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

Abstract

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.

Planning for patient-reported outcome implementation: Development of decision tools and practical experience across four clinics

“…Several rich sources of PRO implementation guidance exist, including materials from the International Society of Quality of Life Research (ISOQOL) [13], the Patient-Centered Outcomes Research Institute (PCORI) [14], and the HealthMeasures website [15], as well as guidance based on existing implementations [5,[16][17][18]. In attempting to apply these resources to actual PRO implementation, however, several gaps were identified.…”

“…To gather planning information, interviews were conducted with 10 key leaders using questions tailored to respondents' clinical or institutional roles (interviews: n = 13), as shown in Table 1 [5,16,18,19]. Chicago area interviews were conducted by an informatics research assistant (n = 7) and by the Northwestern…”

“…4. The article, "Patient reported outcomesexperiences with implementation in a University Health Care setting" by Biber et al, which focuses on a large installation of PROs and provides a wealth of practical information [5].…”

“…During PRO implementation, it is essential to select measures that are consistent with a given clinic's goals, to determine which events in which populations will trigger a request that a patient complete a particular measure, and to decide which clinicians will receive scores and act upon them [4]. Clinics must also design the best approach to implementation by including key personnel in the planning process, working skillfully and knowledgeably within the institutional landscape, arranging technical implementation, and determining an optimal implementation schedule [5]. Finally, teams must plan for post-implementation monitoring and evaluation to ensure that PROs are operating smoothly [6].…”

Cross-cultural adaptation and validation of the RhinAsthma Patient Perspective (RAPP) in the Polish population

“…Unlike in other chronic conditions [16][17][18], the use of PROs in routine medical care with patients with respiratory allergy remains limited. This depends mainly on the lack of questionnaires with the necessary psychometric properties [19,20] and practical characteristics [21] to support individual application.…”