback. Conclusion Patients, caregivers and clinicians in this study generally supported the usefulness and practicality of PROM implementation in the ACFDR.
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Affiliation(s)
- Irushi Ratnayake
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Susannah Ahern
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rasa Ruseckaite
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Nguyen H, Butow P, Dhillon H, Sundaresan P. A review of the barriers to using Patient-Reported Outcomes (PROs) and Patient-Reported Outcome Measures (PROMs) in routine cancer care. J Med Radiat Sci 2021; 68:186-195. [PMID: 32815314 PMCID: PMC8168064 DOI: 10.1002/jmrs.421] [Citation(s) in RCA: 104] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 07/16/2020] [Accepted: 07/18/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Patient-reported outcomes (PROs) are direct reports from patients about the status of their health condition without amendment or interpretation by others. Patient-reported outcome measures (PROMs) are the tools used to measure PROs; they are usually validated questionnaires patients complete by self-assessing their health status. Whilst the benefits of using PROs and PROMs to guide real-time patient care are well established, they have not been adopted by many oncology institutions worldwide. This literature review aimed to examine the barriers associated with using PROs and PROMs in routine oncology care. METHODS A literature search was conducted across EMBASE, Medline and CINAHL databases. Studies detailing barriers to routine PRO use for real-time patient care were included; those focusing on PRO collection in the research setting were excluded. RESULTS Of 1165 records captured, 14 studies informed this review. At the patient level, patient time, incapacity and difficulty using electronic devices to complete PROMs were prominent barriers. At the health professional level, major barriers included health professionals' lack of time and knowledge to meaningfully interpret and integrate PRO data into their clinical practice and the inability for PRO data to be acted upon. Prominent barriers at the service level included difficulties integrating PROs and PROMs into clinical workflows and inadequate information technology (IT) infrastructures for easy PRO collection. CONCLUSION This review has outlined potential barriers to routine PRO use in the oncology setting. Such barriers should be considered when implementing PROs into routine clinical practice.
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Affiliation(s)
- Hanh Nguyen
- Western Sydney Local Health DistrictRadiation Oncology NetworkSydneyAustralia
| | - Phyllis Butow
- Centre for Medical Psychology & Evidence‐based Decision‐makingThe University of SydneySydneyAustralia
| | - Haryana Dhillon
- Centre for Medical Psychology & Evidence‐based Decision‐makingThe University of SydneySydneyAustralia
| | - Puma Sundaresan
- Western Sydney Local Health DistrictRadiation Oncology NetworkSydneyAustralia
- Sydney Medical SchoolThe University of SydneySydneyAustralia
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Tyack Z, Simons M, McPhail SM, Harvey G, Zappala T, Ware RS, Kimble RM. Improving the patient-centred care of children with life-altering skin conditions using feedback from electronic patient-reported outcome measures: protocol for a hybrid effectiveness-implementation study (PEDS-ePROM). BMJ Open 2021; 11:e041861. [PMID: 33837095 PMCID: PMC8043009 DOI: 10.1136/bmjopen-2020-041861] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Using patient-reported outcome measures (PROMs) with children have been described as 'giving a voice to the child'. Few studies have examined the routine use of these measures as potentially therapeutic interventions. This study aims to investigate: (1) the effectiveness of feedback using graphical displays of information from electronic PROMs (ePROMs) that target health-related quality of life, to improve health outcomes, referrals and treatment satisfaction and (2) the implementation of ePROMs and graphical displays by assessing acceptability, sustainability, cost, fidelity and context of the intervention and study processes. METHODS AND ANALYSIS A hybrid II effectiveness-implementation study will be conducted from February 2020 with children with life-altering skin conditions attending two outpatient clinics at a specialist paediatric children's hospital. A pragmatic randomised controlled trial and mixed methods process evaluation will be completed. Randomisation will occur at the child participant level. Children or parent proxies completing baseline ePROMs will be randomised to: (1) completion of ePROMs plus graphical displays of ePROM results to treating clinicians in consultations, versus (2) completion of ePROMs without graphical display of ePROM results. The primary outcome of the effectiveness trial will be overall health-related quality of life of children. Secondary outcomes will include other health-related quality of life outcomes (eg, child psychosocial and physical health, parent psychosocial health), referrals and treatment satisfaction. Trial data will be primarily analysed using linear mixed-effects models; and implementation data using inductive thematic analysis of interviews, meeting minutes, observational field notes and study communication mapped to the Consolidated Framework for Implementation Research. ETHICS AND DISSEMINATION Ethical approval was obtained from Children's Health Queensland Human Research Ethics Committee (HREC/2019/QCHQ/56290), The University of Queensland (2019002233) and Queensland University of Technology (1900000847). Dissemination will occur through stakeholder groups, scientific meetings and peer-reviewed publications. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN12620000174987).
