Abstract 288: The Veterans Affairs Patient Reported Health Status (PROST) System: An Interim Analysis

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Introduction: Elective percutaneous coronary intervention (PCI) for stable angina is intended to reduce symptoms and enhance quality of life. However, measures of patient-reported health status are not yet routinely collected or used. Methods: We developed a telephonic interactive voice response (IVR) system to capture patient-reported health status measures before and after PCI in the Veterans Affairs (VA) Health Care System. The IVR system calls patients to collect Seattle Angina Questionnaire 7 and Rose Dyspnea questionnaire data 1 month prior to PCI and 1 and 6 months after PCI. Reports are provided to primary care and cardiology providers for patients who experience a significant change in health status. We performed a multi-method, interim analysis of sequential roll-out of the IVR system at 6 VA centers, including quantitative process data; semi-structured interviews with 13 patients; and chart review of all patients who experienced a decrement in health status. Results: Of 2,113 patients undergoing elective PCI from November 28, 2015, until September 31, 2019, health status data were collected from 692 (32.7%) prior to PCI, 457 (66.0%) 1 month after PCI, and 59 (8.5%) 6 months after PCI ( Figure 1 ). A total of 83 (18.0%) decrements in health status occurred. In response, 10 (12.0%) clinical actions were recorded in the medical record: 4 (4.8%) patients were called by providers, 2 (2.4%) had their medication regimen reviewed, 3 (3.6%) had their case reviewed by their primary care provider and/or an interventional cardiologist, and an outpatient clinic visit was scheduled earlier than planned for 1 (1.2%) patient. Many patients did not remember receiving a telephone call; others were “fine” with receiving a call and filling out a survey. Some expressed difficulty with completing the survey owing to a lack of technical literacy or difficulty with hearing. Some patients were reassured by a telephone call, saying “That’s good, because it lets me know that I haven’t slipped through the cracks. It builds confidence that they know how I’m feeling before a procedure.” Conclusions: It is feasible to capture patient-reported measures of health status in the real world and integrate their use into routine clinical care. Opportunities to improve the collection and use of patient-reported health status measures persist.