Bringing PROMIS to Practice: Brief and Precise Symptom Screening in Ambulatory Cancer Care
Bringing PROMIS to Practice: Brief and Precise Symptom Screening in Ambulatory Cancer Care
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DOI：
10.1002/cncr.29104
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发表时间：
2015-03-15
期刊：
影响因子：
6.2
通讯作者：
Cella, David
中科院分区：
文献类型：
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作者：
Wagner, Lynne I.;Schink, Julian;Cella, David
背景 通过将简短且经过验证的电子患者报告结果评估整合到电子健康记录 (EHR) 和临床工作流程中，可以增强支持性肿瘤学实践。方法 636 名接受妇科肿瘤门诊护理的女性收到了通过 EHR 患者沟通门户 Epic MyChart 完成临床评估的指示。患者报告结果测量信息系统（PROMIS）计算机适应性测试（CAT）用于评估疲劳、疼痛干扰、身体功能、抑郁和焦虑。检查表确定了社会心理问题、信息和营养需求以及营养不足的风险因素。评估结果（包括记录了严重性阈值的 PROMIS T 评分）立即填充到 EHR 中。通过 EHR 消息向临床医生通报临床症状升高。 EHR 集成旨在为社会工作提供者提供社会心理问题的自动分类，为健康教育者提供信息，为营养师提供营养相关问题的自动分类。 结果 发送了 4,042 条 MyChart 消息，患者审查了 3203 条 (79%)。 1493 名患者（37%）开始了评估，开始后，93%（1386 名患者）完成了评估。仅根据首次评估，查看 MyChart 消息的患者中有 49.8% 完成了评估。平均 PROMIS CAT T 分数表明与一般人群相比，身体机能水平较低，焦虑程度较高。疲劳、疼痛和抑郁评分与一般人群相当。身体机能受损是临床警报的最常见基础，发生在 4% 的患者中。结论 SPROMIS CAT 用于测量常规肿瘤门诊护理中的常见癌症症状。电子病历的立即整合促进了使用症状报告作为转诊心理社会和支持性护理的基础。癌症 2015 年；121：927-934。 (c) 2014 年美国癌症协会。使用患者报告结果测量信息系统成功实施电子患者报告结果 (ePRO) 系统，证明可以精确、有效和稳健地测量常见癌症相关症状，并集成电子健康记录以立即通知临床医生并对已识别的问题进行分类。 636 名妇科肿瘤门诊患者完成了 ePRO 评估，他们证明了其可行性并提供了有关最常见症状相关和心理社会问题的信息。
BACKGROUNDSupportive oncology practice can be enhanced by the integration of a brief and validated electronic patient-reported outcome assessment into the electronic health record (EHR) and clinical workflow.METHODSSix hundred thirty-six women receiving gynecologic oncology outpatient care received instructions to complete clinical assessments through Epic MyChart, an EHR patient communication portal. Patient Reported Outcomes Measurement Information System (PROMIS) computer adaptive tests (CATs) were administered to assess fatigue, pain interference, physical function, depression, and anxiety. Checklists identified psychosocial concerns, informational and nutritional needs, and risk factors for inadequate nutrition. Assessment results, including PROMIS T scores with documented severity thresholds, were immediately populated in the EHR. Clinicians were notified of clinically elevated symptoms through EHR messages. EHR integration was designed to provide automated triage to social work providers for psychosocial concerns, to health educators for information, and to dietitians for nutrition-related concerns.RESULTSFour thousand forty-two MyChart messages sent, and 3203 (79%) were reviewed by patients. The assessment was started by 1493 patients (37%), and once they started, 93% (1386 patients) completed the assessment. According to first assessments only, 49.8% of the patients who reviewed the MyChart message completed the assessment. Mean PROMIS CAT T scores indicated a lower level of physical function and elevated anxiety in comparison with the general population. Fatigue, pain, and depression scores were comparable to those of the general population. Impaired physical functioning was the most common basis for clinical alerts and occurred in 4% of the patients.CONCLUSIONSPROMIS CATs were used to measure common cancer symptoms in routine oncology outpatient care. Immediate EHR integration facilitated the use of symptom reporting as the basis for referral to psychosocial and supportive care. Cancer 2015;121:927-934. (c) 2014 American Cancer Society.The successful implementation of an electronic patient-reported outcome (ePRO) system using the Patient Reported Outcomes Measurement Information System is demonstrated for the precise, valid, and robust measurement of common cancer-related symptoms with electronic health record integration for immediate clinician notification and with triage for identified problems. Six hundred thirty-six gynecologic oncology outpatients complete the ePRO assessment, and they demonstrate its feasibility and provide information on the most common symptom-related and psychosocial concerns.