The role of technical advances in the adoption and integration of patient-reported outcomes in clinical care.
The role of technical advances in the adoption and integration of patient-reported outcomes in clinical care.
复制标题
DOI：
10.1097/mlr.0000000000000289
复制
发表时间：
2015-02
期刊：
影响因子：
3
通讯作者：
Crane PK
中科院分区：
文献类型：
--
作者：
Jensen RE;Rothrock NE;DeWitt EM;Spiegel B;Tucker CA;Crane HM;Forrest CB;Patrick DL;Fredericksen R;Shulman LM;Cella D;Crane PK
患者报告的结果（PRO）作为提高临床护理环境中患者护理质量的关键措施正在获得认可。三个因素使得PRO在临床护理中的实施更加可行：在PRO设计和验证中越来越多地使用现代测量方法，技术的快速发展（例如，触摸屏平板电脑、互联网可访问性和电子健康记录（EHR）），以及监管机构、付款人、认证机构和专业组织对PRO测量和监测的更大需求。随着PRO电子收集和报告能力的提高，收集PRO数据的挑战也发生了变化。更新临床护理中PRO采用考虑因素的信息，强调测量选择、临床工作流程、数据基础设施和结局报告方面的电子和技术进步。在不同的医疗环境和患者人群的五个实际案例研究，用于探讨如何解决实施障碍，以促进PRO收集到临床工作流程的成功整合。案例研究涉及相关内容的选择和报告、工作流程集成、访视前筛选、有效评估和EHR集成。这些案例研究涵盖了精心设计的电子系统的要素，包括响应自动化、项目选择和报告算法的定制、收集位置的灵活性以及与患者医疗保健数据要素的集成。它们还强调了这一领域新出现的后勤障碍，例如需要专门的技术和方法专门知识，以及目前电子数据采集系统的设计局限性。
Patient-reported outcomes (PROs) are gaining recognition as key measures for improving the quality of patient care in clinical care settings. Three factors have made the implementation of PROs in clinical care more feasible: increased use of modern measurement methods in PRO design and validation, rapid progression of technology (e.g., touch screen tablets, Internet accessibility, and electronic health records (EHRs)), and greater demand for measurement and monitoring of PROs by regulators, payers, accreditors, and professional organizations. As electronic PRO collection and reporting capabilities have improved, the challenges of collecting PRO data have changed. To update information on PRO adoption considerations in clinical care, highlighting electronic and technical advances with respect to measure selection, clinical workflow, data infrastructure, and outcomes reporting. Five practical case studies across diverse healthcare settings and patient populations are used to explore how implementation barriers were addressed to promote the successful integration of PRO collection into the clinical workflow. The case studies address selecting and reporting of relevant content, workflow integration, pre-visit screening, effective evaluation, and EHR integration. These case studies exemplify elements of well-designed electronic systems, including response automation, tailoring of item selection and reporting algorithms, flexibility of collection location, and integration with patient health care data elements. They also highlight emerging logistical barriers in this area, such as the need for specialized technological and methodological expertise, and design limitations of current electronic data capture systems.