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Affiliation(s)
- Zephanie Tyack
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia
- Pegg Leditschke Children's Burns Centre, Children's Health Queensland, South Brisbane, Queensland, Australia
- Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Megan Simons
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia
- Department of Occupational Therapy, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Clinical Informatics Directorate, Metro South Health, Brisbane, Queensland, Australia
| | - Gillian Harvey
- Adelaide Nursing School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Tania Zappala
- General Paediatrics and Dermatology Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University - GC Campus, Southport, Queensland, Australia
| | - Roy M Kimble
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia
- Pegg Leditschke Children's Burns Centre, Children's Health Queensland, South Brisbane, Queensland, Australia
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Cox ED, Dobrozsi SK, Forrest CB, Gerhardt WE, Kliems H, Reeve BB, Rothrock NE, Lai JS, Svenson JM, Thompson LA, Tran TDN, Tucker CA. Considerations to Support Use of Patient-Reported Outcomes Measurement Information System Pediatric Measures in Ambulatory Clinics. J Pediatr 2021; 230:198-206.e2. [PMID: 33271193 PMCID: PMC7914197 DOI: 10.1016/j.jpeds.2020.11.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 11/19/2020] [Accepted: 11/24/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To identify challenges to the use of Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric measures in the ambulatory pediatric setting and possible solutions to these challenges. STUDY DESIGN Eighteen semistructured telephone interviews of health system leaders, measurement implementers, and ambulatory pediatric clinicians were conducted. Five coders used applied thematic analysis to iteratively identify and refine themes in interview data. RESULTS Most interviewees had roles in leadership or the implementation of patient-centered outcomes; 39% were clinicians. Some had experience using PROMIS clinically (44%) and 6% were considering this use. Analyses yielded 6 themes: (1) selection of PROMIS measures, (2) method of administration, (3) use of PROMIS Parent Proxy measures, (4) privacy and confidentiality of PROMIS responses, (5) interpretation of PROMIS scores, and (6) using PROMIS scores clinically. Within the themes, interviewees illuminated specific unique considerations for using PROMIS with children, including care transitions and privacy. CONCLUSIONS Real-world challenges continue to hamper PROMIS use. Ongoing efforts to disseminate information about the integration of PROMIS measures in clinical care is critical to impacting the health of children.
