Symptom Care at Home A Comprehensive and Pragmatic PRO System Approach to Improve Cancer Symptom Care
Symptom Care at Home A Comprehensive and Pragmatic PRO System Approach to Improve Cancer Symptom Care
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DOI：
10.1097/mlr.0000000000001037
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发表时间：
2019-05-01
期刊：
影响因子：
3
通讯作者：
Beck, Susan L.
中科院分区：
文献类型：
--
作者：
Mooney, Kathi;Whisenant, Meagan S.;Beck, Susan L.
简介：越来越多的人认识到，使用患者报告的结果（PRO）系统地获得患者对其健康体验的看法，可用于改善真实的患者护理。很少有PRO系统被设计用于监测和提供访视之间的症状管理支持。病人被指示在两次就诊之间联系医疗服务提供者，表达他们的担忧，但他们很少这样做，让病人独自在家科普症状。我们开发并测试了一个自动化系统，家庭症状护理（SCH），以解决在诊所访问之间跟踪和响应PRO数据的差距。本文的目的是描述SCH作为一个例子，一个全面的PRO系统，解决未满足的需要，为症状支持诊所外。PRO评分解释方法：SCH使用实用的单项指标来评估症状，这些指标是患者和提供者常用且易于解释的。我们为PRO症状数据建立了警报值，这对于节省肿瘤提供者响应每日PRO数据的时间尤为重要。制定针对PRO结果采取行动的建议的方法：SCH系统提供自动化、及时的自我管理指导，针对日常电话中报告的特定症状模式和严重程度进行定制。此外，SCH系统还包括一个提供者决策支持系统，用于后续症状评估和干预策略。讨论内容：SCH提供PRO监测、量身定制的自动化自我管理辅导，并通过提供商仪表板提醒肿瘤团队控制不良的症状，该仪表板包括循证决策支持，用于随访，以改善个体患者的症状护理。我们特别强调我们的PRO选择流程、确定警报阈值的基本原理以及提供商仪表板和决策支持的设计。目前，我们正在更新SCH系统，开发基于网络和应用程序的版本以及交互式语音响应电话访问，并将SCH系统集成到电子健康记录中。
Introduction: There is growing recognition that systematically obtaining the patient's perspective on their health experience, using patient-reported outcomes (PRO), can be used to improve patient care in real time. Few PRO systems are designed to monitor and provide symptom management support between visits. Patients are instructed to contact providers between visits with their concerns, but they rarely do, leaving patients to cope with symptoms alone at home. We developed and tested an automated system, Symptom Care at Home (SCH), to address this gap in tracking and responding to PRO data in-between clinic visits. The purpose of this paper is to describe SCH as an example of a comprehensive PRO system that addresses unmet need for symptom support outside the clinic. Methods for PRO Score Interpretation: SCH uses pragmatic, single-item measures for assessing symptoms, which are commonly used and readily interpretable for both patients and providers. We established alerting values for PRO symptom data, which was particularly important for conserving oncology providers' time in responding to daily PRO data. Methods for Developing Recommendations for Acting on PRO Results: The SCH system provides automated, just-in-time self-management coaching tailored to the specific symptom pattern and severity levels reported in the daily call. In addition, the SCH system includes a provider decision support system for follow-up symptom assessment and intervention strategies. Discussion: SCH provides PRO monitoring, tailored automated self-management coaching, and alerts the oncology team of poorly controlled symptoms with a provider dashboard that includes evidence-based decision support for follow-up to improve individual patients' symptom care. We particularly emphasize our process for PRO selection, rationale for determining alerting thresholds, and the design of the provider dashboard and decision support. Currently, we are in the process of updating the SCH system, developing both web-based and app versions in addition to interactive voice response phone access and integrating the SCH system in the electronic health record.