Lessons learned while integrating patient-reported outcomes in a psychiatric hospital.

Abstract

In today's world of smart-device monitoring systems, clinicians may be lulled into the assumption that we can download software to monitor our patients' psychological and behavioral functioning with little or no effort or follow-up. This belief is as erroneous as it is tempting; in fact, implementing effective and efficient systems for utilizing patient-reported outcomes (PROs) in daily practice and research takes a virtual village of stakeholders, clinicians, developers, analysts, and clinical researchers. Here, we describe the iterative processes required for designing, implementing, and updating a large-scale inpatient psychiatric quality improvement/research platform that provides real-time feedback to clinicians and patients. During the past 10 years, many surprises and counterintuitive discoveries have emerged from this project, not the least of which is how difficult it is to establish and maintain "buy-in" and the utilization of PROs with busy clinicians and administrators. Methods for prioritizing and structuring data for different uses, including examining the effectiveness of treatment programs, identifying moderators of change, and improving treatment planning by developing algorithms to alert clinicians to adverse outcomes, are highlighted. The authors conclude by describing a new venture to integrate biological data and between-visit PROs monitoring to enhance well-being and reduce emergency department and hospital admissions for high-risk patients. Clinical Impact StatementQuestion: This article describes the process, challenges, and pitfalls of making patient-reported outcomes (PROs) in daily practice and research a high-value proposition. Findings: Lessons learned from this 10-year project provide broad guidelines to clinical researchers planning to implement PROs in practice. Meaning: Although PRO platforms are driving toward fully automated systems, clinical systems will be best served by a counterbalance of human engagement in the feedback process. Next Steps: Future directions for integrated PROs platforms will include physiological data and ecological momentary assessments between office visits to optimize patient care.

“Operator syndrome”: A unique constellation of medical and behavioral health-care needs of military special operation forces

“…Ongoing assessment allows for the modification of treatment plans, personalization of evidence-based treatments, and enhanced treatment response. 50,51 Standardized collection of clinical data (biomarkers, clinical outcomes) as a routine part of care, including longitudinal follow-up, has been used successfully by other types of behavioral health programs to improve patient outcomes and advance understanding of pathology. [52][53][54][55]…”

Adapting an Outpatient Psychiatric Clinic to Telehealth During the COVID-19 Pandemic: A Practice Perspective

“…In some ways, our clinic had a “head start” on the COVID-19 pandemic compared to most other clinics, as it was already transitioning to digital platforms before the pandemic [ 31 ]. The system-wide support for innovative technologies in our health system had resulted in early adoption of and significant investments in telehealth, including secure and integrated technology to facilitate virtual visits embedded within our electronic health record (EHR), a virtual intensive care unit [ 32 ], and adoption of telemedicine postoperative follow-up [ 33 ].…”

“…The system-wide support for innovative technologies in our health system had resulted in early adoption of and significant investments in telehealth, including secure and integrated technology to facilitate virtual visits embedded within our electronic health record (EHR), a virtual intensive care unit [ 32 ], and adoption of telemedicine postoperative follow-up [ 33 ]. We had already vested and integrated a platform called CareSense (MedTrak, Inc) for previsit and postvisit care coordination and patient-reported outcomes (see [ 31 ] and Fowler et al, forthcoming). Hence, frequently cited sources of provider hesitation to adopt telemedicine, including workflow integration and infrastructure-related logistics [ 4 , 34 - 37 ], did not apply to our practice or to our overall culture.…”

The gap between science and practice: A conversation.

“…STRICKER: (Drill et al, 2018;Fowler et al, 2018;Youn, Xiao, et al, 2018). In addition, many of the articles in this special section directly address the complexity of the implementation process itself (see Oswald, Boswell, Smith, Thompson-Brenner, & Brooks, 2018;Sauer-Zavala et al, 2018;Wolk et al, 2018;Youn, Valentine, et al, 2018).…”