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Affiliation(s)
- Elizabeth D. Cox
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Sarah K. Dobrozsi
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | | | - Wendy E. Gerhardt
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center (retired), Cincinnati, OH
| | - Harald Kliems
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Bryce B. Reeve
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Nan E. Rothrock
- Departments of Medical Social Sciences, Psychiatry and Behavioral Sciences, and Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jin-Shei Lai
- Departments of Medical Social Sciences and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jacob M. Svenson
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Lindsay A. Thompson
- Departments of Pediatrics and Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL
| | - Thuy Dan N. Tran
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Carole A. Tucker
- Department of Health and Rehabilitation Sciences, Temple University College of Public Health, Philadelphia, PA
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Kasturi S, Wong JB, Mandl LA, McAlindon TE, LeClair A. "Unspoken Questions": A Qualitative Study of Rheumatologists' Perspectives on the Clinical Implementation of Patient-reported Outcome Measures. J Rheumatol 2020; 47:1822-1830. [PMID: 32611667 DOI: 10.3899/jrheum.200232] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To identify rheumatologists' views on perceived barriers and facilitators to the clinical implementation of patient-reported outcome measures (PROM). METHODS Semistructured interviews were conducted with academically affiliated clinical rheumatologists. Interviews were audio-recorded and transcribed. Deidentified transcripts were independently coded and analyzed for themes. RESULTS Fifteen attending rheumatologists, 8 women (53%) and 7 men (47%) with a mean of 17.3 years in practice (range 5-43) at 2 urban academic medical centers, participated in interviews. Rheumatologists identified several barriers to integrating PROM in clinical care, highlighting physician buy-in and culture change as significant challenges beyond logistical considerations. They further underscored the lack of effective interventions and resources for addressing the domains of most interest to patients. Physicians also recognized significant benefits of PROM in clinical care, including contributing to the clinical impression by providing the patient perspective, and promoting agenda setting by uncovering "unspoken questions." They additionally noted that PROM could support treatment planning, build patient-physician relationships, and facilitate patient engagement. Participants suggested that technology, physician education, and team-based care could facilitate the effective implementation of PROM. CONCLUSION Rheumatologists identified multiple mechanisms through which PROM could augment clinical care, but also noted several obstacles to implementation, questioning the added value of PROM and the limited availability of interventions to improve patient-centered outcomes. Programs seeking to successfully integrate PROM to enhance patient-centered care and meet quality benchmarks should prioritize physician buy-in and training, and provide resources to address the outcomes that are measured.
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Affiliation(s)
- Shanthini Kasturi
- S. Kasturi, MD, MS, T.E. McAlindon, MD, MPH, Division of Rheumatology, Allergy & Immunology/Department of Medicine, Tufts Medical Center, Boston, Massachusetts;
| | - John B Wong
- J.B. Wong, MD, Division of Clinical Decision Making, Tufts Medical Center, Boston, Massachusetts
| | - Lisa A Mandl
- L.A. Mandl, MD, MPH, Division of Rheumatology/Department of Medicine, Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Timothy E McAlindon
- S. Kasturi, MD, MS, T.E. McAlindon, MD, MPH, Division of Rheumatology, Allergy & Immunology/Department of Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Amy LeClair
- A.LeClair, PhD, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
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Carle AC, Bevans KB, Tucker CA, Forrest CB. Using nationally representative percentiles to interpret PROMIS pediatric measures. Qual Life Res 2020; 30:997-1004. [PMID: 33201388 DOI: 10.1007/s11136-020-02700-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE This study's aim was to use a representative sample of the US pediatric population to estimate percentiles for several PROMIS pediatric measures: Anger, Anxiety, Depressive Symptoms, Family Relationships, Fatigue, Global Health, Life Satisfaction, Meaning and Purpose, Pain Behavior, Pain Interference, Physical Activity, Physical Function Mobility, Physical Function Upper Extremity, Physical Stress Experiences, Positive Affect, Psychological Stress Experiences, Sleep Disturbance, Sleep Impairment, and Peer Relationships. METHODS We used two separate, nationally representative samples of parents and children aged 5-17 years drawn in different years from the GfK Knowledge Panel, a dual-frame online probability panel. RESULTS All measures that were developed using a representative sample had a median at or near the expected value of 50. For the other measures, the 50th percentile was often 10 points or more from 50. Several domains had high floors or low ceilings. No domain's percentiles completely corresponded to the percentiles associated with a normal distribution with a mean of 50 and standard deviation of 10. CONCLUSIONS This work allows users to interpret a child's self-reported quality of life relative to children in the US general population. When attempting to evaluate whether a child falls above or below other children in the US, one should use the values presented in this study. In addition, we recommend that users should focus on whether a child's score falls into one of a few broad severity groups rather than on specific percentile scores.
