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Mohindra NA, Garcia SF, Kircher S, Barnard C, Perry LM, Lyleroehr M, Coughlin A, Morken V, Chmiel R, Hirschhorn LR, Cella D. Development of an electronic health record-integrated patient-reported outcome-based shared decision-making dashboard in oncology. JAMIA Open 2024; 7:ooae056. [PMID: 39049991 PMCID: PMC11268523 DOI: 10.1093/jamiaopen/ooae056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 05/15/2024] [Accepted: 06/28/2024] [Indexed: 07/27/2024] Open
Abstract
Objectives Patient-reported outcomes (PROs) describe a patient's unique experiences with disease or treatment, yet effective use of this information during clinical encounters remains challenging. This project sought to build a PRO based dashboard within the electronic health record (EHR), prioritizing interpretability and utility of PROs for clinical decision-making. Materials and Methods Codesign principles were used to define the goal, features, and visualization of the data elements on the dashboard. Codesign sessions occurred between February 2019 and May 2020 and involved a diverse group of stakeholders. Pilot evaluation of dashboard usability was performed with patients and clinicians not involved in the codesign process through qualitative interviews and the Systems Usability Scale. Results The dashboard was placed into a single tab in the EHR and included select PROM scores, clinical data elements, and goals of care questions. Real-time data analytics and enhanced visualization of data was necessary for the dashboard to provide meaningful feedback to clinicians and patients for decision-making during clinic visits. During soft launch, the dashboard demonstrated "good" usability in patients and clinicians at 3 and 6 months (mean total SUS score >70). Discussion The current dashboard had good usability and made PRO scores more clinically understandable to patients and clinicians. This paper highlights the development, necessary data elements, and workflow considerations to implement this dashboard at an academic cancer center. Conclusion As the use of PROs in clinical care is increasing, patient- and clinician-centered tools are needed to ensure that this information is used in meaningful ways.
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Affiliation(s)
- Nisha A Mohindra
- Division of Hematology and Oncology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, United States
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL 60611, United States
| | - Sofia F Garcia
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL 60611, United States
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, United States
| | - Sheetal Kircher
- Division of Hematology and Oncology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, United States
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL 60611, United States
| | - Cynthia Barnard
- Northwestern Medicine/Northwestern Memorial Health Care, Chicago, IL 60611, United States
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, United States
| | - Laura M Perry
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL 60611, United States
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, United States
| | - Madison Lyleroehr
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, United States
| | - Ava Coughlin
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, United States
| | - Victoria Morken
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, United States
| | - Ryan Chmiel
- Northwestern Medicine/Northwestern Memorial Health Care, Chicago, IL 60611, United States
| | - Lisa R Hirschhorn
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, United States
- Robert J. Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, United States
| | - David Cella
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL 60611, United States
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, United States
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Tonetti J, Riouallon G, Martz P, de Dompsure RB, Erivan R, Guignard A, Tiercelin J, Schmitz A, Belvisi B, Moreau PE, Binheng K, Bengana A, Boudissa M, Reina N. Functional outcomes and center of rotation restoration in total hip arthroplasty after acetabular fracture: A review of 367 hips. Orthop Traumatol Surg Res 2024; 110:103914. [PMID: 38857824 DOI: 10.1016/j.otsr.2024.103914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 01/11/2024] [Accepted: 03/05/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND Total hip arthroplasty (THA) after acetabular fracture is typically performed months or years later for posttraumatic arthritis after initial conservative treatment. But THA can be performed earlier after open reduction and internal fixation (ORIF) of the fracture. The aim of this study was to determine which strategy is best. The primary outcome measure was the radiological restoration of the hip's center of rotation (COR). The secondary outcome measures were the incidence of complications and the hip's functional scores. MATERIALS AND METHODS A multicenter cohort was analyzed by splitting patients into three groups: group A (THA within 3weeks of fracture); group B (THA deferred after early ORIF); group C (THA more than 3weeks after fracture, without ORIF). Group B was separated into two subgroups: B- (THA less than 1year after ORIF) and B+ (THA more than 1year after ORIF). The demographics, surgical techniques, COR superior and lateral migration coefficient and functional scores (HHS, HOOS-PS and FJS) were recorded. The functional scores were gathered using PROMs. RESULTS In all, 367 patients were included: 108 in group A, 69 in group B-, 113 in group B+ and 77 in group C. The mean follow-up was 5.8years [3.4 months-35years]. The mean age of the patients was 69.2years [SD 15; 26-101], 52years [SD 16; 19-83], 49years [SD 16; 16-85] and 58.1years [SD 17; 13-94], respectively (p<0.01). The mean ASA score was 2.13 [SD 0.70], 1.84 [SD 0.65], 1.67 [SD 0.63] and 1.79 [SD 0.60], respectively (p<0.01). A complex Letournel fracture was present in 63 patients (61%), 46 patients (71%), 48 patients (49%) and 38 patients (62%), respectively (p<0.01). A reinforcement cage was implanted in 38 patients (69%), 16 patients (62%), 5 patients (12%) and 19 patients (66%), respectively (p<0.01). Cement was used in 45 patients (45%), 23 patients (35%), 19 patients (18%) and 21 patients (32%), respectively (p<0.01). A graft was needed in 46 patients (46%), 35 patients (53%), 17 patients (16%) and 21 patients (48%), respectively (p<0.01). Posterior ORIF was done in 40 patients (46%), 32 patients (55%), 64 patients (61%) and 9 patients (82%), respectively (p<0.01). The COR lateral migration coefficient was significantly higher in group C with a mean of +0.17 (SD 0.85) [-0.27 to +6] compared to the other groups (p=0.02). The COR superior migration coefficient was comparable between groups, with a mean of +0.77 (SD 2.26) [-0.99 to 27], p>0.05. There were complications in 10 patients (9.2%), 6 patients (8.7%), 6 patients (5.3%) and 3 patients (3.9%), respectively, with no significant difference between groups. The PROMs were completed by 51% of patients. At the final review, the mean HHS was 79.2 (SD 21.8) and the mean HOOS-PS was 77.7 (SD 20.1) in the entire cohort, p>0.05. The mean FJS by group was 55.9 (30.2), 47.7 (SD 36.4), 66.1 (SD 30.4) and 65.8 (SD 30.3), respectively (p=0.02). DISCUSSION AND CONCLUSION The B strategy (B+) yielded good outcomes in terms of function and COR restoration. When using this strategy, anterior ORIF preserves the native hip for a subsequent THA through a posterior approach. Strategy C also produces good functional outcomes but shifts the COR laterally. This study confirms the poor results of strategy A in previous publications. When the prognosis is poor, immediate mobilization after anterior ORIF followed by THA within 1year appears to be a good strategy (group B-). LEVEL OF EVIDENCE IV, observational study.
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Affiliation(s)
- Jerome Tonetti
- Service de chirurgie orthopédique et traumatologie, hôpital Michallon, boulevard de la Chantourne, CS 10217, 38043 Grenoble cedex 9, France.
| | - Guillaume Riouallon
- Service de chirurgie orthopédique et traumatologie, groupe hospitalier Paris-St-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - Pierre Martz
- Service de chirurgie orthopédique et traumatologie, hôpital François-Mitterrand, 2, boulevard Mar-de-Lattre-de-Tassigny, 21000 Dijon, France
| | - Régis Bernard de Dompsure
- Service de chirurgie orthopédique et traumatologie, hôpital Pasteur, 30, voie Romaine, 69, 06001 Nice cedex 1, France
| | - Roger Erivan
- Service de chirurgie orthopédique et traumatologie hôpital Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - Arthur Guignard
- Service de chirurgie orthopédique et traumatologie, hôpital Roger-Salengro, rue Emile-Laine, 59037 Lille, France
| | - Joris Tiercelin
- Service de chirurgie orthopédique et traumatologie, hôpital Purpan, avenue du Professeur-Jean-Dausset, 31300 Toulouse, France
| | - Arthur Schmitz
- Service de chirurgie orthopédique et traumatologie, hôpital Central, 29, avenue Mar-de-Lattre-de-Tassigny, 54000 Nancy, France
| | - Baptiste Belvisi
- Service de chirurgie orthopédique et traumatologie, hôpital Annecy-Genevois, 1, avenue de lHôpital, 74370 Epagny Metz-Tessy, France
| | - Pierre-Emmanuel Moreau
- Service de chirurgie orthopédique et traumatologie, groupe hospitalier Paris-St Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - Kim Binheng
- Service de chirurgie orthopédique et traumatologie, hôpital Michallon, boulevard de la Chantourne, CS 10217, 38043 Grenoble cedex 9, France
| | - Asma Bengana
- Service de chirurgie orthopédique et traumatologie, hôpital Michallon, boulevard de la Chantourne, CS 10217, 38043 Grenoble cedex 9, France
| | - Mehdi Boudissa
- Service de chirurgie orthopédique et traumatologie, hôpital Michallon, boulevard de la Chantourne, CS 10217, 38043 Grenoble cedex 9, France
| | - Nicolas Reina
- Service de chirurgie orthopédique et traumatologie, hôpital Roger-Salengro, rue Emile-Laine, 59037 Lille, France
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Schultz EA, Eppler SL, Gardner M, Hu SS, Chou L, Safran M, Amanatullah DF, Abrams GD, Shapiro LM, Kamal RN. Health Numeracy Is Associated With a Patient's Ability to Interpret Patient-Reported Outcome Measures Data. Orthopedics 2024:1-6. [PMID: 39073043 DOI: 10.3928/01477447-20240718-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) were originally developed as research tools; however, there is increasing interest in using PROMs to inform clinical care. Prior work has shown the benefits of implementing PROMs at the point of care, but a patient's health numeracy (their ability to understand and work with numbers) may affect their ability to interpret PROM results. MATERIALS AND METHODS We recruited patients presenting to an outpatient orthopedic clinic. Forty-nine patients completed a survey that included demographic information, the short-form General Health Numeracy Test, and accuracy questions about four PROM displays (bar graph, table, line graph, pictograph) that indicated the same PROM results. RESULTS Patients with higher health numeracy answered all display accuracy questions correctly (P=.016). Patients who preferred using the table were more likely to answer display accuracy questions incorrectly (odds ratio, 0.013, P=.024). The two most frequently preferred PROM formats were bar graphs and tables, and most patients preferred to learn about their PROM function scores via a combination of displays and verbal discussions. CONCLUSION Patient health numeracy is associated with the ability to correctly interpret visual displays of PROMs. Implementation of PROMs at point of care currently does not account for health numeracy. Efforts to account for health numeracy when using PROMs at point of care may improve the efficacy of using PROMs to improve outcomes in orthopedic surgery. [Orthopedics. 202x;4x(x):xx-xx.].
