Implementation of Electronic Patient-Reported Outcomes in Routine Cancer Care at an Academic Center: Identifying Opportunities and Challenges

2020 ◽  
Vol 16 (11) ◽  
pp. e1255-e1263
Author(s):  
Sahil Sandhu ◽  
Zoe King ◽  
Michelle Wong ◽  
Sean Bissell ◽  
Jessica Sperling ◽  
...  
Keyword(s):  
Cancer Care ◽  
Patient Reported Outcomes ◽  
Medical Center ◽  
Clinical Care ◽  
Qualitative Interviews ◽  
Academic Medical Center ◽  
Implementation Strategies ◽  
Ease Of Use ◽  
Validity And Reliability ◽  
Patient Reported

PURPOSE: Electronic patient-reported outcomes (ePROs) can help clinicians proactively assess and manage their patients’ symptoms. Despite known benefits, there is limited adoption of ePROs into routine clinical care as a result of workflow and technologic challenges. This study identifies oncologists’ perspectives on factors that affect integration of ePROs into clinical workflows. METHODS: We conducted semistructured qualitative interviews with 16 oncologists from a large academic medical center, across diverse subspecialties and cancer types. Oncologists were asked how they currently use or could imagine using ePROs before, during, and after a patient visit. We used an inductive approach to thematically analyze these qualitative data. RESULTS: Results were categorized into the following three main themes: (1) selection and development of ePRO tool, (2) contextual drivers of adoption, and (3) patient-facing concerns. Respondents preferred diagnosis-based ePRO tools over more general symptom screeners. Although they noted information overload as a potential barrier, respondents described strong data visualization and ease of use as facilitators. Contextual drivers of oncologist adoption include identifying target early adopters, incentivizing uptake through use of ePRO data to support billing and documentation, and emphasizing benefits for patient care and efficiency. Respondents also indicated the need to focus on patient-facing issues, such as patient response rate, timing of survey distribution, and validity and reliability of responses. DISCUSSION: Respondents identified several barriers and facilitators to successful uptake of ePROs. Understanding oncologists’ perspectives is essential to inform both practice-level implementation strategies and policy-level decisions to include ePROs in alternative payment models for cancer care.

scholarly journals Clinicians’ knowledge and attitudes towards patient reported outcomes in colorectal cancer care – insights from qualitative interviews

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nora Tabea Sibert ◽  
Christoph Kowalski ◽  
Holger Pfaff ◽  
Simone Wesselmann ◽  
Clara Breidenbach
Keyword(s):  
Colorectal Cancer ◽  
Cancer Care ◽  
Patient Reported Outcomes ◽  
Qualitative Content Analysis ◽  
Qualitative Interviews ◽  
Implementation Strategies ◽  
Clinical Staff ◽  
Successful Implementation ◽  
Patient Reported ◽  
Clinical Benefits

Abstract Introduction Patient-reported outcomes (PROs) can be used in cancer care to monitor patients’ disease-related symptoms and functional status. However, successful implementation of such instruments is only possible if clinical staff are convinced of the clinical benefits. It is therefore crucial to investigate the attitudes of clinical staff to PROs in routine cancer care. Methods Semi-structured, guideline-based interviews were held with 12 clinicians working in certified colorectal cancer centers in Germany who are taking part in an observational study on PROs (five surgeons, two oncologists, one psycho-oncologist, two oncological care nurses, one stoma therapist, and one physician assistant) in order to investigate firstly, how clinicians describe PRO instruments (“wording”); and secondly, the clinicians’ general attitude toward PROs. A qualitative content analysis according to Kuckartz was performed. Results The wording used to describe PROs was not consistent. Statements on attitudes toward PROs were very heterogeneous and were therefore categorized into “(rather) positive” and “(rather) negative.” The principal advantages of PROs mentioned by participants included broader, structured knowledge about patients and treatment, as well as relevance for patients. Subcategories for (rather) negative attitudes included statements expressing doubts about the questionnaires and “no need for PROs.” Discussion The clinicians participating mainly expressed fairly positive attitudes toward PROs. However, they had little knowledge about PROs in general and the interviews therefore mainly reflect their expectations and assumptions about them. These initial impressions may be regarded as providing a basis for future implementation strategies and for training of clinicians on how to use PROs in routine cancer care.

scholarly journals Integration of Patient-reported Outcomes in a Total Joint Arthroplasty Program at a High-volume Academic Medical Center