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Affiliation(s)
- Adam C Carle
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. .,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA. .,Department of Psychology, University of Cincinnati College of Arts and Sciences, Cincinnati, OH, USA.
| | - Katherine B Bevans
- Department of Health and Rehabilitation Sciences, Temple University College of Public Health, Philadelphia, USA
| | - Carole A Tucker
- Department of Health and Rehabilitation Sciences, Temple University College of Public Health, Philadelphia, USA
| | - Christopher B Forrest
- Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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12
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Morgan EM, Carle AC. Measures of Health Status and Quality of Life in Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:565-576. [PMID: 33091241 DOI: 10.1002/acr.24372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 01/04/2023]
Affiliation(s)
- Esi M Morgan
- Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Adam C Carle
- University of Cincinnati College of Arts and Sciences, Cincinnati, Ohio
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13
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Miller DM, Moss B, Rose S, Li H, Schindler D, Weber M, Planchon SM, Alberts J, Boissy A, Bermel R. Obtaining Patient Priorities in a Multiple Sclerosis Comprehensive Care Center: Beyond Patient-Reported Outcomes. J Patient Exp 2020; 7:541-548. [PMID: 33062876 PMCID: PMC7534123 DOI: 10.1177/2374373519864011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: In order to provide patient center care, our multiple sclerosis (MS) clinic assesses patient concerns before clinical encounters, first by asking the optional qualitative question “What is the most important thing you what your health-care provider to know today” (most important concern of the patient [MIPC]) and then completing quantitative patient-reported outcome measures (PROMs) including Quality of Life in Neurological Disorders (Neuro-QoL). Both sets of questions are designed to facilitate encounters that address patients’ values and preferences. Objective: Determine whether the qualitative MIPC responses provided unique information not included in PROMs or clinical assessments. Methods: We randomly selected 400 first-time MIPC responders and 400 first-time MIPC nonresponders from 2788 participants in our database. We categorized MIPC responses by content and number of unique concerns and appended them to the Neuro-QoL framework. Nonresponders were compared to those who provided 1 and 2 or more responses. Results: Several MIPCs MS symptoms categories were added to the Neuro-QoL Physical domain. Most important concern of the patients work and cost-of-care categories were added to the Social Domain. Domains regarding treatment satisfaction and disease management were added. Two hundred thirty (58%) MIPC respondents reported 1 concern, 140 (35%) expressed 2 to 6 concerns, and 30 (7%) reported MS-unrelated concerns and not analyzed. Physical symptoms were the most common MIPC (69.9%). Respondents with more concerns were more likely African American, lacked private insurance, and worse disability. Conclusions: Importantly, MIPC responders described idiosyncratic symptoms, disease management, and social concerns not included in the PROMS, suggesting the MIPC question offered patients a unique opportunity to share specific concerns with their providers.
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Affiliation(s)
- Deborah M Miller
- Mellen Center, Cleveland Clinic, OH, USA.,Lerner College of Medicine, Cleveland Clinic, OH, USA
| | | | - Susannah Rose
- Lerner College of Medicine, Cleveland Clinic, OH, USA.,Office of Patient Experience, Cleveland Clinic, OH, USA
| | - Hong Li
- Quantitative Health Science, Cleveland Clinic, OH, USA
| | | | | | - Sarah M Planchon
- Mellen Center, Cleveland Clinic, OH, USA.,Lerner College of Medicine, Cleveland Clinic, OH, USA
| | - Jay Alberts
- Biomedical Engineering, Cleveland Clinic, OH, USA
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Bhatt S, Davis K, Manning DW, Barnard C, Peabody TD, Rothrock NE. Integration of Patient-reported Outcomes in a Total Joint Arthroplasty Program at a High-volume Academic Medical Center. J Am Acad Orthop Surg Glob Res Rev 2020; 4:e2000034. [PMID: 33970573 PMCID: PMC7434040 DOI: 10.5435/jaaosglobal-d-20-00034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 03/12/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Despite widely appreciated barriers to successful clinical implementation, the literature regarding how to operationalize electronic health record-integrated patient-reported outcomes (PROs) remains sparse. We offer a detailed summary of the implementation of PROs into the standard of care at a major tertiary academic medical center. METHODS