Large-scale clinical implementation of PROMIS computer adaptive testing with direct incorporation into the electronic medical record

Papuga, M. Owen; Dasilva, Chris; McIntyre, Allison W.; Mitten, David J.; Kates, Stephen L.; Baumhauer, Judith F.

doi:10.1057/s41306-016-0016-1

Cited by 72 publications

(98 citation statements)

References 48 publications

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“…We plan to study the data collected within our health care system for clinical improvements and improve the value of care within our system. Our experience is similar to that of others that successfully implemented electronic PRO collection and provided real-time data to clinicians [ 20 – 23 ] and extends this work through closer clinical integration and broader implementation across diverse clinical and specialty settings.…”

Section: Discussionsupporting

confidence: 72%

Patient reported outcomes – experiences with implementation in a University Health Care setting

Biber

Ose

Reese

et al. 2018

J Patient Rep Outcomes

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AimPatient-reported outcomes (PROs) have traditionally been implemented through a manual process of paper and pencil with little standardization throughout a Healthcare System. Each practice has asked patients specific questions to understand the patient’s health as it pertains to their specialty. These data were rarely shared and there has not been a comparison of patient’s health across different specialty domains. We sought to leverage interoperable electronic systems to provide a standardization of PRO assessments across sites of care.MethodsUniversity of Utah Health is comprised of four hospitals, 12 community clinics, over 400,000 unique annual patients, and more than 5000 providers. The enterprise wide implementation of PROs started in November of 2015. Patients can complete an assessment at home via email, or within the clinic on a tablet. Each specialty has the opportunity to add additional specialty-specific instruments. We customized the interval with which the patient answers the assessments based on specialty preference in order to minimize patient burden, while maximizing relevant data for clinicians.ResultsBarriers and facilitators were identified in three phases: Pre-implementation, Implementation, and Post-implementation. Each phase was further broken down into technical challenges, content inclusion and exclusion, and organizational strategy. These phases are unique and require collaboration between several groups throughout the organization with support from executive leadership.DiscussionWe are deploying system-wide standard and customized PRO collection with the goals of providing better patient care, improving physician-patient communication, and ultimately improving the value of the care given. Standardized assessment provides any clinician with information to quickly evaluate the overall, physical and mental health of a patient. This information is available real time to aid in patient communication for the clinician.Electronic supplementary materialThe online version of this article (10.1186/s41687-018-0059-0) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 72%

Patient reported outcomes – experiences with implementation in a University Health Care setting

Biber

Ose

Reese

et al. 2018

J Patient Rep Outcomes

View full text Add to dashboard Cite

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“…Patient-reported outcomes (PROs) are increasingly collected for both research and clinical practice as a gold standard of outcomes measurement 11 , 12 : The American Board of Orthopaedic Surgery (ABOS) now collects PROs for Part II board certification, and The Centers for Medicare & Medicaid Services (CMS) encourage reporting of PRO data for joint replacement. 13 PRO data will continue to be central to improving outcomes as we shift toward a value-based healthcare system.…”

Section: Introductionmentioning

confidence: 99%

Time-Driven Activity-Based Costing: A Better Way to Understand the Cost of Caring for Hip Fractures

Blaschke

Parikh

Vang

et al. 2020

Geriatr Orthop Surg Rehabil

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Geriatric hip fractures are a common and costly injury. They are expected to surge in incidence and economic burden as the population ages. With an increasing financial strain on the healthcare system, payors and providers are looking toward alternative, value-based models to contain costs. Value in healthcare is the ratio of outcomes achieved over costs incurred, and can be improved by reducing cost while maintaining or improving outcomes, or by improving outcomes while maintaining or reducing costs. Therefore, an understanding of cost, the denominator of the value equation, is essential to value-based healthcare. Because traditional hospital accounting methods do not link costs to conditions, there has been little research to date on the costs of treating geriatric hip fractures over the entire cycle of care. The aim of this article is to summarize existing costing methodologies, and in particular, to review the strengths and limitations of Time-Driven Activity-Based Costing (TDABC) in orthopaedic trauma, especially as it pertains to the needs and challenges unique to hip fracture care. TDABC determines costs at the patient-level over the entire care cycle, allowing for population variability, while simultaneously identifying cost drivers that might inform risk-stratification for future alternative payment models. Through process mapping, TDABC also reveals areas of variation or inefficiency that can be targeted for optimization, and empowers physicians by focusing on costs in the control of the provider. Although barriers remain, TDABC is well-positioned to provide transparent costing and targets to improve the value of hip fracture care

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“…While the role of formal governance is still an emerging practice in many areas of health system management, the goals of governance work often center around engaging stakeholders with diverse expertise, establishing shared goals, aligning incentives and resources to facilitate work, and building infrastructure to advance practice through standardization and continuous improvement [37,38]. Learnings from our work with UW Medicine, consistent with other systems' experience [8,25,[39][40][41][42], demonstrate the invaluable role governance could play in supporting health system use of PROs. In particular, governance for PRO implementation can ensure that PRO measurement selection, technology configurations, and workflow design are driven by stakeholder priorities and health system capabilities.…”

Section: Discussionmentioning

confidence: 91%

Capturing the patient voice: implementing patient-reported outcomes across the health system

et al. 2019

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Purpose Supporting the capture and use of patient-reported outcomes (PROs) at the point-of-care enriches information about important clinical and quality of life outcomes. Yet the ability to scale PROs across healthcare systems has been limited by knowledge gaps around how to manage the diversity of PRO uses and leverage health information technology. In this study, we report learnings and practice insights from UW Medicine's practice transformation efforts to incorporate patient voice into multiple areas of care. Methods Using a participatory, action research approach, we engaged with UW Medicine clinical and administrative stakeholders experienced with PRO implementation to inventory PRO implementations across the health system, characterize common clinical uses for PROs, and develop recommendations for system-wide governance and implementation of PROs. Results We identified a wide breadth of PRO implementations (n = 14) in practice and found that nearly half (47%) of employed PRO measures captured shared clinical domains (e.g., depression). We developed three vignettes (use cases) that illustrate how users interact with PROs, characterize common ways PRO implementations support clinical care across the health system (1) Preventive care, (2) Chronic/Specialty care, and (3) Surgical/Interventional care), and elucidate opportunities to enhance efficient PRO implementations through system-level standards and governance. Conclusions Practice transformation efforts increasingly require integration of the patient voice into clinical care, often through the use of PROs. Learnings from our work highlight the importance of proactively considering how PROs will be used across the layers of healthcare organizations to optimize the design and governance of PROs.

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Large-scale clinical implementation of PROMIS computer adaptive testing with direct incorporation into the electronic medical record

Cited by 72 publications

References 48 publications

Patient reported outcomes – experiences with implementation in a University Health Care setting

Patient reported outcomes – experiences with implementation in a University Health Care setting

Time-Driven Activity-Based Costing: A Better Way to Understand the Cost of Caring for Hip Fractures

Capturing the patient voice: implementing patient-reported outcomes across the health system

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