Methods and Uses in Care Settings Roxanne E. Jensen, PhD - - PowerPoint PPT Presentation

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Methods and Uses in Care Settings Roxanne E. Jensen, PhD - - PowerPoint PPT Presentation

Nov 15, 2022 172 likes •432 views

Current PRO Collection Methods and Uses in Care Settings Roxanne E. Jensen, PhD AcademyHealth Annual Research Meeting June 26, 2017 Rapid Adoption in Clinical Care Settings New Methods Item Response Theory Computer Adaptive Testing

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SLIDE 1

Current PRO Collection Methods and Uses in Care Settings

Roxanne E. Jensen, PhD AcademyHealth Annual Research Meeting June 26, 2017

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Rapid Adoption in Clinical Care Settings

  • New Methods

– Item Response Theory – Computer Adaptive Testing

  • New Tools

– Patient-Reported Outcomes Information System (PROMIS)

  • New Technology

– April 3, 2010

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New Technology: The iPad Era (2010)

Before

  • Often Paper
  • Closed Systems
  • High Hardware Costs,

in-house development

  • Patient-Level Use Only

After

  • Electronic
  • Web-Based
  • Lower Costs & Patient

Awareness

  • Clinic & Population-Level

Monitoring

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PRO Use in Clinical Care

  • Individual Care

– Patient fills out a PRO – Scores are reviewed by Clinician – Examples: Depression Screening, Symptom Monitoring during Chemotherapy, Decision Support

  • Clinic-Level Evaluation

– Quality of care evaluation – Quality Improvement – Example: % Screened for Depression

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Data Collection Methods

  • 1. Paper Collection
  • 2. Independent Electronic System
  • 3. Internal Collection within EHR system
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PRO Collection Method #1

  • Paper Collection

– Patient fills out a paper PRO measure

– All scoring is done manually by staff

  • Care Integration

– Discussed in care visit – Uploaded to EHR

  • Scanned Paper Form
  • Manual Data Entry
  • Manual PRO Documentation in the Clinic Note
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Strengths/Weaknesses

  • Best suited for simple screening tasks

– Quick Scoring Screening Measures for Immediate documentation or use. – Quality Evaluations based on screening tasks being performed.

  • May be preferred by some patients
  • Score review and reporting options are

limited

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SLIDE 8

Paper Assessment

MRN:_______

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SLIDE 9

Paper Assessment

MRN:_______

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SLIDE 10

Paper Assessment

MRN:_______

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PRO Collection Method: #2

  • Independent Electronic System

– Stand-alone system – Electronic PRO collection – 3rd party vendor – Developed internally

  • AKA…

– ePRO – Side Car – Wrap Around

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ePRO Care Integration

  • Highly Customizable
  • Visual Formats and Measures
  • Collection Methods (Apps, Web)
  • Staff Management Support and Tools
  • Communication with EHR systems
  • Data pushed to the EHR in real-time
  • Data linked to discrete EHR data fields
  • EHR data pulled to inform assessment
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Strengths/ Weakness

  • Often built with symptom monitoring and

decision support goals.

  • Systems require more steps to log-on,

administer and review content.

  • Data Integration with an EHR system is
  • ften limited

– Difficulty identifying eligible patients – Difficulty pushing information into EHR system

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SLIDE 14

External System: Care Prompter

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Lombardi Electronic Distress Screening Program

  • All new patients

screened in clinic after check-in

  • High scores are:

– Followed up on by a social worker – Available for review in the EHR.

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Integration into EHR

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PRO Collection Method #3

  • Internal Collection within EHR system

– PRO assessment is collected as an integral part of the EHR – Often assessed through a patient portal – Structured data (responses and total score) are accessible

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Strengths/ Weakness

  • Allows for real-time integration of content

for clinical decision-making

  • Easier aggregation of PROs alongside
  • ther standard performance measures
  • PRO content and display options can be

limited.

– Assessment – Score Report and Interpretation

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SLIDE 19

Lurie Screening Initiative

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SLIDE 20

In-Clinic Assessment Using iPads

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Lurie Screening Initiative

  • PROMIS CAT

– Pain – Fatigue – Physical Function – Depression – Anxiety

  • Practical Needs &

Other Concerns:

– Social work needs – Informational needs – Nutritional status Total Length: ~ 40 items (8-10 mins) Frequency: Once every 30 days paired with visit

Pearman et al, 2016; Wagner et al, Cancer, 121(6): 927-934, 2015

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Integration Into Clinical Care

  • Assessment results populated in Epic

– Other Orders tab – .dot phrases for charting

  • Messaging for severe symptoms

– Based on PROMIS T-Score Severe Cut Points. – MD & RN messages when Anxiety > 65 – MD & RN messages when Pain > 70

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Discussion & Conclusion

  • Strengths and Weaknesses of each PRO

system depends on:

– Purpose – Availability – Cost & Expertise Available – Workflow Considerations

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Further Reading:

Snyder C, Wu A (Eds). Users’ Guide to Integrating Patient-Reported Outcomes in Electronic Health

  • Records. Patient-Centered Outcomes Research

Institute, 2017. Available at: https://www.pcori.org/document/users-guide-integrating- patient-reported-outcomes-electronic-health-records