The Role of Technical Advances in the Adoption and Integration of Patient-reported Outcomes in Clinical Care

Abstract

Background Patient-reported outcomes (PROs) are gaining recognition as key measures for improving the quality of patient care in clinical care settings. Three factors have made the implementation of PROs in clinical care more feasible: increased use of modern measurement methods in PRO design and validation, rapid progression of technology (e.g., touch screen tablets, Internet accessibility, and electronic health records (EHRs)), and greater demand for measurement and monitoring of PROs by regulators, payers, accreditors, and professional organizations. As electronic PRO collection and reporting capabilities have improved, the challenges of collecting PRO data have changed. Objectives To update information on PRO adoption considerations in clinical care, highlighting electronic and technical advances with respect to measure selection, clinical workflow, data infrastructure, and outcomes reporting. Methods Five practical case studies across diverse healthcare settings and patient populations are used to explore how implementation barriers were addressed to promote the successful integration of PRO collection into the clinical workflow. The case studies address selecting and reporting of relevant content, workflow integration, pre-visit screening, effective evaluation, and EHR integration. Conclusions These case studies exemplify elements of well-designed electronic systems, including response automation, tailoring of item selection and reporting algorithms, flexibility of collection location, and integration with patient health care data elements. They also highlight emerging logistical barriers in this area, such as the need for specialized technological and methodological expertise, and design limitations of current electronic data capture systems.

Feasibility of the collection of patient-reported outcomes in an ambulatory neurology clinic

“…The literature suggests 3 essential considerations for feasible collection of PROMs: use of modern survey delivery methods, patient engagement, and care provider collaboration. 15 While our study does not provide direct data to support each of these 3 components exactly, we have listed the characteristics of our study that demonstrate the feasibility of our data collection method.…”

“…10,[16][17][18][19][20][21][22][23][24] This finding has been established across multiple comprehensive centers, specialties, and age groups. 15,25 However, delivery models described in the literature contain substantial methodological differences, including various clinical settings, patient characteristics collected, and survey technologies. 15,17,[26][27][28][29] Many cases fail to report participation rate.…”

A clinical perspective on electronically collecting patient-reported outcomes at the point-of-care for overactive bladder

“…(2) "There are a lot of flags that come through [the EMR] now, and it is kind of hard to respond to, but if something is critical it is nice to kind of always have the flags so we can get to it when we can instead of discovering it weeks later when the patient finally shows up in clinic." (4) Changes to patient assessment "I used questionnaires to really confirm that my treatment is working as I interpret it because I don't find that patients ever had a sense of what their questions were before...so I've always found questionnaires are really for me to say, but you are doing well, or you aren't doing well, but the problem is it still comes down to number 1 with the patient: 'How are you doing with this treatment?' and then they'll have their own assessment.…”

“…Advancements in PRO instrument development and technology are driving more clinicians to use PROs as part of a comprehensive approach to the delivery of care. 4 Specific to the treatment of OAB, the Fourth International Consultation on Incontinence recommendations regarding effective care of lower urinary tract symptoms (LUTS) includes assessing patient symptoms and health-related quality of life. 5 However, collecting PROs at the point-of-care can be difficult and time-consuming.…”

Association between Continuity of Care and Health-Related Quality of Life

“…[1][2][3][4][5][6][7] Because PROs capture domains that cross conditions and reflect patient-centered priorities, such measures may more accurately reflect the health and well-being of individuals with multiple chronic medical conditions (MCCs) than do common disease-specific quality measures. 8,9 Across populations, higher scores on these and other domains of health-related quality of life (HRQOL) correlate with lower rates of hospitalization, lower overall mortality, lower cardiovascular morbidity, and lower outpatient services utilization in populations of patients with chronic illness.…”