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McGrath S, Howard M, Webber K, Juckett L. Implementation of a Patient-Reported Outcome Measure: A Quality Improvement Project. J Healthc Qual 2024; 46:e20-e25. [PMID: 38697025 DOI: 10.1097/jhq.0000000000000434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
ABSTRACT Patient-reported outcome measures (PROMs) are seen as increasingly beneficial to patient-centered clinical practice, but implementation of routine collection and utilization into clinical care can be challenging. Our interdisciplinary quality improvement (QI) team used the Institute for Health Care Improvement Model for Improvement methodology to address this problem in our outpatient neurorehabilitation program. We used a participatory approach to identify the PROM rehabilitation stakeholders found to be most appropriate to implement in the outpatient settings; chart audits were conducted to determine the extent to which clinicians implemented the PROM and documented a PROM-related goal. Opportunistic clinician feedback was collected to determine single PROM usefulness and acceptability. Our 4-month initiative demonstrated increased collection of a PROM, the Patient-Specific Functional Scale (PSFS), and incorporation into patient-centered goal. Use of QI methodology was beneficial when planning and executing our initiative. Future work is needed to examine factors to sustain PSFS use, incorporation into patient-centered goal setting, and maximize meaningful patient outcomes.
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Kramer J, Wilens TE, Rao V, Villa R, Yule AM. Feasibility of a 2-Part Substance Use Screener Self-Administered by Patients on Paper: Observational Study. JMIR Form Res 2024; 8:e52801. [PMID: 38916950 PMCID: PMC11234052 DOI: 10.2196/52801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 03/26/2024] [Accepted: 05/08/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Measurement-based care in behavioral health uses patient-reported outcome measures (PROMs) to screen for mental health symptoms and substance use and to assess symptom change over time. While PROMs are increasingly being integrated into electronic health record systems and administered electronically, paper-based PROMs continue to be used. It is unclear if it is feasible to administer a PROM on paper when the PROM was initially developed for electronic administration. OBJECTIVE This study aimed to examine the feasibility of patient self-administration of a 2-part substance use screener-the Tobacco, Alcohol, Prescription medications, and other Substances (TAPS)-on paper. This screener was originally developed for electronic administration. It begins with a limited number of questions and branches to either skip or reflex to additional questions based on an individual's responses. In this study, the TAPS was adapted for paper use due to barriers to electronic administration within an urgent care behavioral health clinic at an urban health safety net hospital. METHODS From August 2021 to March 2022, research staff collected deidentified paper TAPS responses and tracked TAPS completion rates and adherence to questionnaire instructions. A retrospective chart review was subsequently conducted to obtain demographic information for the patients who presented to the clinic between August 2021 and March 2022. Since the initial information collected from TAPS responses was deidentified, demographic information was not linked to the individual TAPS screeners that were tracked by research staff. RESULTS A total of 507 new patients were seen in the clinic with a mean age of 38.7 (SD 16.6) years. In all, 258 (50.9%) patients were male. They were predominantly Black (n=212, 41.8%), White (n=152, 30%), and non-Hispanic or non-Latino (n=403, 79.5%). Most of the patients were publicly insured (n=411, 81.1%). Among these 507 patients, 313 (61.7%) completed the TAPS screener. Of these 313 patients, 76 (24.3%) adhered to the instructions and 237 (75.7%) did not follow the instructions correctly. Of the 237 respondents who did not follow the instructions correctly, 166 (70%) answered more questions and 71 (30%) answered fewer questions than required in TAPS part 2. Among the 237 patients who did not adhere to questionnaire instructions, 44 (18.6%) responded in a way that contradicted their response in part 1 of the screener and ultimately affected their overall TAPS score. CONCLUSIONS It was challenging for patients to adhere to questionnaire instructions when completing a substance use screener on paper that was originally developed for electronic use. When selecting PROMs for measurement-based care, it is important to consider the structure of the questionnaire and how the PROM will be administered to determine if additional support for PROM self-administration needs to be implemented.
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Affiliation(s)
- Joanna Kramer
- Department of Psychiatry, Boston Medical Center, Boston, MA, United States
| | - Timothy E Wilens
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Vinod Rao
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Richard Villa
- Department of Psychiatry, Boston Medical Center, Boston, MA, United States
| | - Amy M Yule
- Department of Psychiatry, Boston Medical Center, Boston, MA, United States
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Kelly P, Grant C, Cochrane N, Horn M, Florance J, Bolognesi M, Ryan S. Decreasing Hip Offset in Total Hip Arthroplasty Results in Decreased Physical Function Scores. J Arthroplasty 2024:S0883-5403(24)00580-1. [PMID: 38851407 DOI: 10.1016/j.arth.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 05/30/2024] [Accepted: 06/03/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND Acetabular and femoral offset play an important role in total hip arthroplasty (THA) for postoperative stability and biomechanical function. However, it is unknown whether offset impacts patient-reported outcomes (PROs). This study evaluated patients undergoing direct anterior (DA) THA with the hypothesis that patients who have a decrease in hip offset postoperatively would have lower physical function scores and higher pain interference. METHODS There were 499 patients who underwent DA THA at a single tertiary academic institution who were retrospectively evaluated. Preoperative and postoperative hip offset was measured by 2 reviewers using the Sundsvall method on standing anteroposterior pelvis radiographs. Postoperative changes in hip offset were categorized as increased (> 5 mm), matched (within 5 mm of the preoperative offset measurement), or decreased ( >5 mm). Postoperative PROs with a minimum 1-year follow-up were recorded. A one-way analysis of variance was utilized to compare postoperative pain and PROs between groups. RESULTS Patients who had decreased offset had the lowest mean postoperative physical function scores at 39.4 (8.0), followed by the increased offset group at 42.2 (10.4) and the matched offset group at 42.8 (9.8) (P < .01). There were significant differences in postoperative physical function scores between matched offset (42.8) and decreased offset (39.4) groups (P < .01), as well as between increased offset (42.2) and decreased offset (39.4) groups (P = .04). There was no difference between matched and increased offset cohorts. CONCLUSIONS Our data suggests that reducing hip offset may result in worse physical function scores compared to those who have matched or increased hip offset. This should be considered intraoperatively, and efforts should be made to avoid reduced offset even in the presence of hip stability.
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Affiliation(s)
- Patrick Kelly
- Duke University Hospital's Department of Orthopaedic Surgery, Durham, North Carolina
| | - Caitlin Grant
- Duke University Hospital's Department of Orthopaedic Surgery, Durham, North Carolina
| | - Niall Cochrane
- Duke University Hospital's Department of Orthopaedic Surgery, Durham, North Carolina
| | - Maggie Horn
- Duke University Hospital's Department of Orthopaedic Surgery, Durham, North Carolina
| | - Jonathon Florance
- Duke University Hospital's Department of Orthopaedic Surgery, Durham, North Carolina
| | - Michael Bolognesi
- Duke University Hospital's Department of Orthopaedic Surgery, Durham, North Carolina
| | - Sean Ryan
- Duke University Hospital's Department of Orthopaedic Surgery, Durham, North Carolina
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Snowdon DA, Collyer TA, Marsh L, Srikanth V, Beare R, Baber S, Naude K, Andrew NE. Healthcare consumer acceptability of routine use of the EQ-5D-5L in clinical care: a cross-sectional survey. Qual Life Res 2024; 33:1307-1321. [PMID: 38321194 PMCID: PMC11045645 DOI: 10.1007/s11136-024-03598-z] [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: 01/02/2024] [Indexed: 02/08/2024]
Abstract
PURPOSE Patient reported outcome measures, such as the EQ-5D-5L, provide a measure of self-perceived health status or health-related quality of life. Understanding the consumer acceptability of a patient reported outcome measure can help to decide about its implementation across a healthcare organisation and possibly increase the likelihood of its use in clinical care. This study established the acceptability of the EQ-5D-5L from the perspective of clients receiving healthcare, and determined if acceptability varied by client sub-types. METHODS A cross-sectional survey explored clients' experience of the EQ-5D-5L. Eligible clients were aged ≥ 18 years and completed the EQ-5D-5L on admission and discharge to one of two multi-disciplinary community health services. Likert scale items explored acceptability, and open-ended questions determined if the EQ-5D-5L reflects experience of illness. Associations between acceptability and client characteristics were established using χ2 test. Open-ended questions were analysed using content analysis. RESULTS Most of the 304 clients (mean age 70 years, SD 16) agreed that the EQ-5D-5L: was easy to use/understand (n = 301, 99%) and useful (n = 289, 95%); improved communication with their therapist (n = 275, 90%); and made them feel more in control of their health (n = 276, 91%). Most clients also agreed that they wished to continue using the EQ-5D-5L (n = 285, 93%). Clients aged ≥ 60 years reported lower acceptability. Clients noted that the EQ-5D-5L did not capture experience of illness related to fatigue, balance/falls, cognition, and sleep. CONCLUSION The EQ-5D-5L is acceptable for use in care but does not capture all aspects of health relevant to clients, and acceptability varies by subgroup.
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Affiliation(s)
- David A Snowdon
- National Centre for Healthy Ageing, 2 Hastings Road, Frankston, VIC, Australia.
- Academic Unit, Peninsula Health, Frankston, VIC, Australia.
