Optimizing Patient-Reported Outcome Collection and Documentation in Medical Music Therapy: Process-Improvement Study

Abstract

Background To measure the effectiveness of nonpharmacologic interventions delivered during clinical care, investigators need to ensure robust and routine data collection without disrupting individualized patient care or adding unnecessary documentation burden. Objective A process-improvement study was undertaken to improve documentation consistency and increase the capture of patient-reported outcomes (PROs; ie, stress, pain, anxiety, and coping) within a medical music therapy (MT) team. Methods We used 2 Plan-Do-Study-Act (PDSA) cycles to improve documentation processes among an MT team (13.3 clinical full-time equivalent staff). Trainings focused on providing skills and resources for optimizing pre- and postsession PRO collection, specific guidelines for entering session data in the electronic health record, and opportunities for the team to provide feedback. Two comparisons of therapists’ PRO collection rates were conducted: (1) between the 6 months before PDSA Cycle 1 (T0) and PDSA Cycle 1 (T1), and (2) between T1 and PDSA Cycle 2 (T2). Results Music therapists’ rates of capturing any PRO within MT sessions increased significantly (P<.001) from T0 to T1 and from T1 to T2 for all domains, including stress (4/2758, 0.1% at T0; 1012/2786, 36.3% at T1; and 393/775, 50.7% at T2), pain (820/2758, 29.7% at T0; 1444/2786, 51.8% at T1; and 476/775, 61.4% at T2), anxiety (499/2758, 18.1% at T0; 950/2786, 34.1% at T1; and 400/775, 51.6% at T2), and coping (0/2758, 0% at T0; 571/2786, 20.5% at T1; and 319/775, 41.2% at T2). Music therapists’ feedback and findings from a retrospective analysis were used to create an improved electronic health record documentation template. Conclusions Rates of PRO data collection improved within the medical MT team. Although the process improvement in this study was applied to a nonpharmacologic MT intervention, the principles are applicable to numerous inpatient clinical providers. As hospitals continue to implement nonpharmacologic therapies in response to the Joint Commission’s recommendations, routine PRO collection will provide future researchers with the ability to evaluate the impact of these therapies on pain relief and opioid use.

Implementing paper-based patient-reported outcome collection within outpatient integrative health and medicine

“…In addition, these locations typically had low-patient-volume clinical operations. While real-time process monitoring was not conducted in this study, providing a comprehensive PRO collection training, managerial expectation, and monitoring process represents an important opportunity to unify administrative efforts to optimize and equalize collection across sites [ 38 , 39 , 44 ].…”

“…2.4.1 Questionnaires. The numeric rating scale (NRS) is commonly used for measuring pain, stress, and anxiety in clinical practice [52][53][54] and research [44,48,51], with demonstrated validity across these constructs. Owing to its simplicity, ease of use across populations, focus on symptoms in the present moment, and generalizability across various age and education levels [52], the NRS was selected as the instrument of choice in the present study.…”

“…Prior research upon largescale, longitudinal PRO collection within both the outpatient and inpatient IHM settings underscores its feasibility, acceptability, and potential benefit following routine implementation [16,[39][40][41][42][43]. A 2023 process-improvement study by Rodgers-Melnick et al [44] highlighted efforts to optimize PRO collection by inpatient music therapists, including offering resources and guidelines for data collection as well as opportunities for staff feedback. However, to our knowledge, there is limited research on patient, clinical-, and operational-level factors associated with PRO collection across IHM modalities in the outpatient setting.…”