2020 ◽  
Vol 4 (5) ◽  
pp. e20.00034 ◽  
Author(s):  
Surabhi Bhatt ◽  
Kristina Davis ◽  
David W. Manning ◽  
Cynthia Barnard ◽  
Terrance D. Peabody ◽  
...  
Keyword(s):  
Total Joint Arthroplasty ◽  
Patient Reported Outcomes ◽  
Medical Center ◽  
Academic Medical Center ◽  
High Volume ◽  
Joint Arthroplasty ◽  
Academic Medical ◽  
Patient Reported

Improving Cancer Care Through the Patient Experience: How to Use Patient-Reported Outcomes in Clinical Practice

2017 ◽  
pp. 695-704 ◽  
Author(s):  
Kathi Mooney ◽  
Donna L. Berry ◽  
Meagan Whisenant ◽  
Daniel Sjoberg
Keyword(s):  
Patient Experience ◽  
Cancer Care ◽  
Patient Reported Outcomes ◽  
Clinical Care ◽  
Population Data ◽  
Population Level ◽  
Clinical Work ◽  
Aggregated Data ◽  
Individual Level ◽  
Patient Reported

Poorly controlled symptoms are common and debilitating during cancer treatment and can affect functional status and quality of life, health care resource utilization, treatment adherence, and cancer survivorship. Historically, the patient experience, including symptoms during treatment, has not been tracked or documented in the patient health record. Measurement of patient-reported outcomes (PROs), including symptoms, is an essential component to cancer care focused on the illness impact to the patient and family. PROs can be useful at the individual level for monitoring and promoting symptom care both in the clinic and remotely and at the population level for aggregating population data for use in research and quality improvement initiatives. Implementation of PROs in cancer clinical care requires a carefully thought out process to overcome challenges related to integrating PROs into existing electronic health records and clinical work flow. Issues with implementing PRO collection may include making decisions about measurement tools, modes of delivery, frequency of measurement, and interpretation that are guided by a clarification of the purpose for collecting PROs. We focus on three aspects of PRO use: (1) improving care for individual patients, (2) analyzing aggregated data to improve care and outcomes overall, and (3) considerations in implementing PRO collection.

scholarly journals AO Patient Outcomes Center: Design, Implementation, and Evaluation of a Software Application for the Collection of Patient-Reported Outcome Measures in Orthopedic Outpatient Clinics (Preprint)

2018 ◽  
Author(s):  
Nan E Rothrock ◽  
Michael Bass ◽  
Andrea Blumenthal ◽  
Richard C Gershon ◽  
Beate Hanson ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
User Satisfaction ◽  
Patient Reported Outcomes ◽  
Clinical Care ◽  
Patient Reported Outcome ◽  
Ease Of Use ◽  
Measurement Information ◽  
Web Based ◽  
Software Application ◽  
Patient Reported

BACKGROUND Patient-reported outcomes are increasingly utilized in routine orthopedic clinical care. Computer adaptive tests (CATs) from the Patient-Reported Outcomes Measurement Information System (PROMIS) offer a brief and precise assessment that is well suited for collection within busy clinical environments. However, software apps that support the administration and scoring of CATs, provide immediate access to patient-reported outcome (PRO) scores, and minimize clinician burden are not widely available. OBJECTIVE Our objective was to design, implement, and test the feasibility and usability of a Web-based system for collecting CATs in orthopedic clinics. METHODS AO Patient Outcomes Center (AOPOC) was subjected to 2 rounds of testing. Alpha testing was conducted in 3 orthopedic clinics to evaluate ease of use and feasibility of integration in clinics. Patients completed an assessment of PROMIS CATs and a usability survey. Clinicians participated in a brief semistructured interview. Beta-phase testing evaluated system performance through load testing and usability of the updated version of AOPOC. In both rounds of testing, user satisfaction, bugs, change requests, and performance of PROMIS CATs were captured. RESULTS Patient feedback supported the ease of use in completing an assessment in AOPOC. Across both phases of testing, clinicians rated AOPOC as easy to use but noted difficulties in integrating a Web-based software application within their clinics. PROMIS CATs performed well; the default assessment of 2 CATs was completed quickly (mean 9.5 items) with a satisfactory range of measurement. CONCLUSION AOPOC was demonstrated to be an easy-to-learn and easy-to-use software application for patients and clinicians that can be integrated into orthopedic clinical care. The workflow disruption in integrating any type of PRO collection must be addressed if patients’ voices are to be better integrated in clinical care.