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, VIC, Australia.
| | - Taya A Collyer
- National Centre for Healthy Ageing, 2 Hastings Road, Frankston, VIC, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Lucy Marsh
- National Centre for Healthy Ageing, 2 Hastings Road, Frankston, VIC, Australia
- Academic Unit, Peninsula Health, Frankston, VIC, Australia
| | - Velandai Srikanth
- National Centre for Healthy Ageing, 2 Hastings Road, Frankston, VIC, Australia
- Academic Unit, Peninsula Health, Frankston, VIC, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Richard Beare
- National Centre for Healthy Ageing, 2 Hastings Road, Frankston, VIC, Australia
- Academic Unit, Peninsula Health, Frankston, VIC, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Developmental Imaging, Murdoch Children's Research Institute, Melbourne, Australia
| | - Stephanie Baber
- Physiotherapy Department, Golf Links Road Rehabilitation Centre, Peninsula Health, Frankston, VIC, Australia
| | - Kim Naude
- National Centre for Healthy Ageing, 2 Hastings Road, Frankston, VIC, Australia
- Academic Unit, Peninsula Health, Frankston, VIC, Australia
| | - Nadine E Andrew
- National Centre for Healthy Ageing, 2 Hastings Road, Frankston, VIC, Australia
- Academic Unit, Peninsula Health, Frankston, VIC, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, VIC, Australia
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Rechenmacher AJ, Ballengee LA, George SZ, Bolognesi MP, Horn ME. Utility of Patient Reported Outcome Measurement Information System measures in predicting shoulder arthroplasty in patients with shoulder osteoarthritis. J Shoulder Elbow Surg 2024:S1058-2746(24)00193-9. [PMID: 38521482 DOI: 10.1016/j.jse.2024.01.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/20/2024] [Accepted: 01/30/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND The decision to treat shoulder osteoarthritis (OA) definitively with shoulder arthroplasty (SA) is multifactorial, considering objective findings, subjective information, and patient goals. The first goal of this study was to determine if Patient Reported Outcome Measurement Information System (PROMIS) measures correlated with patients with shoulder OA who underwent SA within 1 year. The second goal of this study was to determine if score cut-offs in PROMIS domains could further discriminate which shoulder OA patients underwent SA within 1 year. METHODS This retrospective case-control study examined patients with a diagnosis of shoulder OA who consulted an orthopedic provider from November 1, 2020 to May 23, 2022, and recorded PROMIS measures in the domains of Physical Function, Depression, and/or Pain Interference. A surgical group was defined as patients who underwent SA within 1 year of the most recent PROMIS measures and the nonsurgical patients were defined as the control group. Mean PROMIS scores were compared between the surgical and control groups. Separate logistic regression models controlling for age, race, ethnicity, and comorbidity count were performed for each PROMIS domain as a 1) continuous variable, and then as 2) binary variable defined by PROMIS score cut-off points to determine which scores correlated with undergoing SA to further characterize the potential clinical utility of PROMIS score cut-offs in relating to undergoing SA. RESULTS The surgical group of 478 patients was older (68.2 vs. 63.8 years), more often of White race (82.6% vs. 70.9%), and less often of Hispanic Ethnicity (1.5% vs. 2.9%) than the control group of 3343 patients. Using optimal cut-offs in PROMIS scores, Pain Interference ≥63 (odds ratio [OR] = 2.97 (2.41-3.64), P < .001), Physical Function ≤39 (OR = 1.81 (95% confidence interval, 1.48-2.22), P < .001), and depression ≥49 (OR = 1.82 (95% confidence interval, 1.50-2.22), P < .001) were all found to correlate with undergoing SA within 1 year in multivariable logistic regressions. CONCLUSION The results of this study demonstrate that cut-off scores for PROMIS measures differentiated patients undergoing SA within 1 year. These cut-off scores may have clinical utility in aiding in decision-making regarding surgical candidates for SA. Further research is needed to validate these cut-off scores and determine how they relate to patient outcomes after SA.
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Affiliation(s)
| | - Lindsay A Ballengee
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Steven Z George
- Department of Orthopaedic Surgery, Population Health Sciences, Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | | | - Maggie E Horn
- Department of Orthopaedic Surgery, Department of Population Health Sciences, Duke School of Medicine, Duke University, Durham, NC, USA
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Lostelius PV, Gustavsson C, Adolfsson ET, Söderlund A, Revenäs Å, Zakrisson AB, Mattebo M. Identification of health-related problems in youth: a mixed methods feasibility study evaluating the Youth Health Report System. BMC Med Inform Decis Mak 2024; 24:64. [PMID: 38443898 PMCID: PMC10913260 DOI: 10.1186/s12911-024-02465-8] [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] [Received: 06/14/2023] [Accepted: 02/21/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Because poor health in youth risk affecting their entry in adulthood, improved methods for their early identification are needed. Health and welfare technology is widely accepted by youth populations, presenting a potential method for identifying their health problems. However, healthcare technology must be evidence-based. Specifically, feasibility studies contribute valuable information prior to more complex effects-based research. The current study assessed the process, resource, management, and scientific feasibility of the Youth Health Report System prototype, developed within a youth health clinic context in advance of an intervention study. METHODS This mixed-methods feasibility study was conducted in a clinical setting. The process, resource, management, and scientific feasibility of the Youth Health Report System were investigated, as recommended in the literature. Participants were youth aged 16-23 years old, attending a youth health clinic, and healthcare professionals from three clinics. The youth participants used their smart phones to respond to Youth Health Report System health questions and healthcare professionals used their computer to access the results and for registration system entries. Qualitative data were collected from interviews with healthcare professionals, which were described with thematic analysis. Youth participants' quantitative Youth Health Report System data were analyzed for descriptive statistics. RESULTS Feasibility analysis of qualitative data from interviews with 11 healthcare professionals resulted in three themes: We expected it could be hard; Information and routines helped but time was an issue; and The electronic case report form was valuable in the health assessment. Qualitative data were collected from the Youth Health Report System. A total of 54 youth participants completed the evaluation questionnaire, and healthcare professionals retrieved information from, and made post-appointment system entries. Quantitative results revealed few missing items and acceptable data variability. An assessment template of merged qualitative and quantitative data guided a consensus discussion among the researchers, resulting in acceptable feasibility. CONCLUSIONS The process-, resource-, management-, and scientific feasibility aspects were acceptable, with some modifications, strengthening the potential for a successful Youth Health Report System intervention study.
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Affiliation(s)
- Petra V Lostelius
- Centre for Innovation, Research and Education, Region Västmanland, Västmanland Hospital Västerås, Västerås, Sweden.
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.
- Clinic for Pain Rehabilitation Västmanland, Region Västmanland, Västerås, Sweden.
- Centre for Clinical Research, Region Västmanland- Uppsala University, Västerås, Sweden.
| | - Catharina Gustavsson
- Centre for Clinical Research Dalarna, Uppsala University, Falun, Sweden
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Eva Thors Adolfsson
- Centre for Clinical Research, Region Västmanland- Uppsala University, Västerås, Sweden
| | - Anne Söderlund
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Åsa Revenäs
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
- Centre for Clinical Research, Region Västmanland- Uppsala University, Västerås, Sweden
- Orthopedic Clinic, Västerås Hospital Region Västmanland, Västerås, Sweden
| | - Ann-Britt Zakrisson
- University Health Care Research Center, Faculty of Medicine, and Health, Örebro University, Örebro, Sweden
| | - Magdalena Mattebo
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
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10
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Kearney LE, Jansen E, Kathuria H, Steiling K, Jones KC, Walkey A, Cordella N. Efficacy of Digital Outreach Strategies for Collecting Smoking Data: Pragmatic Randomized Trial. JMIR Form Res 2024; 8:e50465. [PMID: 38335012 PMCID: PMC10891497 DOI: 10.2196/50465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 12/19/2023] [Accepted: 12/24/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Tobacco smoking is an important risk factor for disease, but inaccurate smoking history data in the electronic medical record (EMR) limits the reach of lung cancer screening (LCS) and tobacco cessation interventions. Patient-generated health data is a novel approach to documenting smoking history; however, the comparative effectiveness of different approaches is unclear. OBJECTIVE We designed a quality improvement intervention to evaluate the effectiveness of portal questionnaires compared to SMS text message-based surveys, to compare message frames, and to evaluate the completeness of patient-generated smoking histories. METHODS We randomly assigned patients aged between 50 and 80 years with a history of tobacco use who identified English as a preferred language and have never undergone LCS to receive an EMR portal questionnaire or a text survey. The portal questionnaire used a "helpfulness" message, while the text survey tested frame types informed by behavior economics ("gain," "loss," and "helpfulness") and nudge messaging. The primary outcome was the response rate for each modality and framing type. Completeness and consistency with documented structured smoking data were also evaluated. RESULTS Participants were more likely to respond to the text survey (191/1000, 19.1%) compared to the portal questionnaire (35/504, 6.9%). Across all text survey rounds, patients were less responsive to the "helpfulness" frame compared with the "gain" frame (odds ratio [OR] 0.29, 95% CI 0.09-0.91; P<.05) and "loss" frame (OR 0.32, 95% CI 11.8-99.4; P<.05). Compared to the structured data in the EMR, the patient-generated data were significantly more likely to be complete enough to determine LCS eligibility both compared to the portal questionnaire (OR 34.2, 95% CI 3.8-11.1; P<.05) and to the text survey (OR 6.8, 95% CI 3.8-11.1; P<.05). CONCLUSIONS We found that an approach using patient-generated data is a feasible way to engage patients and collect complete smoking histories. Patients are likely to respond to a text survey using "gain" or "loss" framing to report detailed smoking histories. Optimizing an SMS text message approach to collect medical information has implications for preventative and follow-up clinical care beyond smoking histories, LCS, and smoking cessation therapy.
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Affiliation(s)
- Lauren E Kearney
- The Pulmonary Center, Boston University, Boston, MA, United States
| | - Emily Jansen
- Department of Quality and Patient Safety, Boston Medical Center, Boston, MA, United States
| | | | - Katrina Steiling
- The Pulmonary Center, Boston University, Boston, MA, United States
| | - Kayla C Jones
- The Evan's Center for Implementation & Improvement Sciences, Boston University, Boston, MA, United States
| | - Allan Walkey
- The Pulmonary Center, Boston University, Boston, MA, United States
- The Evan's Center for Implementation & Improvement Sciences, Boston University, Boston, MA, United States
| | - Nicholas Cordella
- Department of Quality and Patient Safety, Boston Medical Center, Boston, MA, United States
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11
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Stichler JF, Pelletier LR. Applying the Patient Empowerment, Engagement, and Activation Survey to Improve Patient Outcomes. J Nurs Adm 2023; 53:668-674. [PMID: 37983606 DOI: 10.1097/nna.0000000000001364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
This article focuses on applying the patient empowerment, engagement, and activation (PEEA) model as an implementation strategy to achieve patient- or person-centered care. There is substantial evidence linking PEEA to improved patient care outcomes and reduced healthcare costs. Interrelationships among the 3 concepts are discussed and how the PEEA survey can be used to evaluate patients' activation for self-care postdischarge and their perceptions of nurses' empowering and engaging them during the care encounter.
