Using Electronic Data Collection Platforms to Assess Complementary and Integrative Health Patient-Reported Outcomes: Feasibility Project

Abstract

Background The Veteran Administration (VA) Office of Patient-Centered Care and Cultural Transformation is invested in improving veteran health through a whole-person approach while taking advantage of the electronic resources suite available through the VA. Currently, there is no standardized process to collect and integrate electronic patient-reported outcomes (ePROs) of complementary and integrative health (CIH) into clinical care using a web-based survey platform. This quality improvement project enrolled veterans attending CIH appointments within a VA facility and used web-based technologies to collect ePROs. Objective This study aimed to (1) determine a practical process for collecting ePROs using patient email services and a web-based survey platform and (2) conduct analyses of survey data using repeated measures to estimate the effects of CIH on patient outcomes. Methods In total, 100 veterans from one VA facility, comprising 11 cohorts, agreed to participate. The VA patient email services (Secure Messaging) were used to manually send links to a 16-item web-based survey stored on a secure web-based survey storage platform (Qualtrics). Each survey included questions about patient outcomes from CIH programs. Each cohort was sent survey links via Secure Messaging (SM) at 6 time points: weeks 1 through 4, week 8, and week 12. Process evaluation interviews were conducted with five primary care providers to assess barriers and facilitators to using the patient-reported outcome survey in usual care. Results This quality improvement project demonstrated the usability of SM and Qualtrics for ePRO collection. However, SM for ePROs was labor intensive for providers. Descriptive statistics on health competence (2-item Perceived Health Competence Scale), physical and mental health (Patient-Reported Outcomes Measurement Information System Global-10), and stress (4-item Perceived Stress Scale) indicated that scores did not significantly change over time. Survey response rates varied (18/100, 18.0%-42/100, 42.0%) across each of the 12 weekly survey periods. In total, 74 of 100 participants provided ≥1 survey, and 90% (66/74) were female. The majority, 62% (33/53) of participants, who reported the use of any CIH modality, reported the use of two or more unique modalities. Primary care providers highlighted specific challenges with SM and offered solutions regarding staff involvement in survey implementation. Conclusions This quality improvement project informs our understanding of the processes currently available for using SM and web-based data platforms to collect ePROs. The study results indicate that although it is possible to use SM and web-based survey platforms for ePROs, automating scheduled administration will be necessary to reduce provider burden. The lack of significant change in ePROs may be due to standard measures taking a biomedical approach to wellness. Future work should focus on identifying ideal ePRO processes that would include standardized, whole-person measures of wellness.

Provider reported value and use of virtual resources in extended primary care prior to and during COVID-19

“…Providers reported nearly twice as many patients preferred Telehealth to face-to-face visits. Although we only collected providers' perceived patient preference in this study, this work was an extension of the authors' previous works, which focused on patient perspective and experiences with VHR [14][15][16][17][18].…”

Getting ready for real‐world use of electronic patient‐reported outcomes (ePROs) for patients with cancer: A National Comprehensive Cancer Network ePRO Workgroup paper

“…29,38 Others have the treating clinical team responsible for monitoring and acting on patient responses, 18 although this presents challenges when busy clinicians are not provided adequate time to react to ePRO responses arriving outside of clinical visits. 39 Multidisciplinary care adds complexity in that it often involves many treating clinicians, such as a radiation oncologist, medical oncologist, and surgical oncologist, with unique symptom burden domains, all of whom may at least want or need to know about the concern. 40 Defining who will respond to which ePRO among these providers is necessary to prevent symptoms from going unaddressed or overaddressed, and should be managed proactively as ePROs are decided upon by system governance.…”

“…Some remote symptom monitoring programs have developed centralized teams, siloed from the treating clinical team, to manage patient responses 29,38 . Others have the treating clinical team responsible for monitoring and acting on patient responses, 18 although this presents challenges when busy clinicians are not provided adequate time to react to ePRO responses arriving outside of clinical visits 39 . Multidisciplinary care adds complexity in that it often involves many treating clinicians, such as a radiation oncologist, medical oncologist, and surgical oncologist, with unique symptom burden domains, all of whom may at least want or need to know about the concern 40 .…”

Gulf War Illness: A Randomized Controlled Trial Combining Mindfulness Meditation and Auricular Acupuncture

“…We hypothesized that the combination of these 2 CIH therapies may prove to be more effective in improving health-related functioning and multiple symptom domains of GWI (e.g., pain, fatigue) as compared to an active control group. As individuals often engage in multiple wholistic methods to affect chronic conditions, 13 the purpose of the current study was not to compare these 2 therapies (meditation vs acupuncture), but to assess whether an intervention combining 2 commonly available CIH therapies would result in multiple symptom improvement in Veterans with GWI.…”