Collection of four Patient-Reported Outcomes Measurement Information System computer adaptive tests was piloted in a large academic orthopaedic surgery ambulatory clinic starting in October 2016. The Patient-Reported Outcomes Measurement Information System computer adaptive tests (Physical Function, Pain Intensity, Pain Interference, and Ability to Return to Social Roles and Activities) were initially implemented as manual order sets to be administered before surgery through 2 years after surgery. Completion rate over time, mean time to completion for all PRO domains, and the overall distribution of symptom severity were used to evaluate the success of the pilot. A subsequent optimization and redesign of the pilot was conducted using tablets, automation of questionnaire deployment, and improved results review to address obstacles encountered during the pilot phase. RESULTS Two thousand nine distinct joint arthroplasty patients (mean age = 65) completed at least one set of PRO assessments, with overall completion rates reaching 68% and mean completion time of 3 minutes. Focal points during the implementation process included engagement and training of staff, selection of an appropriate patient population and outcome measures, and user friendly data displays for patients and providers. CONCLUSION Our pilot program successfully demonstrated that PROs can be administered, scored, and made immediately available within the electronic health record to patients and their providers with minimal disruption of clinical workflows. Although considerable operational and technological challenges remain, we found that the implementation of PROs in clinical care within an ambulatory practice at an academic medical center can be achieved through a constellation of several key factors.
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Affiliation(s)
- Surabhi Bhatt
- From the Department of Orthopaedic Surgery (Ms. Bhatt, Dr. Manning, Dr. Peabody), Northwestern University Feinberg School of Medicine; the Northwestern Memorial HealthCare (Ms. Davis, Dr. Barnard), Northwestern University Center for Healthcare Studies; the Department of Medical Social Sciences (Dr. Rothrock), Northwestern University Feinberg School of Medicine; and the Department of Surgery (Dr. Barnard), Feinberg School of Medicine, Northwestern University, Chicago, IL
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Nelson TA, Anderson B, Bian J, Boyd AD, Burton SV, Davis K, Guo Y, Harris BA, Hynes K, Kochendorfer KM, Liebovitz D, Martin K, Modave F, Moses J, Soulakis ND, Weinbrenner D, White SH, Rothrock NE, Valenta AL, Starren JB. Planning for patient-reported outcome implementation: Development of decision tools and practical experience across four clinics. J Clin Transl Sci 2020; 4:498-507. [PMID: 33948226 PMCID: PMC8057386 DOI: 10.1017/cts.2020.37] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 02/27/2020] [Accepted: 03/28/2020] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Many institutions are attempting to implement patient-reported outcome (PRO) measures. Because PROs often change clinical workflows significantly for patients and providers, implementation choices can have major impact. While various implementation guides exist, a stepwise list of decision points covering the full implementation process and drawing explicitly on a sociotechnical conceptual framework does not exist. METHODS To facilitate real-world implementation of PROs in electronic health records (EHRs) for use in clinical practice, members of the EHR Access to Seamless Integration of Patient-Reported Outcomes Measurement Information System (PROMIS) Consortium developed structured PRO implementation planning tools. Each institution pilot tested the tools. Joint meetings led to the identification of critical sociotechnical success factors. RESULTS Three tools were developed and tested: (1) a PRO Planning Guide summarizes the empirical knowledge and guidance about PRO implementation in routine clinical care; (2) a Decision Log allows decision tracking; and (3) an Implementation Plan Template simplifies creation of a sharable implementation plan. Seven lessons learned during implementation underscore the iterative nature of planning and the importance of the clinician champion, as well as the need to understand aims, manage implementation barriers, minimize disruption, provide ample discussion time, and continuously engage key stakeholders. CONCLUSIONS Highly structured planning tools, informed by a sociotechnical perspective, enabled the construction of clear, clinic-specific plans. By developing and testing three reusable tools (freely available for immediate use), our project addressed the need for consolidated guidance and created new materials for PRO implementation planning. We identified seven important lessons that, while common to technology implementation, are especially critical in PRO implementation.