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Affiliation(s)
- Jaynelle F Stichler
- Author Affiliations: Consultant (Dr Stichler) and Clinical Nurse Specialist (Pelletier), Terrence and Barbara Caster Institute for Nursing Excellence, Sharp Prebys Innovation and Education Center, San Diego, California
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12
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Leuchter RK, Ma S, Bell DS, Hays RD, Vidorreta FJS, Binder SL, Sarkisian CA. Embedding research study recruitment within the patient portal preCheck-in. J Am Med Inform Assoc 2023; 30:2028-2035. [PMID: 37595575 PMCID: PMC10654868 DOI: 10.1093/jamia/ocad164] [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] [Received: 03/20/2023] [Accepted: 08/09/2023] [Indexed: 08/20/2023] Open
Abstract
OBJECTIVE Patient portals are increasingly used to recruit patients in research studies, but communication response rates remain low without tactics such as financial incentives or manual outreach. We evaluated a new method of study enrollment by embedding a study information sheet and HIPAA authorization form (HAF) into the patient portal preCheck-in (where patients report basic information like allergies). MATERIALS AND METHODS Eligible patients who enrolled received an after-visit patient-reported outcomes survey through the patient portal. No additional recruitment/messaging efforts were made. RESULTS A total of 386 of 843 patients completed preCheck-in, 308 of whom signed the HAF and enrolled in the study (37% enrollment rate). Of 93 patients who were eligible to receive the after-visit survey, 45 completed it (48% completion rate). CONCLUSION Enrollment and survey completion rates were higher than what is typically seen with recruitment by patient portal messaging, suggesting that preCheck-in recruitment can enhance research study recruitment and warrants further investigation.
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Affiliation(s)
- Richard K Leuchter
- Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, United States
| | - Suzette Ma
- UCLA Health Information Technology, UCLA Health, Los Angeles, CA 90095, United States
| | - Douglas S Bell
- Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, United States
- Clinical and Translational Science Institute, UCLA, Los Angeles, CA 90095, United States
| | - Ron D Hays
- Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, United States
- Department of Health Policy and Management, Fielding School of Public Health, UCLA, Los Angeles, CA 90095, United States
| | | | - Sandra L Binder
- Clinical and Translational Science Institute, UCLA, Los Angeles, CA 90095, United States
| | - Catherine A Sarkisian
- Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, United States
- VA Greater Los Angeles Healthcare System Geriatric Research Education and Clinical Center, Los Angeles, CA 90073, United States
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Tucker NJ, Shah A, Mauffrey C, Hammerberg EM, Parry JA. Disconnected: Electronic Patient-Reported Outcome Measure Collection in Orthopaedic Patients is Less Successful Than In-Person Collection at an Urban Safety Net Trauma Center. J Orthop Trauma 2023; 37:S7-S11. [PMID: 37828695 DOI: 10.1097/bot.0000000000002687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVES Electronic patient-reported outcome measure (E-PROM) collection is a technological advancement that has the potential to facilitate PROM collection in orthopaedic trauma. The purpose of this study was to compare E-PROM versus in-person PROM collection. DESIGN This is a retrospective comparative study. SETTING Urban Level I trauma center. PATIENTS/PARTICIPANTS One hundred and fifty consecutive operative orthopaedic trauma patients. INTERVENTION The Percent of Normal single assessment numerical evaluation and patient-reported outcomes measurement information system physical function were collected through automated e-mails from an online patient-engagement platform (PatientIQ, Chicago, IL) 2-week, 6-week, 3-month, and 6-month postoperatively. The Percent of Normal was also administered to patients in clinic at the same time intervals. MAIN OUTCOME MEASUREMENTS Completion of PROMs; Loss to follow-up. RESULTS The median clinical follow-up time was 4 months (interquartile range: 1.3-6 months), and 42.7% (64/150) were lost to follow-up. Loss to follow-up was associated with a more disadvantaged area deprivation index [observed difference, 7.0, 95% confidence interval, 1.0 to 13.0; P = 0.01] and noncommercial/no insurance (observed difference 34.8%, confidence interval, 20.9%-45.5%; P < 0.0001). In-person PROM collection was more successful than E-PROM collection at all intervals [2-week (51.3% vs 20.7), 6-week (46.7% vs 20.0%), 3-month (50.0% vs 18.7%), and 6-month (38.0% vs 18.7%), P < 0.0001]. Patients who completed 3-month E-PROMs had longer clinical follow-up (5.2 vs. 3.0 months, P = 0.004) and a trend of being less likely to be lost to follow-up (28.6% vs 45.9%, P = 0.13). CONCLUSION E-PROMs were less successful than in-person PROM collection in trauma patients at an urban safety net trauma center. LEVEL OF EVIDENCE Diagnostic Level III.
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Affiliation(s)
- Nicholas J Tucker
- Department of Orthopaedics, Denver Health Medical Center, Denver, CO; and
- Department of Orthopaedics, University of Colorado School of Medicine, Aurora, CO
| | - Ananya Shah
- Department of Orthopaedics, University of Colorado School of Medicine, Aurora, CO
| | - Cyril Mauffrey
- Department of Orthopaedics, Denver Health Medical Center, Denver, CO; and
- Department of Orthopaedics, University of Colorado School of Medicine, Aurora, CO
| | - E Mark Hammerberg
- Department of Orthopaedics, Denver Health Medical Center, Denver, CO; and
- Department of Orthopaedics, University of Colorado School of Medicine, Aurora, CO
| | - Joshua A Parry
- Department of Orthopaedics, Denver Health Medical Center, Denver, CO; and
- Department of Orthopaedics, University of Colorado School of Medicine, Aurora, CO
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14
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Tucker NJ, Shah A, Mauffrey C, Hammerberg M, Parry JA. Disconnected: Electronic Patient-Reported Outcome Measure Collection In Orthopaedic Patients at an Urban Safety-Net Hospital. J Am Acad Orthop Surg 2023; 31:1136-1142. [PMID: 37432990 DOI: 10.5435/jaaos-d-23-00132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/11/2023] [Indexed: 07/13/2023] Open
Abstract
INTRODUCTION Collection of patient-reported outcome measures (PROMs) in orthopaedic patients at safety-net hospitals is challenging. The purpose of this study was to evaluate the success of electronic PROM (E-PROM) collection in this setting. METHODS A retrospective review identified 207 consecutive orthopaedic patients undergoing 77 elective arthroplasty procedures and 130 trauma procedures. E-PROMs were collected through automated e-mails from an online patient engagement platform (PatientIQ) at 2 weeks, 6 weeks, and 3 months postoperatively. Patients with trauma received the percentage of normal Single Assessment Numerical Evaluation (SANE) and Patient-Reported Outcomes Measurement Information System-Physical Function (PROMIS-PF). Arthroplasty patients received the Hip/Knee SANE, Hip/Knee Disability and Osteoarthritis Outcome Score-Joint Replacement (HOOS Jr/KOOS Jr), PROMIS Global Physical Health (PROMIS-G-PH), and Veterans RAND 12-Item (VR-12) Health Survey. RESULTS Compared with patients with trauma, arthroplasty patients were older (median difference 18.0 years; 95% confidence interval [CI] 12.0-22.0; P < 0.0001), more likely to be Hispanic/Black (proportional difference 16.9%; CI 2.8-30.3%; P = 0.02), more likely to have noncommercial or no insurance (proportional difference 34.0%; CI 23.2-43.0%; P < 0.001), and did not differ in Area Deprivation Index or E-PROM completion at each time point. E-PROMs were completed at 2 weeks, 6 weeks, and 3 months by 25.1% (52 of 207), 24.6% (51 of 207), and 21.7% (45 of 207) of all patients, respectively. Trauma and arthroplasty patients had a similar rate of partial E-PROM completion. Patients who completed 3-month E-PROMs were less likely to be Hispanic/Black (PD -16.4%; CI -31.0 to -0.2%; P < 0.04); less likely to have noncommercial/no insurance (PD -20.0%; CI -35.5 to -4.5%; P = 0.01); and did not differ in age, sex, Area Deprivation Index, or procedure type. DISCUSSION The low collection rate of E-PROMs from orthopaedic patients at safety-net hospitals should be weighed against their costs. E-PROM collection may exacerbate disparities in PROM collection among certain patient populations. LEVEL OF EVIDENCE Diagnostic Level III.
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Affiliation(s)
- Nicholas J Tucker
- From the Department of Orthopaedics (Dr. Tucker, Dr. Mauffrey, Dr. Hammerberg, Dr. Parry), Denver Health Medical Center, St. Denver, CO (Tucker, Mauffrey, Hammerberg, and Parry), and the University of Colorado School of Medicine, Denver, Colorado (Tucker, Shah, Mauffrey, Hammerberg, and Parry), Aurora, CO
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15
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Lee Y, Issa TZ, Vaccaro AR. State-of-the-art Applications of Patient-Reported Outcome Measures in Spinal Care. J Am Acad Orthop Surg 2023; 31:e890-e897. [PMID: 36727887 DOI: 10.5435/jaaos-d-22-01009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/13/2022] [Indexed: 02/03/2023] Open
Abstract
Patient-reported outcome measures (PROMs) assign objective measures to patient's subjective experiences of health, pain, disability, function, and quality of life. PROMs can be useful for providers in shared decision making, outcome assessment, and indicating patients for surgery. In this article, we provide an overview of the legacy PROMs used in spinal care, recent advancements in patient-reported outcomes, and future directions in PROMs. Recent advances in patient-reported outcome assessments have included standardization of measurement tools, integration of data collection into workflow, and applications of outcome measures in predictive models and decision-making tools. Continual appraisal of instruments and incorporation into artificial intelligence and machine learning analytics will continue to augment the delivery of high-value spinal care.
