Real-Time Assessment of Patient Reported Outcomes in Heart Failure Clinic

Abstract

Introduction: Patient-reported outcomes (PROs) are commonly used in clinical trials to assess patient health-related quality of life (hrQoL), but PRO implementation in daily practice is rare. We sought to develop a novel approach to integrate PROs within routine clinical practice at a heart failure (HF) clinic. Methods and Results Technical implementation of PRO capture was facilitated by the University of Utah mEVAL Personal Health Assessment team. We deployed a computer program on portable computers (iPad) to collect PRO instruments of interest—Kansas City Cardiomyopathy Questionnaire & physical function, depression, fatigue, and satisfaction with social roles domains of Patient-Reported Outcomes Measurement Information System—PROMIS. We initiated an automated algorithm through which patients are identified at registration for clinic, provided with iPAD and asked to complete the PROs (Fig. 1A). Through secure data transfer, PROs are scored and made immediately available in the electronic health record (EHR) (Fig. 1B). We also conducted provider training in PRO score interpretation. In 2016, serial PRO assessments were done in 685 patients (age 60.1 ± 16.3 yrs, 66% male, average completion time 6.7 min), which represented a 58% completion rate among eligible patients. PRO results indicated marked reduction in hrQoL in a large number of the patients—Table 1. The original design was to collect PROs at 3 month intervals; early experience indicated that it was more useful to collect these at each visit and share the results with patients. This is expected to improve completion rates. Conclusion PRO capture during routine clinical care with real-time EHR uploads is feasible in a large HF outpatient population. Ongoing efforts will better determine how best to share this information with patients and will provide data regarding the utility of routine PRO use in clinical care. While PROs are being proposed as required metrics of quality of health care delivery, our approach intends to make these measures actionable in real-time clinical care.Table 1Scores of completed patient-reported outcome assessmentsInstrument NameSample SizeMedian Score25th Percentile75th PercentileKCCQ-12804573974PROMIS-Depression714504557PROMIS-Fatigue788554861PROMIS-Physical Function719413547PROMIS-Satisfaction Roles Activities791453951 Open table in a new tab