Outpatient implementation of a patient self-reported symptom system in an integrated health system.

Abstract

172 Background: To date, process-related outcomes dominate the landscape of the measurement of quality of oncologic care. Use of patient-reported outcomes has the potential to enhance value-based performance measurement. We performed a pilot study of integrating patient-reported data (PRD), into the daily work-flow of outpatient oncology clinics in an integrated health system, Geisinger Health System (GHS). Methods: All patients in the pilot were asked their pain scores by nurses according to existing procedures. In addition, the MD Anderson Symptom Inventory (MDASI) questionnaire was given to patients via touch screens in exam rooms. Four oncologists participated in the study at two sites. The study was reviewed by the GHS IRB and was granted exemption status. Results: 63 patients successfully used the touch screen monitors to complete the MDASI with minimal impact to clinic flow. Compared to the existing EHR-prompted nursing-collected pain score method, the PRD/MDASI method identified an additional 31% of patients with severe pain who were previously identified as having “no pain” (Table). 75% of patients identified as having “moderate pain” by the current method report “severe pain” by the PRD method. Conclusions: This pilot study demonstrates that the collection of PRD can be integrated into routine oncological clinic workflows with minimal interference with clinical flow. The study also shows that the collection of PRD may be superior to clinician screening at the time of the encounter alone. GHS will integrate PRD fully into its EHR in August 2014. GHS is developing evidence-based, standardized symptom management protocols and expanding the use of PRD in clinical care. [Table: see text]