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Affiliation(s)
| | | | - Jiang Bian
- University of Florida, Gainesville, FL, USA
| | | | | | | | - Yi Guo
- University of Florida, Gainesville, FL, USA
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Rothrock NE, Amtmann D, Cook KF. Development and validation of an interpretive guide for PROMIS scores. J Patient Rep Outcomes 2020; 4:16. [PMID: 32112189 PMCID: PMC7048882 DOI: 10.1186/s41687-020-0181-7] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 02/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Accurate score interpretation is required for the appropriate use of patient-reported outcome measures in clinical practice. OBJECTIVE To create and evaluate figures (T-score Maps) to facilitate the interpretation of scores on Patient-Reported Outcome Measurement Information System (PROMIS) measures. METHODS For 21 PROMIS® short forms, item-level information was used to predict the most probable responses to items for the range of possible scores on each short form. Predicted responses were then "mapped" graphically along the range of possible scores. In a previously conducted longitudinal study, 1594 adult participants with chronic conditions (e.g., multiple sclerosis) responded to four items each of a subset of these PROMIS short forms. Participants' responses to these items were compared to those predicted by the T-score Maps. Difference scores were calculated between observed and predicted scores, and Spearman correlations were calculated. RESULTS We constructed T-score Maps for 21 PROMIS short forms for adults and pediatric self- and parent-proxy report. For the clinical population, participants' actual responses were strongly correlated with their predicted responses (r = 0.762 to 0.950). The majority of predicted responses exactly matched observed responses (range 69.5% to 85.3%). CONCLUSION Results support the validity of the predicted responses used to construct T-score Maps. T-score Maps are ready to be tested as interpretation aids in a variety of applications.
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Affiliation(s)
- Nan E Rothrock
- Department of Medical Social Sciences, Feinberg School of Medicine of Northwestern University, 625 N. Michigan Ave Suite 2700, Chicago, IL, 60660, USA.
| | - Dagmar Amtmann
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Karon F Cook
- Department of Medical Social Sciences, Feinberg School of Medicine of Northwestern University, 625 N. Michigan Ave Suite 2700, Chicago, IL, 60660, USA
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Skovlund PC, Ravn S, Seibaek L, Thaysen HV, Lomborg K, Nielsen BK. The development of PROmunication: a training-tool for clinicians using patient-reported outcomes to promote patient-centred communication in clinical cancer settings. J Patient Rep Outcomes 2020; 4:10. [PMID: 32048085 PMCID: PMC7013008 DOI: 10.1186/s41687-020-0174-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 01/13/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The value of using real-time patient-reported outcome (PRO) measures in cancer communication has gained attention both in the clinic and in research. Despite this, no internationally accepted guidelines or training programs for clinicians on how to engage in patient-centred communication based on PROs exist. Lack of training may complicate implementation and systematic use of PROs in the clinic. We aimed to develop a short and feasible manual and training session in PRO-based dialogue rooted in patient-centred communication, coined PROmunication. METHODS PROmunication was implemented in two studies using PROs in different clinical cancer settings. We interviewed clinicians twice during the development phase. First, adopting a clinical perspective, they provided ideas for content, length and structure of the training session and the manual. Second, they approved the draft of the manual with minor adjustments on how to document clinician-patient communication. The final version of the PROmunication tool was built on clinicians' input, theory on patient-centred communication, a literature review, and didactic considerations. RESULTS The one-page manual gave clinicians a brief and clear overview of how to prepare for, undergo and document a PRO-based consultation. Illustrations and verbal phrases were offered to operationalize and facilitate patient-centred communication. The training session included elements like evidence-based knowledge about the rationale, benefits and challenges of using PROs and comprised theory, experimental training and instructions for the use of the manual in clinical practice. Ad hoc training and feedback in the clinic followed the training session. CONCLUSIONS This paper presents the development of a short, theory-driven manual and training session intended to support and engage clinicians in PRO-based dialogue leading to patient-centred communication. Further testing of the tool is necessary and adjustments may be required if the PROmunication tool should be applied in other clinical settings were patients are seen regularly. An evaluation of the tool is planned to be performed in future studies. Training in PROmunication may further systematic and consistent use of PRO data in the consultation, leading to patient-centred consultations and increased patient involvement.
