Oh, the Places We'll Go: Patient-Reported Outcomes and Electronic Health Records
Oh, the Places We'll Go: Patient-Reported Outcomes and Electronic Health Records
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DOI：
10.1007/s40271-018-0321-9
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发表时间：
2018-12-01
影响因子：
3.6
通讯作者：
Snyder, Claire F.
中科院分区：
文献类型：
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作者：
Gensheimer, Sarah G.;Wu, Albert W.;Snyder, Claire F.
越来越多的患者报告结果（PRO）的测量和电子健康记录（EHR）的采用为改善患者和人群的医疗保健提供了前所未有的机会。将PRO整合到EHR中可以促进以患者为中心的护理，并推进质量改进计划，研究和人口健康。尽管有这些潜在的好处，但帮助组织实现集成的最佳实践很少。为了将PRO整合到EHR中，组织应该在三个主题内评估各种方法的优缺点：规划，选择和参与。整合的规划考虑因素包括将使用什么策略、如何管理整合后的系统、伦理和法律的问题，以及如何在组织间汇集来自多个EHR的数据。选择考虑因素包括根据数据在医疗保健系统中的预期用途，确定PRO数据收集的目标患者人群，然后选择特定结局及其指标。参与考虑因素包括患者如何、在哪里以及以什么频率对PRO措施做出反应，如何在EHR中显示PRO数据，临床团队如何对PRO数据采取行动，以及如何培训、支持和激励临床团队和患者将PRO数据纳入护理。没有一种最有效的模式能在所有情况下都起作用。希望整合专业项目和电子健康档案的组织应汇集所需的多学科专门知识，以评估各种方法在其特定背景下的利弊。我们特别建议组织仔细考虑利益相关者的参与;设计他们的系统时考虑到数据共享;制定一个框架来帮助PRO选择;为患者和临床医生制定支持PRO解释和行动的指南;并确保患者可以访问自己的PRO数据。
The growing measurement of patient-reported outcomes (PROs) and adoption of electronic health records (EHRs) presents an unprecedented opportunity to improve health care for patients and populations. The integration of PROs into EHRs can promote patient-centered care and advance quality improvement initiatives, research, and population health. Despite these potential benefits, there are few best practices to help organizations achieve integration. To integrate PROs into EHRs, organizations should evaluate the advantages and disadvantages of various approaches within three themes: Planning, Selection, and Engagement. Planning considerations for integration include what strategy will be used, how the integrated system will be governed, ethical and legal issues, and how data from multiple EHRs can be pooled across organizations. Selection considerations involve identifying which patient population to target for PRO data collection on the basis of the intended use of the data in the health care system, and then choosing specific outcomes and their measures. Engagement considerations include how, where, and with what frequency patients will respond to PRO measures, how to display PRO data in EHRs, how clinical teams will act upon PRO data, and how to train, support and incent clinical teams and patients to incorporate PRO data into care. There is no most effective model that will work in all contexts. Organizations wishing to integrate PROs and EHRs should assemble the multidisciplinary expertise needed to evaluate the advantages and disadvantages of the various approaches for their particular context. We specifically recommend that organizations think carefully about stakeholder participation; design their system with data sharing in mind; develop a framework to aid in PRO selection; create guidelines to support PRO interpretation and action for patients and clinicians; and ensure patients have access to their own PRO data.