Implementing patient-reported outcomes in routine clinical care for diverse and underrepresented patients in the United States

Abstract

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

Real time patient‐reported outcome measures in patients with cancer: Early experience within an integrated health system

“…Education interventions to increase patient portal use in vulnerable patients have demonstrated success and may allow future improvement in remote completion, which may facilitate patient‐provider communication outside of physician visits 34 . Targeted interventions to improve PROMs have been attempted in a variety of vulnerable populations and the findings in this study can help guide future directions to improve equity in PROMs implementation within the cancer population 35 …”

“…34 Targeted interventions to improve PROMs have been attempted in a variety of vulnerable populations and the findings in this study can help guide future directions to improve equity in PROMs implementation within the cancer population. 35 While integration of PROMs in usual clinical care has been successful, there continues to be limitations to this study. Importantly, further evaluation of this initial implementation is essential and currently, a mixed methods study of providers, clinical staff, and patients is ongoing to provide insight into facilitators and barriers in this initial effort.…”

“… 34 Targeted interventions to improve PROMs have been attempted in a variety of vulnerable populations and the findings in this study can help guide future directions to improve equity in PROMs implementation within the cancer population. 35 …”

Der Einsatz von Patient-reported Outcome Measures (PROM) und die Perspektive digitaler Biomarker bei der Amyotrophen Lateralsklerose

“…Grundsätzlich kann die Beschäftigung mit der eigenen Erkrankung möglicherweise eine zusätzliche psychologische Belastung für den Patienten oder sein Umfeld bedeuten [40]. Soziodemographische Faktoren wie Geschlecht, Bildung oder kultureller Hintergrund haben Einfluss auf die mit PROM erhobenen Daten [41]. Diese Effekte können verstärkt werden, wenn die PROM digital erhoben werden [28].…”

“…Soziodemographische Faktoren wie Geschlecht, Bildung oder kultureller Hintergrund haben Einfluss auf die mit PROM erhobenen Daten 41 . Diese Effekte können verstärkt werden, wenn die PROM digital erhoben werden 28 .…”