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Affiliation(s)
- Pernille C. Skovlund
- Experimental Clinical Oncology, Department of Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- The Research Centre for Patient Involvement, Aarhus University & the Central Region, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Sissel Ravn
- The Research Centre for Patient Involvement, Aarhus University & the Central Region, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- Department of Surgery, Aarhus University Hospital, Palle Juul Jensens Boulevard, 8200 Aarhus N, Denmark
| | - Lene Seibaek
- The Research Centre for Patient Involvement, Aarhus University & the Central Region, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 137, 8200 Aarhus N, Denmark
| | - Henriette Vind Thaysen
- The Research Centre for Patient Involvement, Aarhus University & the Central Region, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- Department of Surgery, Aarhus University Hospital, Palle Juul Jensens Boulevard, 8200 Aarhus N, Denmark
| | - Kirsten Lomborg
- The Research Centre for Patient Involvement, Aarhus University & the Central Region, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Incuba Skejby, building 2, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Berit Kjærside Nielsen
- The Research Centre for Patient Involvement, Aarhus University & the Central Region, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- DEFACTUM, Social & Health Services and Labour Market, Central Denmark Region, Olof Palmes Allé 15, 8200 Aarhus N, Denmark
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Austin E, LeRouge C, Hartzler AL, Segal C, Lavallee DC. Capturing the patient voice: implementing patient-reported outcomes across the health system. Qual Life Res 2020; 29:347-355. [PMID: 31606809 PMCID: PMC6995985 DOI: 10.1007/s11136-019-02320-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2019] [Indexed: 01/03/2023]
Abstract
PURPOSE Supporting the capture and use of patient-reported outcomes (PROs) at the point-of-care enriches information about important clinical and quality of life outcomes. Yet the ability to scale PROs across healthcare systems has been limited by knowledge gaps around how to manage the diversity of PRO uses and leverage health information technology. In this study, we report learnings and practice insights from UW Medicine's practice transformation efforts to incorporate patient voice into multiple areas of care. METHODS Using a participatory, action research approach, we engaged with UW Medicine clinical and administrative stakeholders experienced with PRO implementation to inventory PRO implementations across the health system, characterize common clinical uses for PROs, and develop recommendations for system-wide governance and implementation of PROs. RESULTS We identified a wide breadth of PRO implementations (n = 14) in practice and found that nearly half (47%) of employed PRO measures captured shared clinical domains (e.g., depression). We developed three vignettes (use cases) that illustrate how users interact with PROs, characterize common ways PRO implementations support clinical care across the health system (1) Preventive care, (2) Chronic/Specialty care, and (3) Surgical/Interventional care), and elucidate opportunities to enhance efficient PRO implementations through system-level standards and governance. CONCLUSIONS Practice transformation efforts increasingly require integration of the patient voice into clinical care, often through the use of PROs. Learnings from our work highlight the importance of proactively considering how PROs will be used across the layers of healthcare organizations to optimize the design and governance of PROs.