scholarly journals Implementation of a cloud-based electronic patient-reported outcome (ePRO) platform in patients with advanced cancer

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Olga Generalova ◽  
Mohana Roy ◽  
Evan Hall ◽  
Sumit A. Shah ◽  
Kristen Cunanan ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Supportive Care ◽  
Healthcare Utilization ◽  
Advanced Cancer ◽  
Data Privacy ◽  
Medical Center ◽  
Academic Medical Center ◽  
Ease Of Use ◽  
Cancer Center ◽  
Patient Reported

Abstract Background Patient reported outcomes (PROs) have been associated with improved symptom management and quality of life in patients with cancer. However, the implementation of PROs in an academic clinical practice has not been thoroughly described. Here we report on the execution, feasibility and healthcare utilization outcomes of an electronic PRO (ePRO) application for cancer patients at an academic medical center. Methods We conducted a randomized trial comparing an experimental ePRO arm to standard of care in patients with advanced cancer in the thoracic, gastrointestinal, and genitourinary oncology groups at Stanford Cancer Center from March 2018 to November 2019. We describe the pre-implementation, implementation, and post-implementation phases of the ePRO arm, technological barriers, electronic health record (EHR) integration, clinician burden, and patient data privacy and security. Feasibility was pre-specified to be at least 70% completion of all questionnaires. Acceptability was based on patient and clinician feedback. Ambulatory healthcare utilization was assessed by reviewing numbers of phone messages, electronic portal messages, and referrals for supportive care. Results Of 617 ePRO questionnaires sent to 72 patients, 445 (72%) were completed. Most clinicians (87.5%) and patients (93%) felt neutral or positive about the ePRO tool’s ease of use. Exposure to ePRO did not cause a measurable change in ambulatory healthcare utilization, with a median of less than two phone messages and supportive care referrals, and 5–6 portal messages. Conclusions Web-based ePRO tools for patients with advanced cancer are feasible and acceptable without increasing clinical burden. Key lessons include the importance of pilot testing, engagement of stakeholders at all levels, and the need for customization by disease group. Future directions for this work include completion of EHR integration, expansion to other centers, and development of integrated workflows for routine clinical practice.

Preoperative Expectations of Patients Undergoing Knee Surgery

2019 ◽  
Author(s):  
Kali N. Stevens ◽  
Vidushan Nadarajah ◽  
Julio J. Jauregui ◽  
Xuyang Song ◽  
Shaun H. Medina ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Medical Center ◽  
Academic Medical Center ◽  
Well Being ◽  
Knee Surgery ◽  
Measurement Information ◽  
Patient Reported ◽  
Preoperative Expectations ◽  
The Relationship ◽  
Preoperative Patient

AbstractThere is limited validated data regarding the relationship between preoperative expectations and patient-reported outcomes (PROs) in patients undergoing knee surgery. The purpose of this study was to (1) assess the preoperative expectations of patients undergoing knee surgery and (2) determine the relationship between preoperative patient demographics, PROs, and preoperative patient expectations. We hypothesized that younger patients with worse function and worse general health status would have greater expectations of knee surgery. We analyzed data from 399 patients undergoing knee surgery at an urban academic medical center. We utilized the Musculoskeletal Outcomes Data Evaluation and Management System to measure preoperative expectations. Multiple legacy PRO measures were recorded, as well as the new Patient-Reported Outcomes Measurement Information Systems (PROMIS) Computer Adaptive Testing. Nonparametric statistical analyses were performed to determine significance. Overall, patients undergoing knee surgery had high expectations, with a mean of 88.0 (95% confidence interval [CI], 86.7–89.3) and median of 91.7 (95% CI, 89.2–94.3). Greater preoperative expectations of knee surgery were associated with higher income, surgically naïve knee, lower Charlson Comorbidity Index, better PROMIS Depression and Anxiety scores, greater Marx knee activity scores, and lower total body pain (p < 0.05). Preoperative expectations of patients undergoing knee surgery are associated with a history of prior knee surgery, income, general and mental health, activity, and pain. Expectations were also found to be associated with PRO measures of function and psychological well-being. These findings may have implications for patient education and shared decision-making preoperatively. The Level of Evidence for the study is IV.

Methods for alerting clinicians to concerning symptom questionnaire responses during cancer care: Approaches from two randomized trials (STAR, AFT-39 PRO-TECT).

