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Personalized symptom management: a quality improvement collaborative for implementation of patient reported outcomes (PROs) in 'real-world' oncology multisite practices.
- Source :
- Journal of Patient-Reported Outcomes; 6/17/2020, Vol. 4 Issue 1, p1-13, 13p
- Publication Year :
- 2020
-
Abstract
- Background: Little research has focused on implementation of electronic Patient Reported Outcomes (e-PROs) for meaningful use in patient management in 'real-world' oncology practices. Our quality improvement collaborative used multi-faceted implementation strategies including audit and feedback, disease-site champions and practice coaching, core training of clinicians in a person-centered clinical method for use of e-PROs in shared treatment planning and patient activation, ongoing educational outreach and shared collaborative learnings to facilitate integration of e-PROs data in multi-sites in Ontario and Quebec, Canada for personalized management of generic and targeted symptoms of pain, fatigue, and emotional distress (depression, anxiety). Patients and methods: We used a mixed-methods (qualitative and quantitative data) program evaluation design to assess process/implementation outcomes including e-PROs completion rates, acceptability/use from the perspective of patients/clinicians, and patient experience (surveys, qualitative focus groups). We secondarily explored impact on symptom severity, patient activation and healthcare utilization (Ontario sites only) comparing a pre/post population cohort not exposed/exposed to our implementation intervention using Mann Whitney U tests. We hypothesized that the iPEHOC intervention would result in a reduction in symptom severity, healthcare utilization, and higher patient activation. We also identified key implementation strategies that sites perceived as most valuable to uptake and any barriers. Results: Over 6000 patients completed e-PROs, with sites reaching 51%–95% population completion rates depending on initial readiness. e-PROs were acceptable to patients for communicating symptoms (76%) and by clinicians for treatment planning (80%). Patient experience was better than the provincial average. Compared to the pre-population, we observed a significant reduction in levels of anxiety (p = 0.008), higher levels of patient activation (p = 0.045), and reduced hospitalization rates (12.3% not exposed vs 10.1% exposed, p = 0.034). A pre/post population trend towards significance for reduced emergency department visit rates (14.8% not exposed vs 12.8% exposed, p = 0.081) was also noted. Conclusion: This large-scale pragmatic quality improvement project demonstrates the impact of implementation strategies and a collaborative improvement approach on acceptability of using PROs in clinical practice and their potential for reducing anxiety and healthcare utilization; and improving patient experience and patient activation when implemented in 'real-world' multi-site oncology practices. [ABSTRACT FROM AUTHOR]
- Subjects :
- ONCOLOGY
IMPLEMENTATION (Social action programs)
CANCER patients
QUALITY of life
MEDICAL care
EDUCATION of physicians
AUDITING
TEACHING methods
EVALUATION of human services programs
FOCUS groups
RESEARCH methodology
INDIVIDUALIZED medicine
HEALTH outcome assessment
PHYSICIANS' attitudes
MANN Whitney U Test
HUMAN services programs
PATIENTS' attitudes
SEVERITY of illness index
MEDICAL care use
QUALITY assurance
INTERPROFESSIONAL relations
DECISION making
DESCRIPTIVE statistics
MENTAL depression
FATIGUE (Physiology)
ELECTRONIC health records
ANXIETY
PAIN management
PSYCHOLOGICAL distress
CANCER patient medical care
DISEASE management
Subjects
Details
- Language :
- English
- ISSN :
- 25098020
- Volume :
- 4
- Issue :
- 1
- Database :
- Complementary Index
- Journal :
- Journal of Patient-Reported Outcomes
- Publication Type :
- Academic Journal
- Accession number :
- 143819419
- Full Text :
- https://doi.org/10.1186/s41687-020-00212-x