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Affiliation(s)
- Elizabeth Austin
- Surgical Outcomes Research Center, University of Washington, 1107 NE 45th Street, Suite 502, Box 354808, Seattle, WA 98105 USA
| | - Cynthia LeRouge
- Information Systems and Business Analytics, Florida International University, Miami, FL USA
- Department of Health Services, University of Washington, Seattle, WA USA
| | - Andrea L. Hartzler
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA USA
| | - Courtney Segal
- Surgical Outcomes Research Center, University of Washington, 1107 NE 45th Street, Suite 502, Box 354808, Seattle, WA 98105 USA
- Department of Health Services, University of Washington, Seattle, WA USA
| | - Danielle C. Lavallee
- Surgical Outcomes Research Center, University of Washington, 1107 NE 45th Street, Suite 502, Box 354808, Seattle, WA 98105 USA
- Department of Health Services, University of Washington, Seattle, WA USA
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How Can Health Systems Advance Patient-Reported Outcome Measurement? Jt Comm J Qual Patient Saf 2019; 44:439-440. [PMID: 30071963 DOI: 10.1016/j.jcjq.2018.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2018] [Indexed: 11/21/2022]
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Austin E, LeRouge C, Hartzler AL, Chung AE, Segal C, Lavallee DC. Opportunities and challenges to advance the use of electronic patient-reported outcomes in clinical care: a report from AMIA workshop proceedings. JAMIA Open 2019; 2:407-410. [PMID: 32025635 PMCID: PMC6994002 DOI: 10.1093/jamiaopen/ooz042] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/22/2019] [Accepted: 08/13/2019] [Indexed: 12/01/2022] Open
Abstract
Despite the demonstrated value of patient-centered care, health systems have been slow to integrate the patient’s voice into care delivery through patient-reported outcomes (PROs) with electronic tools. This is due in part to the complex interplay of technology, workflow, and human factors that shape the success of electronic PROs (ePROs) use. The 2018 American Medical Informatics Association Annual Symposium served as the setting for a half-day interactive workshop with diverse stakeholders to discuss proposed best practices for the planning, design, deployment, and evaluation of ePROs. We provide this collective commentary that synthesizes participant feedback regarding critical challenges that prohibit the scale and spread of ePROs across healthcare delivery systems, including governance and leadership, workflow and human factors, informatics, and data science. In order to realize the promise of ePROs at scale, adaptable approaches are critical to balance the needs of individual users with health systems at large.
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Affiliation(s)
- Elizabeth Austin
- Department of Surgery, Surgical Outcomes Research Center, University of Washington, Seattle, Washington, USA
| | - Cynthia LeRouge
- Department of Information Systems & Business Analytics, College of Business, Florida International University, Miami, Florida, USA
| | - Andrea L Hartzler
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
| | - Arlene E Chung
- Department of Health Services, University of Washington, Seattle, Washington, USA
| | - Courtney Segal
- Department of Surgery, Surgical Outcomes Research Center, University of Washington, Seattle, Washington, USA.,Department of Health Services, University of Washington, Seattle, Washington, USA.,Department of Medicine; Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Danielle C Lavallee
- Department of Surgery, Surgical Outcomes Research Center, University of Washington, Seattle, Washington, USA.,Department of Health Services, University of Washington, Seattle, Washington, USA
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Liu LH, Choden S, Yazdany J. Quality improvement initiatives in rheumatology: an integrative review of the last 5 years. Curr Opin Rheumatol 2019; 31:98-108. [PMID: 30608250 PMCID: PMC7391997 DOI: 10.1097/bor.0000000000000586] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW We reviewed recent quality improvement initiatives in the field of rheumatology to identify common strategies and themes leading to measurable change. RECENT FINDINGS Efforts to improve quality of care in rheumatology have accelerated in the last 5 years. Most studies in this area have focused on interventions to improve process measures such as increasing the collection of patient-reported outcomes and vaccination rates, but some studies have examined interventions to improve health outcomes. Increasingly, researchers are studying electronic health record (EHR)-based interventions, such as standardized templates, flowsheets, best practice alerts and order sets. EHR-based interventions were most successful when reinforced with provider education, reminders and performance feedback. Most studies also redesigned workflows, distributing tasks among clinical staff. Given the common challenges and solutions facing rheumatology clinics under new value-based payment models, there are important opportunities to accelerate quality improvement by building on the successful efforts to date. Structured quality improvement models such as the learning collaborative may help to disseminate successful initiatives across practices. SUMMARY Review of recent quality improvement initiatives in rheumatology demonstrated common solutions, particularly involving leveraging health IT and workflow redesign.
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Affiliation(s)
- Lucy H Liu
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, California, USA
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