Background The monitoring and management of chronic illness has always been a challenge. Patient-reported outcome measures (PROMs) can be powerful tools for monitoring symptoms and guiding treatment of chronic diseases, but the available PROM tools are either too broad or too disease specific for the needs of a primary care practice focused on longitudinal care. Objective In this study we describe the development and preliminary validation of the Parsley Symptom Index (PSI). Methods This prospective cohort study took place from January 5, 2018, to June 05, 2020, among a sample of 4621 adult patients at Parsley Health. After a review of literature, followed by binning and winnowing of potential items, a 45-item PROM that also served as a review of systems (ROS) was developed. The PSI was deployed and completed by patients via an online portal. Construct and face validity was performed by clinicians, tested on patients, and feasibility was measured by response rate, completion rate, and percentage of missing data. Results The response rate for 12,175 collected PSIs was 93.72% (4331/4621) with a 100% item completion rate. A confirmatory factor analysis confirmed the model structure was satisfactory by a Comparative Fit Index of 0.943, Tucker–Lewis index of 0.938, and root mean square error of approximation of 0.028. Conclusions A 45-item ROS-style PROM designed to capture chronic disease symptoms was developed, and preliminary validation suggests that the PSI can be deployed, completed, and helpful to both patients and clinicians.

BackgroundA holistic, personalized approach to medicine can be used to prevent and manage a variety of chronic diseases. However, effectively managing chronic diseases can be difficult due to barriers related to insufficient provider time, staffing, and lack of patient engagement. To address these challenges telehealth strategies are being increasingly adopted, yet few studies have explored how to evaluate the feasibility and implementation success of large-scale holistic telehealth models for chronic disease care. The aim of this study is to assess the feasibility and acceptability of a large-scale holistic telehealth program for the management of chronic diseases. Our study findings can inform the future development and assessment of chronic disease programs delivered through telehealth strategies.MethodsData was collected from participants enrolled in a Parsley Health membership from June 1, 2021 to June 1, 2022, a subscription-based holistic medicine practice designed to help people prevent or manage chronic diseases. Implementation outcome frameworks were used to understand engagement with services, participant satisfaction, and preliminary effectiveness of the program via a patient-reported symptom severity tool.ResultsData from 10,205 participants with a range of chronic diseases were included in our analysis. Participants averaged 4.8 visits with their clinical team and reported high levels of satisfaction with their care (average NPS score of 81.35%). Preliminary evidence also showed substantial reduction in patient reported symptom severity.ConclusionOur findings suggest the Parsley Health program is a feasible and acceptable large-scale holistic telehealth program for chronic disease care. Successful implementation was due, in part, to services that promoted participant engagement along with tools and interfaces that were helpful and easy to use. These findings can be used to develop future holistic-focused telehealth programs for the management and prevention of chronic diseases.

Background Electronic patient-reported outcomes measures (e-PROMs) are a valuable tool for the monitoring and management of chronic conditions over time. However, there are few validated tools available that capture symptoms across body systems in telehealth settings. The Parsley Symptom Index (PSI) is a recently developed symptom assessment for adults with chronic disease in telehealth settings. A previous study demonstrated the feasibility and acceptability of the PSI in a clinical telehealth setting. Objective The purpose of this study was to assess convergent validity between the PSI and the self-rated health (SRH) item. Methods This prospective cohort study took place from January 15, 2021, to December 15, 2021, among a sample of 10,519 adult patients at Parsley Health, a subscription-based holistic medical practice. The PSI and the SRH were completed by patients via an online portal. The association between the PSI and SRH was assessed via polyserial and polychoric correlations, while weighted κ scores provided information related to agreement between the PSI and SRH. Results From 22,748 responses, there were moderate levels of association (polyserial r=0.51; polychoric r=0.52) and agreement (weighted κ=0.46) between the PSI and SRH. In total, 74.13% (n=16,865) of responses between the PSI and SRH were relatively congruent while 36.17% (n=8229) were literally congruent. Conclusions The PSI demonstrates convergent validity with the SRH for adults with chronic disease in a telehealth setting. This finding further supports the validation of the PSI in a real-world clinical setting. Although it is conceptually similar to the 1-question SRH, the PSI is a 45-item PROM designed to capture quality of life and specific symptoms by body system. Future studies will compare the PSI to multi-item PROMs.

BACKGROUND The Parsley Symptom Index (PSI) is a recently developed symptom assessment for adults with chronic disease in telehealth settings. OBJECTIVE The purpose of this study was to validate the PSI against the Self-Rated Health (SRH) item. METHODS This prospective cohort study took place from January 15, 2021 to December 15, 2021 among a sample of 10,519 adult patients at Parsley Health, a subscription based holistic medical practice. The PSI and the SRH were completed by patients via an online portal. The association between the PSI and SRH was assessed via polyserial and polychoric correlations, while weighted kappa scores provided information related to agreement between the PSI and SRH. RESULTS From 22,748 responses, there were moderate levels of association (polyserial r=0.51; polychoric r=0.52) and agreement (weighted ???? = 0.46) between the PSI and SRH. In total 74.2% (16865) of responses between the PSI and SRH were relatively congruent while 36.2% (8229) were literally congruent. CONCLUSIONS The PSI demonstrates validity with the SRH for adults with chronic disease in a telehealth setting.

Background / PurposeThe Parsley Symptom Index (PSI) is a recently developed symptom assessment for adults with chronic disease in telehealth settings. The purpose of this study was to validate the PSI against the Self-Rated Health (SRH) item.Materials and MethodsThis prospective cohort study took place from January 15, 2021 to December 15, 2021 among a sample of 10,519 adult patients at Parsley Health, a subscription based holistic medical practice. The PSI and the SRH were completed by patients via an online portal. The association between the PSI and SRH was assessed via polyserial and polychoric correlations, while weighted kappa scores provided information related to agreement between the PSI and SRH.ResultsFrom 22,748 responses, there were moderate levels of association (polyserial r=0.51; polychoric r=0.52) and agreement (weighted □ = 0.46) between the PSI and SRH. In total 74.2% (16865) of responses between the PSI and SRH were relatively congruent while 36.2% (8229) were literally congruent.ConclusionsThe PSI demonstrates validity with the SRH for adults with chronic disease in a telehealth setting.