Orientation to the Electronic Patient Reported Outcome (ePRO) Tool: - - PowerPoint PPT Presentation

Orientation to the Electronic Patient Reported Outcome (ePRO) Tool: A look at the tool and the pragmatic trial planned for 2017-2018

Carolyn Steele Gray, PhD Institute for Health Policy Management and Evaluation University of Toronto Lunenfeld-Tanenbaum Research Institute, Sinai Health Systems Walter Wodchis, PhD Institute for Health Policy Management and Evaluation University of Toronto

Webinar hosted by the Association of Family Health Teams of Ontario (AFHTO) June 2nd 2016

Today’s Agenda

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• Project Overview

– CIHR eHIPP funding aims – Project team and partners

• Introducing the ePRO tool

– Development of the tool – Demo

• Trial design

– Project aims/goals/research questions – Site recruitment – Patient recruitment – Data collection – Post-study

CIHR eHealth Innovation Partnership Program

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• Canadian Institute for Health Research invested $13.8 million in

funding for 22 innovative eHealth projects

• Projects aimed at improving patient empowerment and patient-

centered care delivery through adoption of new technologies into health care delivery

• Aim of stimulating collaborations between health researchers with

the technology industry and supporting research teams that include providers, clients and families

• Projects focus on either youth mental health (8) or seniors with

complex care needs at home (14)

• Supporting Goal-Oriented Primary Health Care for Seniors with

Complex Care Needs using Mobile Technology

http://news.morningstar.com/all/canada-news-wire/20160303C4314/government-of-canada-supports-new- ehealth-research-projects-to-empower-patients-and-enable-better-health-care.aspx

Project Team

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Co-Principal Investigators Carolyn Steele Gray, PhD (Bridgepoint & UofT) Walter P Wodchis, PhD (UofT) Ross Upshur, MSc, MD, CCFP, FRCPC (Bridgepoint & UofT) Co-Investigators Cheryl Cott, DipPT, M.Sc., Ph.D. (UofT) Brian McKinstry, MD, FRCPE, FRCGP (UofEdinburgh) Stewart Mercer, PhD, MRCGP, FRCGP (UofGlasgow) Ted Palen, PhD, MD (Kaiser Permanente) Tim Ramsay, PhD (OHRI) Kednapa Thavorn, PhD (OHRI) Collaborators Angie Heydon, Carol Mulder & Catherine Macdonald (AFHTO) Lee Fairclough & Sandie Seaman (HQO) Renee Lyons, PhD (UofT, Emeritus) Technology Partner QoC Health Inc. (Sarah Sharpe) Patient & Caregiver Valerie Hepburn Bob Alexander (previous)

ePRO Project Partners

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All icon images from www.iconfinder.com

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Title image designed by FreePik

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Icon images from www.iconfinder.com Clock icon designed by FreePik

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All icon images from www.iconfinder.com

GOALS

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e/mHealth Enabled Goal-Oriented Care using ePRO tool

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User-centred Design Evaluation Approach

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Phase 1: Needs Assessment Patient focus groups & provider interviews Phase 2: Tool Development Working groups and iterative design Phase 3: Usability Pilot 4 week pilot with 11 patients and 6 providers Phase 4: Exploratory Trial 4 month trial exploring impact and implementation Full Evaluation, Scale and Spread Multi-center pragmatic trial to evaluate impact

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Peer-Reviewed Publications

Needs Assessment Steele Gray C, Miller D, Kuluski K, Cott, C. (2014) Tying eHealth Tools to Patient-Needs: Exploring the Use of eHealth for Community-Dwelling Patients with Complex Chronic Disease and Disability. JMIR Res Protoc, 3(4): e67. doi:10.2196/resprot.3500 http://dx.doi.org/10.2196/resprot.3500. Development Steele Gray C, Khan AI, Kuluski K, McKillop I, Sharpe S, Bierman AS, Lyons R, Cott C. (2016) Improving patient experience and healthcare quality in primary care for patients with complex chronic disease: Adopting qualitative methods into a user- centred design approach to develop the electronic Patient Reported Outcomes (ePRO)

• tool. Journal of Medical Informatics Research Protocols, 5(1), e28. doi:

10.2196/resprot.5204 Usability Pilot (in press) Steele Gray C, Gill A, Khan AI, Hans P, Kuluski K, Cott C. (in press) The electronic Patient Reported Outcome Tool: Testing Usability and Feasibility of a Mobile App and Portal to Support Care for Patients with Complex Chronic Disease and Disability in Primary Care

• Settings. JMIR mHealth uHealth. doi:10.2196/mhealth.5331

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ePRO Video

Check-in point

Any Questions

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ePRO Video

https://epros.bridgepoint.care

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ePRO Video

http://hsprn.ca/?p=189 Videos Long version – covers entire project Short version – covers tool only

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ePRO Video

Check-in point

Any Questions

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Pragmatic Trial Phase

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Phase 1: Needs Assessment Patient focus groups & provider interviews Phase 2: Tool Development Working groups and iterative design Phase 3: Usability Pilot 4 week pilot with 11 patients and 6 providers Phase 4: Exploratory Trial 4 month trial exploring impact and implementation Full Evaluation, Scale and Spread Multi-center pragmatic trial to evaluate impact

