Integration of Patient-reported Outcomes in a Total Joint Arthroplasty Program at a High-volume Academic Medical Center
Integration of Patient-reported Outcomes in a Total Joint Arthroplasty Program at a High-volume Academic Medical Center
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DOI：
10.5435/jaaosglobal-d-20-00034
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发表时间：
2020-05-01
影响因子：
1.5
通讯作者：
Rothrock, Nan E.
中科院分区：
文献类型：
--
作者：
Bhatt, Surabhi;Davis, Kristina;Rothrock, Nan E.
简介：尽管广泛认识到成功的临床实施的障碍，关于如何操作电子健康记录集成的患者报告的结果（PRO）的文献仍然很少。我们提供了一个详细的摘要实施PRO到标准的护理在一个主要的三级学术medical center.Methods：收集四个患者报告的结果测量信息系统计算机自适应测试在一个大型的学术骨科手术门诊诊所开始在2016年10月进行试点。患者报告结局测量信息系统计算机自适应测试（身体功能、疼痛强度、疼痛干扰和恢复社会角色和活动的能力）最初作为手动顺序集实施，在术前至术后2年进行。使用随时间推移的完成率、所有PRO领域的平均完成时间以及症状严重程度的总体分布来评估试点的成功。随后的优化和重新设计的试点进行了使用平板电脑，自动化的问卷调查部署，并改进了结果审查，以解决试点phase.Results过程中遇到的障碍：2009年不同的关节置换术患者（平均年龄= 65）完成了至少一组PRO评估，整体完成率达到68%，平均完成时间为3分钟。在实施过程中的焦点包括参与和培训的工作人员，选择适当的患者人群和结果的措施，和用户友好的数据显示为patients and provider.Conclusion：我们的试点计划成功地证明，PRO可以管理，评分，并立即提供电子健康记录内的患者和他们的供应商与最小的临床工作流程的中断。虽然相当大的操作和技术挑战仍然存在，我们发现，在学术医疗中心的门诊实践中的临床护理中的PRO的实施可以通过几个关键因素的星座来实现。
Introduction: Despite widely appreciated barriers to successful clinical implementation, the literature regarding how to operationalize electronic health record-integrated patient-reported outcomes (PROs) remains sparse. We offer a detailed summary of the implementation of PROs into the standard of care at a major tertiary academic medical center.Methods: Collection of four Patient-Reported Outcomes Measurement Information System computer adaptive tests was piloted in a large academic orthopaedic surgery ambulatory clinic starting in October 2016. The Patient-Reported Outcomes Measurement Information System computer adaptive tests (Physical Function, Pain Intensity, Pain Interference, and Ability to Return to Social Roles and Activities) were initially implemented as manual order sets to be administered before surgery through 2 years after surgery. Completion rate over time, mean time to completion for all PRO domains, and the overall distribution of symptom severity were used to evaluate the success of the pilot. A subsequent optimization and redesign of the pilot was conducted using tablets, automation of questionnaire deployment, and improved results review to address obstacles encountered during the pilot phase.Results: Two thousand nine distinct joint arthroplasty patients (mean age = 65) completed at least one set of PRO assessments, with overall completion rates reaching 68% and mean completion time of 3 minutes. Focal points during the implementation process included engagement and training of staff, selection of an appropriate patient population and outcome measures, and user friendly data displays for patients and providers.Conclusion: Our pilot program successfully demonstrated that PROs can be administered, scored, and made immediately available within the electronic health record to patients and their providers with minimal disruption of clinical workflows. Although considerable operational and technological challenges remain, we found that the implementation of PROs in clinical care within an ambulatory practice at an academic medical center can be achieved through a constellation of several key factors.