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BACKGROUND Despite acceptability and efficacy of patient reported outcome (PRO) electronic systems, implementation in routine clinical care remains challenging. OBJECTIVE This pragmatic trial implemented the PROMPT-Care web-based system into existing clinical workflows and evaluating its effectiveness among a diverse cancer patient population. METHODS Participants were adult patients with solid tumours receiving active treatment or follow-up care in four cancer centers. The PROMPT-Care intervention supported patient management through a) monthly off-site electronic PRO (ePRO) physical symptom and psychosocial wellbeing assessments, b) automated electronic clinical alerts notifying the care team of unresolved clinical issues following two consecutive assessments, and c) tailored online patient self-management resources. Controls comprised the general cancer patient population (n=1911) seen at participating hospitals during the study period. The primary outcome was reduction in emergency department (ED) presentations. Secondary outcomes were time on chemotherapy and allied health service (AHS) referrals. RESULTS From April 2016-October 2018, 329 patients from four public hospitals received the intervention. Intention-to-treat analysis showed no significant between-group difference in ED presentations (p=0.961). In sub-group analyses, younger patients using PROMPT-Care as intended (completed ≥4 monthly ePROs over 6 months) had significantly fewer ED presentations (p=0.0037) than younger controls. Intervention patients with stage 0/1 disease (RR=5.54; p<0.0001) or in follow-up care (RR=3.42; p<0.0001) had more AHS referrals compared to controls. The majority of clinical feedback reports were reviewed by nursing staff (82%; 729/893), largely in response to the automated clinical alerts (n=877). CONCLUSIONS This study did not demonstrate a significant effect on the primary outcome. However, the results of the sub-group analyses are important for informing future implementation and which patients are likely to benefit most from such an intervention. This study also highlighted the importance of automated triggers for reviewing above-threshold patient reports, rather than passive manual access in patient records; and the instrumental role nurses play in managing alerts. Together these factors will inform the integration of ePRO systems into future models of routine cancer care. CLINICALTRIAL The study is registered with the Australian New Zealand Clinical Trials Registry with registration number ACTRN12616000615482. INTERNATIONAL REGISTERED REPORT RR2-https://doi.org/10.1186/s12885-018-4729-3
BACKGROUND Despite acceptability and efficacy of patient reported outcome (PRO) electronic systems, implementation in routine clinical care remains challenging. OBJECTIVE This pragmatic trial implemented the PROMPT-Care web-based system into existing clinical workflows and evaluating its effectiveness among a diverse cancer patient population. METHODS Participants were adult patients with solid tumours receiving active treatment or follow-up care in four cancer centers. The PROMPT-Care intervention supported patient management through a) monthly off-site electronic PRO (ePRO) physical symptom and psychosocial wellbeing assessments, b) automated electronic clinical alerts notifying the care team of unresolved clinical issues following two consecutive assessments, and c) tailored online patient self-management resources. Controls comprised the general cancer patient population (n=1911) seen at participating hospitals during the study period. The primary outcome was reduction in emergency department (ED) presentations. Secondary outcomes were time on chemotherapy and allied health service (AHS) referrals. RESULTS From April 2016-October 2018, 329 patients from four public hospitals received the intervention. Intention-to-treat analysis showed no significant between-group difference in ED presentations (p=0.961). In sub-group analyses, younger patients using PROMPT-Care as intended (completed ≥4 monthly ePROs over 6 months) had significantly fewer ED presentations (p=0.0037) than younger controls. Intervention patients with stage 0/1 disease (RR=5.54; p<0.0001) or in follow-up care (RR=3.42; p<0.0001) had more AHS referrals compared to controls. The majority of clinical feedback reports were reviewed by nursing staff (82%; 729/893), largely in response to the automated clinical alerts (n=877). CONCLUSIONS This study did not demonstrate a significant effect on the primary outcome. However, the results of the sub-group analyses are important for informing future implementation and which patients are likely to benefit most from such an intervention. This study also highlighted the importance of automated triggers for reviewing above-threshold patient reports, rather than passive manual access in patient records; and the instrumental role nurses play in managing alerts. Together these factors will inform the integration of ePRO systems into future models of routine cancer care. CLINICALTRIAL The study is registered with the Australian New Zealand Clinical Trials Registry with registration number ACTRN12616000615482. INTERNATIONAL REGISTERED REPORT RR2-https://doi.org/10.1186/s12885-018-4729-3
BACKGROUND WalkIT Arizona was a 2x2 factorial trial examining the effects of goal type (adaptive vs. static) and reinforcement (immediate vs. delayed) to increase moderate to vigorous physical activity (MVPA) among insufficiently active adults. The 12-month intervention combined mobile health (mHealth) technology with behavioral strategies to test scalable population-health approaches to increasing MVPA. Self-reported physical activity provided domain-specific information to help contextualize the intervention effects. OBJECTIVE This study reports secondary outcomes of self-reported walking for transportation and leisure over the course of the 12-month WalkIT intervention. METHODS Participants (N=512, 64% women, 19-60 yrs old, 84% Non-Hispanic White, 18% Hispanic) were randomized into goal type and reinforcement type interventions. The IPAQ-long form assessed walking for transportation and leisure at baseline, months 6 and 12 during the intervention. Negative binomial hurdle models examined the effects of goal and reinforcement types on 1) odds of reporting any (versus no) walking and 2) total reported minutes of walking/week, adjusting for neighborhood walkability and socioeconomic status. Separate analyses were conducted for transportation and leisure walking, and with complete cases and using multiple imputation. RESULTS All intervention groups reported increased walking at 12-months relative to baseline. Effects of the intervention differed by domain: a significant three-way goal by reinforcement by time interaction was observed for total minutes of leisure walking/week, whereas time was the only significant factor that contributed to transportation walking. A sensitivity analysis indicated minimal differences between complete case analysis and multiple imputation. CONCLUSIONS This study is the first to report differential effects of adaptive vs. static goals for self-reported walking by domain. Results support the premise that individual level PA-interventions are domain and context-specific and may be helpful in guiding further intervention refinement. CLINICALTRIAL Preregistered at clinicaltrials.gov (NCT02717663). INTERNATIONAL REGISTERED REPORT RR2-10.1016/j.cct.2019.05.001
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