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Pragmatic Trial Phase

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Phase 1: Needs Assessment Patient focus groups & provider interviews Phase 2: Tool Development Working groups and iterative design Phase 3: Usability Pilot 4 week pilot with 11 patients and 6 providers Phase 4: Exploratory Trial 4 month trial exploring impact and implementation Full Evaluation, Scale and Spread Multi-center pragmatic trial to evaluate impact

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Steele Gray C, Wodchis W, Upshur R, Cott C, Fairclough L, Haydon A, Kuluski K, McKinstry B, Mercer S, Palen T, Ramsay T, Thavorn K. (in press) Supporting Goal- Oriented Primary Health Care for Seniors with Complex Care Needs using Mobile Technology: Evaluation and implementation

• f the HSPRN-Bridgepoint ePRO Tool.

Research Protocol. Invited paper as part of a Special Issue of JMIR Res Prot. doi:10.2196/resprot.5756

Project Aims

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Evaluate the use, effectiveness, and value for money of the ePRO tool

• 1. Does ePRO improve quality of life, care experience,

and self-management in older adults with complex needs?

• 2. Is ePRO cost-effective for older adults with complex

needs from the perspective of the health care system?

• 3. What are the most important implementation

factors to effectively scale and spread ePRO in primary health care settings?

Trial Design

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Developmental Evaluation

– Evaluation questions are used to support decision-making and modifications to improve interventions and programs [15]

• Cluster randomized pragmatic trial

– Outcomes and cost-effectiveness (RQs 1 & 2)

• Embedded case study

– Implementation (RQ 3)

Project Timeline

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Site Recruitment Patient Recruitment & Training Intervention Final data collection

June – Sept 2016 Oct – Dec 2016 Jan – Dec 2017 Jan – Dec 2018

Site Recruitment

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• Cluster randomized pragmatic trial of Family

Health Teams across Ontario

• 22 sites

– 11 randomly assigned to intervention group – Should vary in terms of geography and

• rganizational structure

– Site leads identified at each site (EDs and/or clinician leads).

• Weekly or bi-weekly communication with research

team

– Readiness assessments conducted to assess readiness to uptake new technology

• 4 selected for case study

Patient recruitment

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• 30 patients recruited at each site

– >/ 65 years – 2+ chronic conditions – 10+ visits in last 12 months (can include home visiting patients) – Ability to use mobile phone OR has a caregiver who can assist

• Expect more than 300 patients from each practice will be

eligible (ie. 10% participation rate)

• Use EMR data to identify eligible patients

– randomly placed on an ordered list until reach required number

• Recruitment will occur:

– During a scheduled visit – By phone within one month of the study start date

• FHT admin staff will provide eligible patients with information

about the study and will share contact information of those interested with the research team.

ePRO Video

Check-in point

Any Questions

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Training and on-boarding (intervention sites)

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• Providers will be trained in a single 30-minute session

at the practice by a member of research staff

• Patients will be trained individually in 30-minute

sessions just prior to on-boarding to the trial

• Handbooks will be provided to both providers and

patients

• Webinar training refreshers will be offered every 3

months for both patients and providers

• Patient on-boarding will be scheduled in a 1-2 week

block (up to 4 weeks maximum) – January 2017

Intervention

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12 months Set-up Final visit Monitoring Follow-up visits (2-3), part of usual care

Pragmatic Trial Measures

• Patients (baseline, 3,6,9,12 months)

– Information sheet (demographics) (baseline only) – Assessment of Quality of Life (AQoL-4D) – Patient Activation Measure (PAM) – Patient experience survey (AFHTO & HQO) – Self-reported health care utilization – Goal-attainment (intervention only) – Post-study system usability questionnaire (PSSUQ) (intervention, not baseline)

• Providers

– Information sheet (demographics) (baseline only) – PSSUQ (intervention only) (3,6,9,12 months)

• Health administrative data

– Health system utilization (Institute for Clinical Evaluative Sciences) – EMR extraction

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Case Site Measures

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• 4 sites, selected on a most-different design
• Capturing process and contextual measures
• Patients

– Focus groups (6 months and post-study)

• Providers

– Interviews, based on Assessment of Chronic Illness Care (6 months and post-study)

• Organizational managers/leaders

– Interviews (6 months and post-study)

• Document analysis

– Capturing additional organizational variables

Total participant sites N=22 Intervention sites (N=11) Per site: 3-5 providers; 30 patients Collect baseline data AQoL-4D, PAM, utilization, self- report, ICES data, demographic information Intervention ePRO tool monitoring (goal attainment & health outcomes) Collect mid-study data All outcome measures at 3, 6 and 9 months & PSSUQ Focus Groups with paitents Interviews with providers Case sites only Collect end study Data All outcome measures & PSSUQ Focus Groups with paitents Interviews with providers Case sites only Control sites (N=11) Per site: 3-5 providers; 30 patients Collect baseline data AQoL-4D, PAM, utilization, self- report, ICES data, demographic information Usual care Collect mid-study data All outcome measures at 3, 6 and 9 months Usual care Collect end study data All outcome measures