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 158-158
Author(s):  
Angela M. Stover ◽  
Sydney Henson ◽  
Allison Mary Deal ◽  
Carrie Tompkins Stricker ◽  
Karen Joan Hammelef ◽  
...  
Keyword(s):  
High School ◽  
Physical Function ◽  
Advanced Cancer ◽  
Cancer Care ◽  
Randomized Trials ◽  
Care Delivery ◽  
Medical Center ◽  
Academic Medical Center ◽  
Clinical Decision ◽  
Patient Reported

158 Background: There is limited research on methods for alerting clinicians to concerning patient-reported outcome (PRO) responses and how often PROs trigger alerts to nurses during cancer care. Methods: In two randomized trials, adults with advanced cancer receiving chemotherapy were enrolled. Participants were randomized to usual care vs. weekly PROs completed between visits (with automated feedback to nurses). PRO responses in the intervention arm triggered automated email alerts to nurses for frequent, severe, or worsening symptoms in the last 7 days. Alert thresholds for PROs were chosen a priori but were unique to each study. The “Symptom Tracking and Reporting” (STAR) trial was conducted at one academic medical center. The “PROs to Enhance Cancer Treatment” (PRO-TECT [AFT-39]) cluster-randomized trial is being conducted in > 30 community practices. Results: In STAR, 766 patients participated (58% female, 38% ages ≥65, 17% minority, 28% ≤high school). 441 participants were randomized to the intervention arm, where 1,431/84,212 items (2%) triggered a concerning symptom alert, during 1,070/8,498 weeks (13%). Frequent alerts were for fatigue (62%), pain (32%), and appetite (16%). In PRO-TECT (AFT-39), 300 patients have been enrolled (58% female, 49% ages ≥65, 8% minority, 47% ≤high school) out of 1,000. 146 participants have been randomized to the intervention arm, where 1,422/24,739 items (6%) triggered an alert, during 824/2249 weeks (37%). Common alerts were for pain (48%), physical function (35%), and diarrhea (15%). PRO-TECT provided clinical decision support with alerts. Conclusions: In two randomized trials in advanced cancer, PROs collected during care delivery enabled tailored treatment based on issues identified on PROs. Pain, physical function, appetite, and diarrhea commonly triggered alerts for concerning symptoms. Early PRO-TECT results are showing a trend for higher weekly alert rates for concerning symptoms (37% vs. 13% in STAR), which may indicate that the PRO intervention will be even more effective in community practices. Results assist in addressing logistical considerations for implementing PROs into routine care. Clinical trial information: NCT03249090.

scholarly journals A Comparison of PROMIS Physical Function and Pain Interference Scores in Patients With Carpal Tunnel Syndrome: Research Collection Versus Routine Clinical Collection

Hand ◽  
2019 ◽  
Vol 15 (6) ◽  
pp. 771-775 ◽  
Author(s):  
David N. Bernstein ◽  
Bilal Mahmood ◽  
Constantinos Ketonis ◽  
Warren C. Hammert
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Physical Function ◽  
Carpal Tunnel ◽  
Medical Center ◽  
Clinical Care ◽  
Pearson Correlation ◽  
Academic Medical Center ◽  
Pain Interference ◽  
Patient Reported ◽  
Tunnel Syndrome

Background: There is a concern that patients may answer patient-reported outcome (PRO) questionnaires differently depending on the purpose—clinical care or research (eg, “Hawthorne effect”). We sought to determine whether Patient-Reported Outcomes Management Information System (PROMIS) scores differ at the same clinic visit based on whether a patient was completing the PRO tool for study or clinical care purposes. Methods: Patients presenting to one surgeon at an academic medical center hand clinic were asked to complete PROMIS Physical Function (PF) and Pain Interference (PI) questionnaires as part of routine care. Those diagnosed with carpal tunnel syndrome from February 2015 to April 2017 were then asked to participate in a clinical research project, which had them complete PROMIS PF and PROMIS PI again. Data from those who completed both routine and research PROs at each visit were compared. Between the 2 settings, test-retest reliability was determined using Pearson correlation coefficients ( r), and internal consistency was evaluated using Cronbach α. Results: A total of 128 unique office visits representing 67 patients fit our inclusion criteria. There was a strong correlation between PROMIS PF and PI in the research and patient care setting (PF: r = 0.82, P < .01; PI: r = 0.83, P < .01). Both domains had a Cronbach α of 0.90. The PROMIS PF scores were not different between the 2 groups ( P = .19), but the PROMIS PI scores were slightly different ( P < .01). Conclusions: Patients appear to be consistent when completing PROMIS for both clinical care and research, supporting the idea that data obtained in either setting are generalizable and appropriate for research purposes.

