Implementing routine patient-reported outcome collection in a large, academic health system.

7053 Background: Patients' symptoms and side effects have traditionally been assessed by clinicians. There is increasing evidence that patient self-reported symptom severity often differs from clinician assessment, and that collecting patient-reported outcomes (PRO) can improve communication, symptom management, and even survival. However, the implementation of routine PRO collection across a large healthcare system poses operational and informatics challenges. Methods: Using native electronic health record (EHR) functionality, we implemented a standardized PRO questionnaire across a large academic cancer center and associated community-based practices. The questionnaire is based on the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) developed by the National Cancer Institute. It assesses eleven common side effects of cancer care and is available for completion from home via the EHR patient portal or in clinic via tablet PC. Implementation was stepwise, beginning with a disease-specific patient population in the main academic cancer center and expanding over two years to include all cancer types, three specialties (radiation oncology, hematology/oncology, gynecologic oncology), and multiple satellite practice locations. Results: PRO collection was initiated for patients with gastrointestinal malignancies in two clinic locations at the main cancer center in 12/2017. During the first 3 months of implementation (12/2017-2/2018), questionnaires were completed for 1838 (56.3%) of 3267 eligible patient visits. Work with practice managers and staff to refine operational workflows led to improvement to a 75.6% capture rate for the period 3/2018 – 5/2018. From 6/2018 through 6/2019, the program was expanded to all multidisciplinary clinics in the main cancer center, as well as eight satellite practices. Aggregate capture rates from 7/2018 through 12/2019 have shown sustained performance, with 101,082 (76.7%) of 131,720 eligible visits captured. Of twelve total clinics participating, eleven have sustained capture rates above 70%, and nine capture over 80% of eligible visits. Questionnaires were completed through the online patient portal 12.1% of the time, with the remainder completed in clinic via tablet PC. Conclusions: Routine PRO collection as standard-of-care is possible across a variety of practice environments in a large, complex health system, with sustained capture of approximately three-fourths of eligible visits. Most patients prefer to complete the questionnaire in clinic.