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Affiliation(s)
- Yunsoo Lee
- From the Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA
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16
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Penrose CT, George SZ, Bolognesi MP, Bhavsar NA, Horn ME. Do You PROMIS (Patient Reported Outcomes Measurement Information System)? Physical Function and Pain Interference Scores After Total Knee and Hip Arthroplasty. Arthroplast Today 2023; 23:101208. [PMID: 37745958 PMCID: PMC10517261 DOI: 10.1016/j.artd.2023.101208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 06/21/2023] [Accepted: 07/26/2023] [Indexed: 09/26/2023] Open
Abstract
Background Physical function and pain outcomes vary after arthroplasty. We investigated differences in postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) physical function (PF) and pain interference (PI) scores for patients undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA). We aimed to identify preoperative factors that predict postoperative PROMIS scores. Methods Patients who underwent TKA and THA from 2014-2020 were eligible. Preoperative variables including demographics, comorbidities, and pain scores were obtained from the medical record. Patients completed surveys measuring postoperative PF and PI. Descriptive statistics and separate linear regression models for each anatomical location were performed to examine factors predicting postoperative PROMIS PF and PI scores. Results Surveys were completed by 2411 patients (19.5% response rate). Unadjusted mean PF postoperative scores were 47.2 for TKA and 48.8 for THA. Preoperative predictors of lower PF included female sex; body mass index and comorbidities for TKA and THA; and age, tobacco use, and non-White race for THA. Mean PI scores were 47.9 for THA and 49.0 for TKA. Preoperative predictors of increased PI included non-White race and increased body mass index for TKA and THA; higher preoperative pain for TKA; and female sex and increased comorbidity for THA. Conclusions Postoperative PROMIS scores were similar for TKA and THA, with THA having slightly higher PF and lower PI scores. Regression models using preoperative variables showed similar performance for TKA compared with THA. These findings suggest areas for future development of clinical decision support tools.
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Affiliation(s)
- Colin T. Penrose
- Division of Adult Reconstruction, Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Steven Z. George
- Department of Orthopaedic Surgery and Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Michael P. Bolognesi
- Division of Adult Reconstruction, Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Nrupen A. Bhavsar
- Department of General Internal Medicine, Duke University, Durham, NC, USA
| | - Maggie E. Horn
- Division of Physical Therapy, Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
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Dhingra LS, Shen M, Mangla A, Khera R. Cardiovascular Care Innovation through Data-Driven Discoveries in the Electronic Health Record. Am J Cardiol 2023; 203:136-148. [PMID: 37499593 PMCID: PMC10865722 DOI: 10.1016/j.amjcard.2023.06.104] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/24/2023] [Accepted: 06/29/2023] [Indexed: 07/29/2023]
Abstract
The electronic health record (EHR) represents a rich source of patient information, increasingly being leveraged for cardiovascular research. Although its primary use remains the seamless delivery of health care, the various longitudinally aggregated structured and unstructured data elements for each patient within the EHR can define the computational phenotypes of disease and care signatures and their association with outcomes. Although structured data elements, such as demographic characteristics, laboratory measurements, problem lists, and medications, are easily extracted, unstructured data are underused. The latter include free text in clinical narratives, documentation of procedures, and reports of imaging and pathology. Rapid scaling up of data storage and rapid innovation in natural language processing and computer vision can power insights from unstructured data streams. However, despite an array of opportunities for research using the EHR, specific expertise is necessary to adequately address confidentiality, accuracy, completeness, and heterogeneity challenges in EHR-based research. These often require methodological innovation and best practices to design and conduct successful research studies. Our review discusses these challenges and their proposed solutions. In addition, we highlight the ongoing innovations in federated learning in the EHR through a greater focus on common data models and discuss ongoing work that defines such an approach to large-scale, multicenter, federated studies. Such parallel improvements in technology and research methods enable innovative care and optimization of patient outcomes.
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Affiliation(s)
| | - Miles Shen
- Section of Cardiovascular Medicine, Department of Internal Medicine; Department of Internal Medicine
| | - Anjali Mangla
- Section of Cardiovascular Medicine, Department of Internal Medicine; Department of Neuroscience, Yale School of Medicine, New Haven, Connecticut
| | - Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal Medicine; Center for Outcomes Research and Evaluation (CORE), Yale New Haven Hospital, New Haven, Connecticut; Section of Health Informatics, Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut.; Section of Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, Connecticut.
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Pavetto C, Burla M, Lavallee DC, Levison TJ, DiGioia AM, Franklin PD. Optimizing PROM Implementation in Orthopedic Clinics for Longitudinal Outcome Monitoring: Lessons from a Multisite Study. Jt Comm J Qual Patient Saf 2023; 49:474-484. [PMID: 37455194 DOI: 10.1016/j.jcjq.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 05/31/2023] [Accepted: 05/31/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Systematic patient-reported outcome measure (PROM) collection is challenging for clinics, particularly when patients are not in the office. The Arthritis care through Shared Knowledge (ASK) study deployed multimodal approaches to collect PROMs using a clinical microsystem framework. CONCEPTUAL MODEL Informed by the clinical microsystem model, the authors coached 12 orthopedic practices to implement shared processes to support best practices for PROM collection and use. Orthopedic sites collected PROMs from new patients before the first office visit; patients completed the PROM from home via an online assessment in a personalized e-mail. Site staff placed follow-up phone reminders. At 6 and 12 months after the visit, PROMs were collected from home, prompted by an e-mail or phone call. PERFORMANCE OUTCOMES Of the 25,043 new patients identified by clinical sites during the study enrollment, approximately 60% completed a pre-visit PROM-36.6% completed the online PROM after receiving a single automated e-mail, and an additional 31.1% completed the PROM after receiving a text, an e-mail, or a phone call from the staff. The remaining 32.2% of PROMs were collected on arrival at the office. Of patients completing PROMs, 11,140 were eligible to participate in longitudinal collection, and 51.3% consented. Of these, approximately 84% completed a 6-month survey, more than 83% completed a 12-month survey, and more than 91% completed either a 6-month PROM, a 12-month PROM, or both. LEARNING This study illustrates that a multimodal approach to PROM collection using a clinical microsystem approach sustainably supports PROM completion rates. Further efforts are needed to define strategies to engage all patients in understanding and reporting PROMs to inform their care.
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Vaitkevičienė GE, Ažukaitis K, Jankauskienė A, Petrėnė J, Puronaitė R, Trinkūnas J, Jankauskienė D. Development and Integration of Patient-Reported Measures into E-Health System: Pilot Feasibility Study. Healthcare (Basel) 2023; 11:2290. [PMID: 37628488 PMCID: PMC10454584 DOI: 10.3390/healthcare11162290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/26/2023] [Accepted: 08/12/2023] [Indexed: 08/27/2023] Open
Abstract
Patient-centered care is recognized as a key element in recent healthcare management strategies. However, the integrated collection of patient feedback capturing the entire journey of patients with complex medical conditions remains understudied. Herein, we aimed to describe the development of an instrument prototype for the collection of PROMs and PREMs that would encompass a whole patient journey at a single time point. We further describe the process of its integration into a hospital's information system (HIS) and the results of a pilot feasibility study in adult patients with kidney and hematological diseases. We developed an instrument consisting of original PREM and generic EQ-5D-5L questionnaires. E-questionnaires were handled with REDCap software (version 12.5.14) and integrated into the HIS. Patients refusing to use e-questionnaires (48%) were offered paper administration and were older (64 vs. 50 years). The overall response rate for e-questionnaires was 57.1% with a median completion time of 2.0 and 3.7 min for PROM and PREM, respectively. Psychological and social services and primary care setting (diagnosis establishment and involvement in continuous care) were identified as most problematic. The majority of PREM dimensions encompassing different levels of care significantly correlated with PROM responses. Our data indicate the feasibility and potential relevance of the proposed approach, although wider-scale studies in diverse settings are needed.
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Affiliation(s)
- Goda Elizabeta Vaitkevičienė
- Center of Pediatric Oncology and Hematology, Vilnius University Hospital Santaros Klinikos, 08406 Vilnius, Lithuania
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania; (K.A.); (A.J.); (R.P.)
| | - Karolis Ažukaitis
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania; (K.A.); (A.J.); (R.P.)
- Center of Pediatrics, Vilnius University Hospital Santaros Klinikos, 08406 Vilnius, Lithuania
| | - Augustina Jankauskienė
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania; (K.A.); (A.J.); (R.P.)
- Center of Pediatrics, Vilnius University Hospital Santaros Klinikos, 08406 Vilnius, Lithuania
| | - Justė Petrėnė
- Center of Hematology, Oncology and Transfusiology, Vilnius University Hospital Santaros Klinikos, 08406 Vilnius, Lithuania;
| | - Roma Puronaitė
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania; (K.A.); (A.J.); (R.P.)
- Center of Informatics and Development, Vilnius University Hospital Santaros Klinikos, 08406 Vilnius, Lithuania;
| | - Justas Trinkūnas
- Center of Informatics and Development, Vilnius University Hospital Santaros Klinikos, 08406 Vilnius, Lithuania;
- Faculty of Fundamental Sciencies, Vilnius Gediminas Technical University, 10223 Vilnius, Lithuania
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Snowdon DA, Srikanth V, Beare R, Noeske KE, Le E, O'Bree B, Andrew NE. Acceptability of the routine use and collection of a generic patient reported outcome measure from the perspective of healthcare staff: a qualitative study. J Patient Rep Outcomes 2023; 7:81. [PMID: 37522943 PMCID: PMC10390450 DOI: 10.1186/s41687-023-00617-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 07/11/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) provide a measure of self-perceived health status or health-related quality of life. They have been used to support provider-patient decisions, healthcare delivery, and value-based healthcare models. A barrier to routine collection of PROMs is the perception that PROMs lack clinical utility. As such, it is important to establish clinicians' acceptability of the PROM prior to large-scale implementation. This study explored the acceptability of the routine use and collection of a generic PROM in healthcare services from the perspective of healthcare staff. METHODS Individual semi-structured interviews were completed from September 2020 to March 2021 with 26 staff from two multi-disciplinary community healthcare services in Melbourne, Australia. Interviews explored their experiences of using the EQ-5D-5L in their routine care. Interviews were recorded and transcribed verbatim. Data were analysed according to a framework approach, using inductive and deductive techniques. RESULTS Participants discussed the acceptability of the EQ-5D-5L with reference to four themes: practicalities of use; holistic nature; influence on client care; and influence on health service. Participants found the EQ-5D-5L quick and easy to administer, and appreciated that it measured multiple domains of health that were relevant to their clients' care. They believed the EQ-5D-5L helped to identify client problems, and inform service delivery. They also reported features that were less acceptable, including a lack of item specificity to some healthcare disciplines. Participants reported the challenge of managing conflict between their assessment of the client's health and the client's perspective of their own health, leading some to question whether the client could provide an accurate reflection of their own health. CONCLUSIONS The EQ-5D-5L has several features that healthcare staff viewed as acceptable for routine collection and use in healthcare. Training on the validity of the patient reported perspective and broadening the scope of PROMs collection beyond the EQ-5D-5L should be considered to facilitate large-scale implementation.