Post-study

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• Working with local and international partners we will

develop an implementation and knowledge translation strategy

• If the tool proves effective we will work with AFHTO

and HQO to spread tool locally

– Work with our international network to spread more widely

• Continue to scale tool, adding in features and

functions to improve effectiveness and usability

• Identify new opportunities for eHealth and mHealth

innovation to support primary care delivery to seniors with complex care needs

ePRO Video

Thank you!

csteele@bridgepointhealth.ca walter.wodchis@utoronto.ca

Final Questions

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References

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1. Noël PH, Frueh BC, Larme AC, Pugh JA. Collaborative care needs and preferences of primary care patients with multimorbidity. Health Expect 2005 Mar;8(1):54-63. [doi: 10.1111/j.1369- 7625.2004.00312.x] [Medline: 15713171] 2. Marengoni A, Angleman S, Melis R, Mangialasche F, Karp A, Garmen A, et al. Aging with multimorbidity: a systematic review of the literature. Ageing Res Rev 2011 Sep;10(4):430-439. [doi: 10.1016/j.arr.2011.03.003] [Medline: 21402176] 3. Bayliss EA, Bosworth HB, Noel PH, Wolff JL, Damush TM, Mciver L. Supporting self-management for patients with complex medical needs: recommendations of a working group. Chronic Illn 2007 Jun;3(2):167-175. [doi: 10.1177/1742395307081501] [Medline: 18083671] 4. Canadian Institute for Health Information. Primary Health Care. Seniors and the Health Care System: What Is the Impact of Multiple Chronic Conditions URL: https://www.cihi.ca/en/info_phc_chronic_seniors_en.pdf [accessed 2015-11-06] [WebCite Cache ID 6cqDy149T] 5. Boyd CM, Darer J, Boult C, Fried LP, Boult L, Wu AW. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA 2005 Aug 10;294(6):716-724. [doi: 10.1001/jama.294.6.716] [Medline: 16091574] 6. Upshur Ross E G. Do clinical guidelines still make sense? No. Ann Fam Med 2014;12(3):202-203 [FREE Full text] [doi: 10.1370/afm.1654] [Medline: 24821890] 7. Institute of Medicine (US) Committee on Quality of Health Care in Amercia. Crossing the Quality Chasm: A New Health System for the 21st Century. National Academy of Sciences 2001 Mar:1-8. [Medline: 25057539]

References

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8. Boyd CM, Fortin M. Future of Multimorbidity Research: How Should Understanding of Multimorbidity Inform Health System Design? Public Health Reviews 2010;32(2):451-474 [FREE Full text] [WebCite Cache ID http://www.publichealthreviews.eu/upload/pdf_files/8/PHR_32_2_Boyd.pdf] [WebCite Cache] 9. Upshur C, Weinreb L. A survey of primary care provider attitudes and behaviors regarding treatment of adult depression: what changes after a collaborative care intervention? Prim Care Companion J Clin Psychiatry 2008;10(3):182-186 [FREE Full text] [Medline: 18615167] 10. Sinnott C, McHugh S, Browne J, Bradley C. GPs' perspectives on the management of patients with multimorbidity: systematic review and synthesis of qualitative research. BMJ Open 2013;3(9):e003610 [FREE Full text] [doi: 10.1136/bmjopen-2013-003610] [Medline: 24038011] 11. Reuben DB, Tinetti ME. Goal-oriented patient care--an alternative health outcomes paradigm. N Engl J Med 2012 Mar 1;366(9):777-779. [doi: 10.1056/NEJMp1113631] [Medline: 22375966] 12. Kuluski K, Gill A, Naganathan G, Upshur R, Jaakkimainen RL, Wodchis WP. A qualitative descriptive study on the alignment of care goals between older persons with multi-morbidities, their family physicians and informal caregivers. BMC Fam Pract 2013;14:133 [FREE Full text] [doi: 10.1186/1471-2296-14-133] [Medline: 24010523] 13. Ekdahl AW, Hellström I, Andersson L, Friedrichsen M. Too complex and time-consuming to fit in! Physicians' experiences of elderly patients and their participation in medical decision making: a grounded theory study. BMJ Open 2012;2(3):e001063 [FREE Full text] [doi: 10.1136/bmjopen-2012-001063] 14. Steele Gray C, Khan A, Kuluski K, McKillop I, Sharpe S, Bierman A, et al. Improving Patient Experience and Primary Care Quality for Patients With Complex Chronic Disease Using the Electronic Patient-Reported Outcomes Tool: Adopting Qualitative Methods Into a User-Centered Design Approach. JMIR Res Protoc 2016;5(1):e28 [FREE Full text] [doi: 10.2196/resprot.5204] [Medline: 26892952] 15. Patton M. Utilization-focused evaluation. 2008, Thousand Oaks, CA: Sage.