Domain

Clinical Informatics

Type

Infrastructure/Architecture Overview

Theme

operations

Start Date

7-6-2014 2:55 PM

End Date

7-6-2014 4:15 PM

Structured Abstract

Introduction:

Patients’ perceptions of their health and well-being, collected through patient-reported outcomes (PROs), are increasingly being considered as important outcome measures when evaluating care and overall patient health by clinicians, healthcare researchers, the FDA, and health payers. In addition to health policy- reasons for collecting PROs, there is an interest in using them to aid management in individual patients. There are significant logistical challenges, however, to systematically collecting PROs, including workflow issues, clinician acceptance, and patient and provider burden. We describe a framework for successful implementation of patient-reported outcomes data within clinical care and discuss lessons learned.

Methods:

The Cleveland Clinic Knowledge Program (KP) data collection system is a scalable platform for the collection of data from both patient and provider. Disease-specific questionnaire sets have been developed by clinical experts that include condition-specific PROs and 2 generic measures that allow comparison across patient populations: the European Quality of Life and Patient Health Questionnaire 9 depression scale. Patients complete the web-based questionnaires either in the waiting room using a wireless tablet or at a computer kiosk or at home over a secure internet connection prior to their appointment. The patient responses are immediately available to the provider through a link within the electronic health record.

Findings:

The electronic collection of PROs was first implemented throughout the Neurological Institute (NI) in 2008 and has expanded to include 6 other clinical institutes. The process is fully integrated within the workflow and data is currently collected on over 40,000 patient appointments each month. As of December 2013, over 60 questionnaire sets are in uses that consist of 168 validated scales and an additional 342 individual data elements. Data from KP questionnaires were available from over 1 million clinical encounters. Most patients (73.2%) reported that completing the questionnaires was at least somewhat helpful in relaying information about their condition to their provider. Completion rates for questionnaires in the NI by patients and providers were 77% and 89% respectively, reflecting a high degree of success with this data collection process.

Discussion:

Implementation of PROs within clinical care is feasible in a large hospital system in the ambulatory setting. Several important lessons have been learned. Leadership support is critical. The PROs could be categorized into 3 non-mutually exclusive groups based upon their primary use: outcomes assessment (eg. health-related quality of life), screening (eg. autism screen), and clinical status assessment (eg. pain score, functional status). Questionnaire sets that contained a mixture of these categories have been the most successful. Keys to utilization and acceptance include: integration within the clinical workflow, the ability to easily obtain PRO data for secondary uses, availability of analytic support, and guidance on PRO selection.

Next Steps

Given our experience along with others, and the many potential uses of PRO data for clinical care, quality and research, it is time for the development of national recommendations on how best to collect and integrate PROs within clinical practice. These should include consideration for the different purposes of data collection, technological capabilities, and patient populations.

Acknowledgements

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Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

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Jun 7th, 2:55 PM Jun 7th, 4:15 PM

Collection of Patient-Reported Outcomes in Clinical Practice: Healthcare May Be Ready!

Introduction:

Patients’ perceptions of their health and well-being, collected through patient-reported outcomes (PROs), are increasingly being considered as important outcome measures when evaluating care and overall patient health by clinicians, healthcare researchers, the FDA, and health payers. In addition to health policy- reasons for collecting PROs, there is an interest in using them to aid management in individual patients. There are significant logistical challenges, however, to systematically collecting PROs, including workflow issues, clinician acceptance, and patient and provider burden. We describe a framework for successful implementation of patient-reported outcomes data within clinical care and discuss lessons learned.

Methods:

The Cleveland Clinic Knowledge Program (KP) data collection system is a scalable platform for the collection of data from both patient and provider. Disease-specific questionnaire sets have been developed by clinical experts that include condition-specific PROs and 2 generic measures that allow comparison across patient populations: the European Quality of Life and Patient Health Questionnaire 9 depression scale. Patients complete the web-based questionnaires either in the waiting room using a wireless tablet or at a computer kiosk or at home over a secure internet connection prior to their appointment. The patient responses are immediately available to the provider through a link within the electronic health record.

Findings:

The electronic collection of PROs was first implemented throughout the Neurological Institute (NI) in 2008 and has expanded to include 6 other clinical institutes. The process is fully integrated within the workflow and data is currently collected on over 40,000 patient appointments each month. As of December 2013, over 60 questionnaire sets are in uses that consist of 168 validated scales and an additional 342 individual data elements. Data from KP questionnaires were available from over 1 million clinical encounters. Most patients (73.2%) reported that completing the questionnaires was at least somewhat helpful in relaying information about their condition to their provider. Completion rates for questionnaires in the NI by patients and providers were 77% and 89% respectively, reflecting a high degree of success with this data collection process.

Discussion:

Implementation of PROs within clinical care is feasible in a large hospital system in the ambulatory setting. Several important lessons have been learned. Leadership support is critical. The PROs could be categorized into 3 non-mutually exclusive groups based upon their primary use: outcomes assessment (eg. health-related quality of life), screening (eg. autism screen), and clinical status assessment (eg. pain score, functional status). Questionnaire sets that contained a mixture of these categories have been the most successful. Keys to utilization and acceptance include: integration within the clinical workflow, the ability to easily obtain PRO data for secondary uses, availability of analytic support, and guidance on PRO selection.

Next Steps

Given our experience along with others, and the many potential uses of PRO data for clinical care, quality and research, it is time for the development of national recommendations on how best to collect and integrate PROs within clinical practice. These should include consideration for the different purposes of data collection, technological capabilities, and patient populations.