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Affiliation(s)
- David A Snowdon
- National Centre for Healthy Ageing, Melbourne, VIC, Australia.
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, VIC, Australia.
- Academic Unit, Peninsula Health, Frankston, VIC, Australia.
| | - Velandai Srikanth
- National Centre for Healthy Ageing, Melbourne, VIC, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Academic Unit, Peninsula Health, Frankston, VIC, Australia
| | - Richard Beare
- National Centre for Healthy Ageing, Melbourne, VIC, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Academic Unit, Peninsula Health, Frankston, VIC, Australia
- Developmental Imaging, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Kate E Noeske
- Academic Unit, Peninsula Health, Frankston, VIC, Australia
| | - Elizabeth Le
- National Centre for Healthy Ageing, Melbourne, VIC, Australia
- Academic Unit, Peninsula Health, Frankston, VIC, Australia
| | - Bridget O'Bree
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Academic Unit, Peninsula Health, Frankston, VIC, Australia
| | - Nadine E Andrew
- National Centre for Healthy Ageing, Melbourne, VIC, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Academic Unit, Peninsula Health, Frankston, VIC, Australia
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Lin MP, Kligler SK, Friedman BW, Kim H, Rising K, Samuels-Kalow M, Eucker SA. Barriers and Best Practices for the Use of Patient-Reported Outcome Measures in Emergency Medicine. Ann Emerg Med 2023; 82:11-21. [PMID: 36682996 PMCID: PMC10293024 DOI: 10.1016/j.annemergmed.2022.12.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 11/28/2022] [Accepted: 12/12/2022] [Indexed: 01/21/2023]
Abstract
Patient-reported outcome measures are commonly used in clinical trials and have been incorporated into routine clinical care in select specialties but have not been widely implemented in emergency medicine research and clinical care. We describe measurement-related barriers to patient-reported outcome measure use in the emergency department; administrative and practical considerations; implications of developing novel emergency medicine-specific patient-reported outcome measures; and key considerations for the use of patient-reported outcome measures in emergency medicine research and clinical care. Despite the unique barriers of the ED environment, potential solutions include the use of ED-validated patient-reported outcome measures when available; adapting existing short-form, multidimensional patient-reported outcome measures previously validated in diverse populations, ideally using computer-adapted testing; and collecting responses during anticipated wait times. With this work, we aim to inform barriers and best practices to the use of patient-reported outcome measures in emergency medicine research and clinical care to support future, more widespread implementation of patient-reported outcome measures within emergency care. The successful adoption of patient-reported outcome measures for diverse ED patient populations within the unique constraints of the acute care environment may help researchers, clinicians, and policymakers improve the quality and patient-centeredness of acute care.
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Affiliation(s)
- Michelle P Lin
- Department of Emergency Medicine, Stanford University, Palo Alto, CA.
| | | | - Benjamin W Friedman
- Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore, Bronx, NY
| | - Howard Kim
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kristin Rising
- Jefferson Center for Connected Care, Thomas Jefferson University, Philadelphia, PA; Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia PA
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Rafiq RB, Yount S, Jerousek S, Roth EJ, Cella D, Albert MV, Heinemann AW. Feasibility of PROMIS using computerized adaptive testing during inpatient rehabilitation. J Patient Rep Outcomes 2023; 7:44. [PMID: 37162607 PMCID: PMC10172423 DOI: 10.1186/s41687-023-00567-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/21/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND There has been an increased significance on patient-reported outcomes in clinical settings. We aimed to evaluate the feasibility of administering patient-reported outcome measures by computerized adaptive testing (CAT) using a tablet computer with rehabilitation inpatients, assess workload demands on staff, and estimate the extent to which rehabilitation inpatients have elevated T-scores on six Patient Reported Outcomes Measurement Information System® (PROMIS®) measures. METHODS Patients (N = 108) with stroke, spinal cord injury, traumatic brain injury, and other neurological disorders participated in this study. PROMIS computerized adaptive tests (CAT) were administered via a web-based platform. Summary scores were calculated for six measures: Pain Interference, Sleep Disruption, Anxiety, Depression, Illness Impact Positive, and Illness Impact Negative. We calculated the percent of patients with T-scores equivalent to 2 standard deviations or greater above the mean. RESULTS During the first phase, we collected data from 19 of 49 patients; of the remainder, 61% were not available or had cognitive or expressive language impairments. In the second phase of the study, 40 of 59 patients participated to complete the assessment. The mean PROMIS T-scores were in the low 50 s, indicating an average symptom level, but 19-31% of patients had elevated T-scores where the patients needed clinical action. CONCLUSIONS The study demonstrated that PROMIS assessment using a CAT administration during an inpatient rehabilitation setting is feasible with the presence of a research staff member to complete PROMIS assessment.
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Affiliation(s)
- Riyad Bin Rafiq
- Department of Computer Science and Engineering, University of North Texas, Denton, TX, 76201, USA.
| | - Susan Yount
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Evanston, USA
| | - Sara Jerousek
- Ann & Robert H. Lurie Children's Hospital, Chicago, USA
| | - Elliot J Roth
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Evanston, USA
| | - David Cella
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Evanston, USA
| | - Mark V Albert
- Department of Computer Science and Engineering, University of North Texas, Denton, TX, 76201, USA
- Department of Biomedical Engineering, University of North Texas, Denton, USA
| | - Allen W Heinemann
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Evanston, USA
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, USA
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Gibbs D, Toop N, Grossbach AJ, Keister A, Mallory N, Hatef B, Weinberg J, Viljoen S, Xu D. Electronic versus paper patient-reported outcome measure compliance rates: A retrospective analysis. Clin Neurol Neurosurg 2023; 226:107618. [PMID: 36773533 DOI: 10.1016/j.clineuro.2023.107618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 01/31/2023] [Accepted: 02/04/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVE Patient-reported outcome measures (PROMs) are key tools used to inform clinical research and patient-centered care. Application of data collected from PROMs, however, may be limited by incomplete responses, and little is known regarding the efficacy of varied PROM delivery methods. The objective of this study was to compare PROMs compliance when delivered via paper and electronic formats. METHODS Elective adult spinal deformity patients were screened for inclusion. Data collected included demographics, type of surgery, PROMs compliance, and discharge care. Descriptive statistics and multivariate analysis (MVA) were performed to compare pre- and postoperative compliance rates. RESULTS Of the 474 included patients, 177 were administered paper PROMs, while 297 were electronic. Preoperatively, 101 patients (57.1%) had any portion of their paper PROMs available; 179 (60.3%) had any of their electronic PROMs available (p = 0.492). Among all patients, 76 (42.9%) and 170 (57.2%) had all of their completed preop PROMs available (p = 0.003). Among patients with any of their preop PROMs completed, 75.2% with paper and 95.0% with electronic were completed in their entirety (p < 0.001). Similar trends were observed among postoperative PROMs. MVA demonstrated electronic delivery as the only significant correlate with pre- and post-operative PROMs compliance (p < 0.001 and p = 0.003, respectively). CONCLUSIONS No differences were observed across modalities when considering any available PROMs, yet electronic PROM delivery was associated with higher completion of PROMs. In order to improve the quality of patient-reported data, electronic delivery with alternative methods of quality improvement may be considered to increase PROMs retention rates.
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Affiliation(s)
- David Gibbs
- The Ohio State University College of Medicine, Columbus, OH, USA.
| | - Nathaniel Toop
- The Ohio State University Wexner Medical Center, Department of Neurological Surgery, Columbus, OH, USA
| | - Andrew J Grossbach
- The Ohio State University Wexner Medical Center, Department of Neurological Surgery, Columbus, OH, USA
| | | | - Noah Mallory
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Benjamin Hatef
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Joshua Weinberg
- The Ohio State University Wexner Medical Center, Department of Neurological Surgery, Columbus, OH, USA
| | - Stephanus Viljoen
- The Ohio State University Wexner Medical Center, Department of Neurological Surgery, Columbus, OH, USA
| | - David Xu
- The Ohio State University Wexner Medical Center, Department of Neurological Surgery, Columbus, OH, USA
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Snowdon DA, Srikanth V, Beare R, Marsh L, Parker E, Naude K, Andrew NE. A landscape assessment of the use of patient reported outcome measures in research, quality improvement and clinical care across a healthcare organisation. BMC Health Serv Res 2023; 23:94. [PMID: 36707827 PMCID: PMC9883937 DOI: 10.1186/s12913-023-09050-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 11/23/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Patient reported outcome measures (PROMs) can be used by healthcare organisations to inform improvements in service delivery. However, routine collection of PROMs is difficult to achieve across an entire healthcare organisation. An understanding of the use of PROMs within an organisation can provide valuable insights on the purpose, scope and practical considerations of PROMs collection, which can inform implementation of PROMs. METHODS We used multiple research methods to assess the use of PROMs in research projects, data registries and clinical care across a healthcare organisation from January 2014 to April 2021. The methods included an audit of ethics applications approved by the organisation's human research ethics committee and registries which the health organisation had contributed data to; a literature review of peer-reviewed journal articles reporting on research projects conducted at the organisation; and a survey of health professionals use of PROMs in research projects, data registries and clinical care. The scope of PROMs was determined by classifying PROMs as either 'specific' to a particular disease and/or condition, or as a 'generic' measure with further classification based on the health domains they measured, using the World Health Organization International Classification Framework. Practical considerations included mode and timing of PROMs administration. Data were described using frequency and proportion. RESULTS PROMs were used by 22% of research projects (n = 144/666), 68% of data registries (n = 13/19), and 76% of clinical specialties in their clinical care (n = 16/21). Disease specific PROMs were most commonly used: 83% of research projects (n = 130/144), 69% of clinical registries (n = 9/13), and 75% of clinical specialties (n = 12/16). Greater than 80% of research projects, clinical registries and clinical specialties measured health domains relating to both body impairments and participation in daily life activities. The most commonly used generic PROM was the EQ-5D (research projects n = 56/144, 39%; data registries n = 5/13, 38%; clinical specialties n = 4/16, 25%). PROMs used in clinical care were mostly paper-based (n = 47/55, 85%). CONCLUSIONS We have elicited information on the use of PROMs to inform a health organisation wide implementation strategy. Future work will determine clinician and patient acceptability of the EQ-5D, and co-design a system for the collection of PROMs.