scholarly journals Implementation analysis of patient reported outcomes (PROs) in oncological routine care: an observational study protocol

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Mirja Gianna Görlach ◽  
Theresa Schrage ◽  
Carsten Bokemeyer ◽  
Nicolaus Kröger ◽  
Volkmar Müller ◽  
...  
Keyword(s):  
Observational Study ◽  
Patient Care ◽  
Cancer Care ◽  
Medical Staff ◽  
Patient Reported Outcomes ◽  
Implementation Strategies ◽  
Implementation Process ◽  
Routine Care ◽  
Barriers And Facilitators ◽  
Patient Reported

Abstract Background The successful implementation of patient-reported outcomes (PROs) in clinical routine faces many challenges, first and foremost the lack of consideration thereof in the patient care process. The aim of this study will be to first identify relevant barriers and facilitators and then design suitable implementation strategies which will be evaluated to improve the effectiveness of a PRO measure assessment in inpatient and outpatient cancer routine care. Methods During the preparation phase, interviews with oncological patients (N = 28) and medical staff (N = 4) as well as focus groups with medical staff (N = 18) across five different departments caring for cancer patients were conducted. On the basis of these, qualitative content analysis revealed relevant barriers and facilitators for implementation of PROs in cancer care. Subsequently, implementation strategies and a model of implementation were developed. In the study phase, implementation strategies will be evaluated based on nine different implementation outcomes in five different oncological clinics. Evaluation of the implementation process will take place during three months in each clinic and data will be conducted pre, while and post implementation of the PRO measure. Therefore a sample size of 60 participants of whom 30 staff members and 30 participants will be questioned using existing and newly developed implementation outcome evaluation instruments. Discussion Key to improving the effectiveness of PRO assessment in the time-critical clinical environment is the utilization of easy-to-use, electronic PRO questionnaires directly linked to patients’ records thereby improving consideration of PROs in patient care. In order to validate the effectiveness of this implementation process further, an evaluation parallel to implementation following an observational study design with a mixed-methods approach will be conducted. This study could contribute to the development of adequate evaluation processes of implementation of PROs to foster sustainable integration of PRO measures into routine cancer care. Trial registration This study was registered at Open Science Framework (https://osf.io/y7xce/).

Influence of Standardized Orientation on Patient Perception of Perioperative Care following Alveolar Cleft Repair: A Survey Based Study of Patients Treated in a Large Academic Medical Center

2017 ◽  
Vol 54 (3) ◽  
pp. 287-294 ◽  
Author(s):  
Brian L. Chang ◽  
Anthony J. Wilson ◽  
Bianca C. Chin ◽  
Christopher Friedman ◽  
Oksana A. Jackson
Keyword(s):  
Bone Grafting ◽  
Patient Reported Outcomes ◽  
Patient Adherence ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Iliac Bone ◽  
Care Hospital ◽  
Alveolar Cleft ◽  
Patient Reported

Objective This study aims to better understand patient-reported outcomes for iliac bone grafting surgery for alveolar cleft repair and to determine how standardizing perioperative patient instruction affects patient-reported outcomes. Design Retrospective survey-based assessment of patients undergoing iliac bone grafting with and without hospital-based systems standardization. Setting Academic tertiary care hospital. Patients Of the 195 identified patients, 127 participated. Interventions Survey on pain and satisfaction regarding iliac bone grafting surgery. Main Outcome Measures Survey answers measured patient opinions about the surgery. Answers of the pre- and poststandardization patients were compared to determine the effect of standardizing patient instructions. Results Patients rated their satisfaction with the surgery and recovery a 4.5 and 4.4 out of 5, respectively. They rated their overall pain in the hospital a 5.5 out of 10 (4.9 in the mouth, 5.7 in the hip). Patients were discharged an average of 1.2 days after surgery and could return to normal daily activity in 6.1 days. Poststandardization patients were more likely to adhere to instructions regarding use of an antibacterial mouthrinse and a protective oral splint. Conclusions Patients were highly satisfied with the iliac bone grafting procedure and the recovery and reported only moderate levels of postoperative pain. Implementing standardized patient instructions may not affect patient satisfaction or pain severity, but it significantly increased patient adherence to physician instructions.

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