Factors Associated With Increased Collection of Patient-Reported Outcomes Within a Large Health Care System

Sisodia, Rachel; Dankers, Christian; Orav, John; Joseph, Bernard; Meyers, Peter; Wright, Patrick; Amand, David St.; Carmen, Marcela del; Ferris, Tim; Heng, Marilyn; Licurse, Adam; Meyer, Gregg S.; Sequist, Thomas D.

doi:10.1001/jamanetworkopen.2020.2764

Cited by 68 publications

(72 citation statements)

References 9 publications

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“…Patient-related outcome information is a prerequisite for patient centered care, which has increasingly been recognized as an ethical imperative in modern health care [ 7 ]. However, the integration of PROMs into clinical care presents many challenges for health systems [ 8 ], and widespread implementation of routine collection has been limited due to clinician, staff, and patient reluctance, inadequate resources to deal with positive or unexpected results, concerns about how the data will be used, and workflow and technology challenges [ 9 ]. However, effective patient-centered care requires the routine integration of PROMs [ 10 ], and integration of PROMs into the electronic health record (EHR) is fundamental to advancing clinical care by providing quantitative data regarding patient reported patient health status [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Electronic health record–integrated approach for collection of patient-reported outcome measures: a retrospective evaluation

Horn

Reinke

Mather

et al. 2021

BMC Health Serv Res

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Background The integration of Patient Reported Outcome Measures (PROMs) into clinical care presents many challenges for health systems. PROMs provide quantitative data regarding patient-reported health status. However, the most effective model for collecting PROMs has not been established. Therefore the purpose of this study is to report the development and preliminary evaluation of the standardized collection of PROMs within a department of orthopedic surgery at a large academic health center. Methods We utilized the Users’ Guide to Integrating Patient-Reported Outcomes in Electronic Health Records by Gensheimer et al., 2018 as a framework to describe the development of PROMs collection initiative. We framed our initiative by operationalizing the three aspects of PROM collection development: Planning, Selection, and Engagement. Next, we performed a preliminary evaluation of our initiative by assessing the response rate of patients completing PROMs (no. of PROMs completed/no. of PROMs administered) across the entire department (18 clinics), ambulatory clinics only (14 clinics), and hospital-based clinics only (4 clinics). Lastly, we reported on the mean response rates for the top 5 and bottom 5 orthopaedic providers to describe the variability across providers. Results We described the development of a fully-integrated, population health based implementation strategy leveraging the existing resources of our local EHR to maximize clinical utility of PROMs and routine collection. We collected a large volume of PROMs over a 13 month period (n = 10,951) across 18 clinical sites, 7 clinical specialties and over 100 providers. The response rates varied across the department, ranging from 29 to 42%, depending on active status for the portal to the electronic health record (MyChart). The highest single provider mean response rate was 52%, and the lowest provider rate was 13%. Rates were similar between hospital-based (26%) and ambulatory clinics (29%). Conclusions We found that our standardized PROMs collection initiative, informed by Gensheimer et al., achieved scope and scale, but faced challenges in achieving a high response rate commensurate with existing literature. However, most studies reported a targeted recruitment strategy within a narrow clinical population. Further research is needed to elucidate the trade-off between scalability and response rates in PROM collection initiatives.

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Section: Introductionmentioning

confidence: 99%

Electronic health record–integrated approach for collection of patient-reported outcome measures: a retrospective evaluation

Horn

Reinke

Mather

et al. 2021

BMC Health Serv Res

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“…Payer incentives and higher PRO completion rates during the initial month of launch were also associated with improved PRO completion rates. ( 19 )…”

Section: Steps To Pro Integrationmentioning

confidence: 99%

Integrating Patient‐Reported Outcomes Within Routine Hepatology Care: A Prompt to Action

Younossi

2021

Hepatology

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“…In 2014, Mass General Brigham built what would become the largest patient reported outcomes (PRO) program in the world, spanning 10 hospitals, 200 clinics, and more than 75 specialties. 1 Arguably one of the best indices of quality and value in health care, PROs allow us to integrate the patient’s voice into their care, converting it to a quantitative measure to assess whether their condition is improving or worsening. In addition, routine collection and integration of PROs into clinical care has been widely associated with: improved patient outcomes, ranging from improved overall survival in patients with malignancy to better palliative care experiences; the ability to adequately describe postoperative outcomes and set expectations for patients undergoing arthroplasty; identifying and effectively triaging patients with occult depression and anxiety in routine primary care and obstetrics populations, and countless other fields as diverse as rheumatology, neurology, and surgery.…”

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confidence: 99%

“… 12–14 The majority of current programs assign PROMs through the patient portal in the week prior to a clinic visit; on the day of the visit, tablets with PROMS are distributed to any patient who failed to complete them online. 1 , 15–19 It is important to note, however, that historically the majority of patients have not chosen to use the portal to complete PROMs. As an example, prior to the COVID-19 pandemic only 17% of Mass General Brigham’s 10 million PROs were collected using our online patient portal.…”

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confidence: 99%

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Digital disparities: lessons learned from a patient reported outcomes program during the COVID-19 pandemic

Sisodia

Rodriguez

Sequist

2021

Journal of the American Medical Informatics Association

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The collection of patient reported outcomes (PROs) allows us to incorporate the patient’s voice within their care in a quantifiable, validated manner. Large scale collection of PROs is facilitated by the electronic health record (EHR) and its portal, though historically patients have eschewed the portal and completed patient reported outcome measures (PROMS) in clinic via tablet. Furthermore, access to and use of the portal is associated with known racial inequities. Our institution oversees the largest clinical PRO program in the world, and has a long history of racially equitable PRO completion rates via tablet. However, when the COVID-19 pandemic forced us to remove tablets from clinics and rely exclusively on portal use for PRO completion, profound racial disparities resulted immediately. Our experience quantifiably demonstrates the magnitude of inequity that the portal, in its current configuration, generates and serves as a cautionary tale to other health care systems and EHRs.

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Factors Associated With Increased Collection of Patient-Reported Outcomes Within a Large Health Care System

Cited by 68 publications

References 9 publications

Electronic health record–integrated approach for collection of patient-reported outcome measures: a retrospective evaluation

Electronic health record–integrated approach for collection of patient-reported outcome measures: a retrospective evaluation

Integrating Patient‐Reported Outcomes Within Routine Hepatology Care: A Prompt to Action

Digital disparities: lessons learned from a patient reported outcomes program during the COVID-19 pandemic

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