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Affiliation(s)
- David A. Snowdon
- National Centre for Healthy Ageing, Melbourne, VIC Australia ,grid.1002.30000 0004 1936 7857Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, VIC Australia ,grid.466993.70000 0004 0436 2893Academic Unit, Peninsula Health, Frankston, VIC Australia
| | - Velandai Srikanth
- National Centre for Healthy Ageing, Melbourne, VIC Australia ,grid.1002.30000 0004 1936 7857Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, VIC Australia ,grid.466993.70000 0004 0436 2893Academic Unit, Peninsula Health, Frankston, VIC Australia
| | - Richard Beare
- National Centre for Healthy Ageing, Melbourne, VIC Australia ,grid.1002.30000 0004 1936 7857Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, VIC Australia ,grid.466993.70000 0004 0436 2893Academic Unit, Peninsula Health, Frankston, VIC Australia
| | - Lucy Marsh
- National Centre for Healthy Ageing, Melbourne, VIC Australia ,grid.466993.70000 0004 0436 2893Academic Unit, Peninsula Health, Frankston, VIC Australia
| | - Emily Parker
- National Centre for Healthy Ageing, Melbourne, VIC Australia ,grid.466993.70000 0004 0436 2893Academic Unit, Peninsula Health, Frankston, VIC Australia
| | - Kim Naude
- National Centre for Healthy Ageing, Melbourne, VIC Australia ,grid.466993.70000 0004 0436 2893Academic Unit, Peninsula Health, Frankston, VIC Australia
| | - Nadine E. Andrew
- National Centre for Healthy Ageing, Melbourne, VIC Australia ,grid.1002.30000 0004 1936 7857Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, VIC Australia ,grid.466993.70000 0004 0436 2893Academic Unit, Peninsula Health, Frankston, VIC Australia
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25
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Yedulla NR, Hester JD, Patel MM, Cross AG, Peterson EL, Makhni EC. Pre-Visit Digital Messaging Improves Patient-Reported Outcome Measure Participation Prior to the Orthopaedic Ambulatory Visit: Results from a Double-Blinded, Prospective, Randomized Controlled Trial. J Bone Joint Surg Am 2023; 105:20-26. [PMID: 36598473 DOI: 10.2106/jbjs.21.00506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) are metrics that assess physical health, mental health, pain, and satisfaction. However, PROM collection in orthopaedic clinics presents numerous logistical and financial challenges. These challenges are reduced when PROMs are completed before clinic encounters, relieving the workflow constraints of in-office PROM collection. The purpose of this study was to determine the efficacy of 3 different methods with respect to pre-visit electronic PROM completion. METHODS Consecutive adult orthopaedic patients with no previous PROM participation were enrolled. Patients who registered with the electronic medical record (EMR) patient portal (MyChart) and with active e-mail addresses were randomly assigned to 1 of 3 arms: control (no pre-visit messages), MyChart (EMR patient portal pre-visit messages), and e-mail (e-mail pre-visit messages). The primary outcome measure was pre-visit PROM completion rates in orthopaedic patients, and the secondary outcome measures were time to pre-visit PROM form completion and PROM form completion rates according to patient demographic characteristics. By default, the Patient-Reported Outcomes Measurement Information System (PROMIS) forms were available for completion through the portal by 7 days before scheduled visits. Pre-visit messages were sent 7 days prior to the scheduled visit except in the control group, with reminders sent 3 days prior if still not completed. The patients in each arm who completed all assigned forms were labeled as having total PROM completion, and those who completed at least 1 completed form were considered as having partial PROM completion. Multivariable logistic regression models were used to assess differences in PROM completion rates between study arms. Kruskal-Wallis tests were performed to compare the date of the form completion. RESULTS A total of 291 patients were included. The pre-visit total completion rates for assigned PROMs were higher in the MyChart arm (49% of 97 patients; p = 0.005) and the e-mail arm (52% of 100 patients; p = 0.002) in comparison with the control arm (30% of 94 patients). Male patients were more likely than female patients to have partial pre-visit PROM completion (odds ratio [OR], 1.74; p = 0.03), and Caucasian patients were more likely to have partial pre-visit PROM completion than African American patients (OR, 2.28; p = 0.01). CONCLUSIONS Orthopaedic patients receiving either e-mail or patient portal messages demonstrated higher pre-visit PROM completion rates. Pre-visit messaging appears to be a useful strategy for increasing PROM completion rates and limiting the clinical workflow strain imposed by in-clinic PROM administration. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Nikhil R Yedulla
- Department of Orthopedic Surgery, Henry Ford Health System, Detroit, Michigan
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Donnelly C, Janssen A, Vinod S, Stone E, Harnett P, Shaw T. A Systematic Review of Electronic Medical Record Driven Quality Measurement and Feedback Systems. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:ijerph20010200. [PMID: 36612522 PMCID: PMC9819986 DOI: 10.3390/ijerph20010200] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/16/2022] [Accepted: 12/21/2022] [Indexed: 06/09/2023]
Abstract
Historically, quality measurement analyses utilize manual chart abstraction from data collected primarily for administrative purposes. These methods are resource-intensive, time-delayed, and often lack clinical relevance. Electronic Medical Records (EMRs) have increased data availability and opportunities for quality measurement. However, little is known about the effectiveness of Measurement Feedback Systems (MFSs) in utilizing EMR data. This study explores the effectiveness and characteristics of EMR-enabled MFSs in tertiary care. The search strategy guided by the PICO Framework was executed in four databases. Two reviewers screened abstracts and manuscripts. Data on effect and intervention characteristics were extracted using a tailored version of the Cochrane EPOC abstraction tool. Due to study heterogeneity, a narrative synthesis was conducted and reported according to PRISMA guidelines. A total of 14 unique MFS studies were extracted and synthesized, of which 12 had positive effects on outcomes. Findings indicate that quality measurement using EMR data is feasible in certain contexts and successful MFSs often incorporated electronic feedback methods, supported by clinical leadership and action planning. EMR-enabled MFSs have the potential to reduce the burden of data collection for quality measurement but further research is needed to evaluate EMR-enabled MFSs to translate and scale findings to broader implementation contexts.
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Affiliation(s)
- Candice Donnelly
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia
| | - Anna Janssen
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia
| | - Shalini Vinod
- Liverpool Cancer Therapy Centre, South Western Sydney Local Health District, Liverpool, NSW 2170, Australia
- South West Sydney Clinical Campuses, University of New South Wales, Liverpool, NSW 2170, Australia
| | - Emily Stone
- Department of Thoracic Medicine and Lung Transplantation, St Vincent’s Hospital, Darlinghurst, NSW 2010, Australia
- School of Clinical Medicine, University of New South Wales, Randwick, NSW 2031, Australia
| | - Paul Harnett
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia
- Crown Princess Mary Cancer Centre, Western Sydney Local Health District, Westmead, NSW 2145, Australia
| | - Tim Shaw
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia
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Campbell LA, Clark SE, Chorney J, Emberly D, MacDonald J, MacKenzie A, Warner G, Wozney L. Choice and Partnership Approach to community mental health and addiction services: a realist-informed scoping review. BMJ Open 2022; 12:e064436. [PMID: 36261240 PMCID: PMC9582326 DOI: 10.1136/bmjopen-2022-064436] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/09/2022] Open
Abstract
OBJECTIVES The Choice and Partnership Approach (CAPA) was developed to create an accessible, child-centred and family-centred model of child and adolescent mental health service delivery that is adaptable to different settings. We sought to describe the state of evidence regarding the extent, outcomes and contextual considerations of CAPA implementation in community mental health services. DESIGN Scoping review. DATA SOURCES Published and grey literature were searched using MEDLINE, Embase, CINAHL, PsycINFO, Scopus and Google to 13 and 20 July 2022, respectively. ELIGIBILITY CRITERIA We included reports focused on the implementation, outcomes (clinical, programme or system) or a discussion of contextual factors that may impact CAPA implementation in either child and adolescent or adult mental health services. DATA EXTRACTION AND SYNTHESIS Data were extracted using a codebook that reflected the five domains of the Consolidated Framework for Implementation Research (CFIR) and reviewed for agreement and accuracy. Data were synthesised according to the five CFIR domains. RESULTS Forty-eight reports describing 36 unique evaluations were included. Evaluations were observational in nature; 10 employed pre-post designs. CAPA implementation, regardless of setting, was largely motivated by long wait times. Characteristics of individuals (eg, staff buy-in or skills) were not reported. Processes of implementation included facilitative leadership, data-informed planning and monitoring and CAPA training. Fidelity to CAPA was infrequently measured (n=9/36) despite available tools. Health system outcomes were most frequently reported (n=28/36); few evaluations (n=7/36) reported clinical outcomes, with only three reporting pre/post CAPA changes. CONCLUSIONS Gaps in evidence preclude a systematic review and meta-analysis of CAPA implementation. Measurement of clinical outcomes represents an area for significant improvement in evaluation. Consistent measurement of model fidelity is essential for ensuring the accuracy of outcomes attributed to its implementation. An understanding of the change processes necessary to support implementation would be strengthened by more comprehensive consideration of contextual factors.
