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Open Access
CC BY 4.0 · ACI open 2024; 08(02): e79-e88
DOI: 10.1055/a-2461-3027
Research Article
Special Section on Patient-Reported Outcomes and Informatics

Stakeholder Perspectives on the Meaningful Integration of Clinical Informatics Interventions Using Patient-Reported Outcomes in Healthcare

Autoren

  • David Russell

    1   Department of Sociology, Appalachian State University, Boone, North Carolina, United States

  • Yashika Sharma

    2   Columbia University School of Nursing, New York, New York, United States

  • Andrew P. Ambrosy

    3   Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, California, United States

  • Kelly Axsom

    4   Columbia University Vagelos College of Physicians and Surgeons, New York, New York, United States

  • Janejira J. Chaiyasit

    5   University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom

  • Margaret O. Cuomo

    4   Columbia University Vagelos College of Physicians and Surgeons, New York, New York, United States

  • Christi Deaton

    4   Columbia University Vagelos College of Physicians and Surgeons, New York, New York, United States
    5   University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom

  • Anne J. Goldberg

    2   Columbia University School of Nursing, New York, New York, United States

  • Parag Goyal

    6   Weill Cornell Medicine, New York, New York, United States

  • Angel Guan

    2   Columbia University School of Nursing, New York, New York, United States

  • Fernanda C. G. Polubriaginof

    7   Memorial Sloan Kettering Cancer Center, New York, New York, United States

  • Lucy McGurk

    1   Department of Sociology, Appalachian State University, Boone, North Carolina, United States

  • Alexander T. Sandhu

    8   Division of Cardiology and Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California, United States

  • John A. Spertus

    9   University of Missouri - Kansas City's Healthcare Institute for Innovations in Quality and Saint Luke's Mid America Health Institute, Kansas City, Missouri, United States

  • Meghan Reading Turchioe

    2   Columbia University School of Nursing, New York, New York, United States

  • David K. Vawdrey

    10   Geisinger, Danville, Pennsylvania, United States

  • Ruth Masterson Creber

    2   Columbia University School of Nursing, New York, New York, United States

Funding We acknowledge that this work has been funded by R01HL161458 (PI: Masterson Creber).
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Abstract

Background Patient-reported outcomes (PROs) capture where patients are on their disease trajectory and can identify changes in health status from their perspective.

Objectives This study applied the equity and sustainability-informed RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance) to gain insights into clinical informatics interventions for collection and use of PROs across health systems.

Methods A total of 14 health informatics and clinical professionals were interviewed about the development and use of PROs within their health systems and individual practices. Directed content analysis was performed to highlight patterns, similarities, and differences in stakeholder perspectives across RE-AIM domains.

Results The reach of clinical informatics interventions using PROs varied across clinical practices and settings based upon institutional commitment and support, integration of clinical information systems, and engagement with patients and families. Although interventions using PROs were viewed as effective for enabling focused conversations with patients and facilitating shared decision-making, barriers to adoption included licensing requirements associated with PRO instruments, lack of incentives for their use, limited integration of PRO results into electronic medical record systems, and poor support for patients with low technology and/or health literacy. Implementation of interventions using PROs was facilitated through training and support staff who aided clinicians with clinical workflow integration, availability of questionnaires in multiple languages, identifying thresholds and strategies for action, and presenting interpretable visualizations showing changes over time alongside significant clinical events. Maintenance of interventions using PROs was enabled through multimodal data collection approaches and data governance groups that evaluated organizational requests to track new measures.

Conclusion Initiatives to increase the reach of clinical informatics interventions using PROs will require health system investments into medical record system integration, education, and implementation support for clinicians and patients, and efforts to reach patient populations with language barriers or limited technology literacy.

Keywords

patient-reported outcomes - qualitative - RE-AIM - equity - sustainability

Protection of Human and Animal Subjects

This qualitative interview study of health informatics and medical professionals about factors for their use of patient-reported outcome measures was determined to pose no more than minimal risk to subjects by the Institutional Review Board at Columbia University (Protocol#AAAU9136).


Supplementary Material



Publikationsverlauf

Eingereicht: 28. März 2024

Angenommen: 10. September 2024

Artikel online veröffentlicht:
17. Dezember 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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