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Affiliation(s)
- Leslie Anne Campbell
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Psychiatry, IWK Health, Halifax, Nova Scotia, Canada
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sharon E Clark
- Mental Health and Addictions, IWK Health, Halifax, Nova Scotia, Canada
| | - Jill Chorney
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- Mental Health and Addictions, IWK Health, Halifax, Nova Scotia, Canada
| | - Debbie Emberly
- Mental Health and Addictions, IWK Health, Halifax, Nova Scotia, Canada
| | - Julie MacDonald
- Mental Health and Addictions, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Adrian MacKenzie
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Research, Innovation, and Discovery, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Grace Warner
- School of Occupational Therapy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lori Wozney
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- Mental Health and Addictions, Nova Scotia Health, Halifax, Nova Scotia, Canada
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Metz C, McCracken P, Hanmer J. Common Patient-Reported Outcomes Within the Food and Drug Administration Voice of the Patient Reports. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1743-1751. [PMID: 35577642 DOI: 10.1016/j.jval.2022.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/08/2022] [Accepted: 03/29/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Proponents of disease-specific patient-reported outcome measurements (PROMs) often argue disease-agnostic measures do not adequately capture their patient population's experience. Patient-Reported Outcomes Measurement Information System (PROMIS) provides a disease-agnostic domain set that may adequately cover many diseases. This study seeks to investigate whether PROMIS's quality of life domain coverage can span patient-reported outcomes (PROs) elicited from patients across unrelated diseases. METHODS The Food and Drug Administration Voice of the Patient reports were an initiative to elevate patient voices regarding their condition and associated treatments. Two reviewers extracted patient-reported health-related (quality of life) domains from the reports and categorized them into PROMIS domains or non-PROMIS domains. Domain coverage was summarized for each report. Any extracted PROs not covered by PROMIS domains were placed in an "other" category and analyzed for common themes. RESULTS Across 26 reports, PROMIS covered 216 of 374 (70%) of the reports' PRO domains. The heritable bleeding disorders report had the highest coverage (82%). Human immunodeficiency virus had the lowest coverage (50%). The most common PROMIS domain, "ability to participate in social roles," appeared in 25 reports (96%). The most common domains not included in PROMIS were stigma, sensitivities, and sensory deficits as evident in 19 (73%), 18 (69%), and 18 reports (69%), respectively. If the top 3 unincluded domains were amended into PROMIS, the total domain coverage would increase to 84%. CONCLUSIONS PRO domains elicited in the Food and Drug Administration Voice of the Patient reports were widely captured by PROMIS, suggesting domains patients experience contain enough overlap to be recorded by appropriate PROMIS domains. PROMIS could increase its coverage by adding domains.
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Affiliation(s)
- Cameron Metz
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Polly McCracken
- Department of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Janel Hanmer
- Department of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Harrison NJ, Lopez AA, Shroder MM, Bachmann JM, Burnell E, Hopkins MB, Geiger TM, Hawkins AT. Collection and Utilization of Patient-Reported Outcome Measures in a Colorectal Surgery Clinic. J Surg Res 2022; 280:515-525. [PMID: 36081311 DOI: 10.1016/j.jss.2022.07.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 07/13/2022] [Accepted: 07/28/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The routine collection of patient-reported outcome measures (PROMs) promises to improve patient care. However, in colorectal surgery, PROMs are uncommonly collected outside of clinical research studies and rarely used in clinical care. We designed and implemented a quality improvement project with the goals of routinely collecting PROMs and increasing the frequency that PROMs are utilized by colorectal surgeons in clinical practice. METHODS This mixed-methods, quality improvement project was conducted in the colorectal surgery clinic of a tertiary academic medical center. Patients were administered up to five PROMs before each appointment. PROM completion rates were measured. Additionally, we performed two educational interventions to increase utilization of our electronic health record's PROM dashboard by colorectal surgeons. Utilization rates and attitudes toward the PROM dashboard were measured. RESULTS Overall, patients completed 3600 of 3977 (90.9%) administered PROMs during the study period. At baseline, colorectal surgeons reviewed 6.7% of completed PROMs. After two educational interventions, this increased to 39.3% (P = 0.004). Colorectal surgeons also felt that the PROM dashboard was easier to use. Barriers to greater PROM dashboard utilization included poor user interface/user experience and a perceived lack of knowledge, time, and relevance. CONCLUSIONS The collection of PROMs in colorectal surgery clinics is feasible and can result in high PROM completion rates. Educational interventions can improve the utilization of PROMs by colorectal surgeons in clinical practice. Our experience collecting PROMs through this quality improvement initiative can serve as a template for other colorectal surgery clinics interested in collecting and utilizing data from PROMs.
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Affiliation(s)
- Noah J Harrison
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Andrea A Lopez
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Megan M Shroder
- Division of General Surgery, Vanderbilt University Medical Center, Section of Colon & Rectal Surgery, Nashville, Tennessee
| | - Justin M Bachmann
- Medicine Service, Veterans Affairs Tennessee Valley Healthcare System; Assistant Professor, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Emily Burnell
- Vanderbilt University Medical Center, Population Health, Nashville, Tennessee
| | - Michael B Hopkins
- Division of General Surgery, Vanderbilt University Medical Center, Section of Colon & Rectal Surgery, Nashville, Tennessee
| | - Timothy M Geiger
- Division of General Surgery, Vanderbilt University Medical Center, Section of Colon & Rectal Surgery, Nashville, Tennessee
| | - Alexander T Hawkins
- Division of General Surgery, Vanderbilt University Medical Center, Section of Colon & Rectal Surgery, Nashville, Tennessee.
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Penedo FJ, Medina HN, Moreno PI, Sookdeo V, Natori A, Boland C, Schlumbrecht MP, Calfa C, MacIntyre J, Crane TE, Garcia SF. Implementation and Feasibility of an Electronic Health Record-Integrated Patient-Reported Outcomes Symptom and Needs Monitoring Pilot in Ambulatory Oncology. JCO Oncol Pract 2022; 18:e1100-e1113. [PMID: 35290096 PMCID: PMC9287298 DOI: 10.1200/op.21.00706] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/14/2021] [Accepted: 02/11/2022] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Describe the feasibility and implementation of an electronic health record (EHR)-integrated symptom and needs screening and referral system in a diverse racial/ethnic patient population in ambulatory oncology. METHODS Data were collected from an ambulatory oncology clinic at the University of Miami Health System from October 2019 to January 2021. Guided by a Patient Advisory Board and the Exploration, Preparation, Implementation, and Sustainment model, My Wellness Check was developed to assess physical and psychologic symptoms and needs of ambulatory oncology patients before appointments to triage them to supportive services when elevated symptoms (eg, depression), barriers to care (eg, transportation and childcare), and nutritional needs were identified. Patients were assigned assessments at each appointment no more than once in a 30-day period starting at the second visit. Assessments were available in English and Spanish to serve the needs of the predominantly Spanish-speaking Hispanic/Latino population. RESULTS From 1,232 assigned assessments, more than half (n = 739 assessments; 60.0%) were initiated by 506 unique patients. A total of 65.4% of English and 49.9% of Spanish assessments were initiated. Among all initiated assessments, the majority (85.1%) were completed at home via the patient portal. The most common endorsed items were nutritional needs (32.9%), followed by emotional symptoms (ie, depression and anxiety; 27.8%), practical needs (eg, financial concerns; 21.7%), and physical symptoms (17.6%). Across the physical symptom, social work, and nutrition-related alerts, 77.1%, 99.7%, and 78.8%, were addressed, respectively, by the corresponding oncology health professional, social work team member, or nutritionist. CONCLUSION The results demonstrate encouraging feasibility and initial acceptability of implementing an EHR-integrated symptom and needs screening and referral system among diverse oncology patients. To our knowledge, this is the first EHR-integrated symptom and needs screening system implemented in routine oncology care for Spanish-speaking Hispanics/Latinos.
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Affiliation(s)
- Frank J. Penedo
- Departments of Psychology and Medicine and Sylvester Comprehensive Cancer Center, University of Miami, Coral Gables, FL
| | - Heidy N. Medina
- Department of Public Health Sciences, University of Miami, Miami, FL
| | | | - Vandana Sookdeo
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | - Akina Natori
- Division of Medical Oncology, Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL
| | - Cody Boland
- Department of Psychology, University of Miami, Coral Gables, FL
| | - Matthew P. Schlumbrecht
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Miller School of Medicine, Miami, FL
| | - Carmen Calfa
- Division of Medical Oncology, Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL
| | | | - Tracy E. Crane
- Division of Medical Oncology, Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL
| | - Sofia F. Garcia
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Can Patient-Reported Outcome Measurement Information System Measures Differentiate Patients Who Will Undergo Hip and Knee Total Joint Arthroplasty: A Retrospective Case-Control Study. J Arthroplasty 2022; 37:S56-S62. [PMID: 35196566 DOI: 10.1016/j.arth.2022.02.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 01/31/2022] [Accepted: 02/11/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The Patient-Reported Outcome Measurement Information System (PROMIS) can be used to monitor patients in population-health-based programs. However, it is unknown which measures are most appropriate to differentiate patients who will undergo hip or knee total joint arthroplasty (TJA) in a cohort of patients with osteoarthritis. METHODS A retrospective cohort of new patients consulting for treatment from November 17, 2017 to April 20, 2020 (cases: hip: n = 157, knee: n = 112; randomly selected nonsurgical controls: hip: n = 314, knee: n = 224) was extracted from the electronic health record. We recorded demographics, comorbidity, and PROMIS scores for 8 domains (physical function, pain interference, pain intensity, anxiety, depression, sleep disturbance, ability to participate in social roles and activities, and fatigue). We performed descriptive statistics to characterize the cohorts and baseline PROMIS scores and conducted logistic regression models to determine which PROMIS domains differentiated patients undergoing hip and knee TJA. RESULTS In univariate comparisons of PROMIS domains, the hip and knee surgical cohorts differed from controls in physical function (P < .01), pain interference (P < .01), and ability to participate in social roles and activities (P < .02). In logistic regression models informed by univariate analyses, PROMIS physical function was the only PROMIS measure to differentiate undergoing surgery in both hip and knee cohorts (P < .01). CONCLUSION PROMIS physical function can differentiate TJA cases from nonsurgical controls in both hip and knee patients. These findings have implications for considering which PROMIS measures to administer in patients with hip and knee osteoarthritis.
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