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Usability Testing of an Electronic Patient-Reported Outcome System for Survivors of Critical Illness
Christopher E Cox1, Nicholas G Wysham2, Arif H Kamal2
1Christopher E. Cox is an associate professor of medicine, Nicholas G. Wysham is a fellow in the Division of Pulmonary and Critical Care Medicine, and Derek M. Jones is a clinical research project manager, Department of Medicine and Program to Support People and Enhance Recovery, Duke University, Durham, North Carolina. Arif H. Kamal is an assistant professor of medicine, Duke Clinical Research Institute and an oncologist in the Department of Medicine, Duke University. Brian Cass is a project manager and Maria Tobin is a programming specialist, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Douglas B. White and Jeremy M. Kahn are associate professors of medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Catherine L. Hough is an associate professor of medicine, University of Washington, Seattle, Washington. Shannon S. Carson is a professor of medicine, University of North Carolina at Chapel Hill. christopher.cox@duke.edu.
Background:
Web-based electronic patient-reported outcomes (ePRO) measures are increasingly used to facilitate patient-centered health assessments. However, it is unknown if ePRO completion is feasible for recently ill intensive care unit (ICU) survivors and their families.
Objective:
To develop and evaluate the usability of a novel ePRO system (ePRO to Support People and Enhance Recovery [ePROSPER]) among ICU survivors and their families within an ongoing clinical trial.
Methods:
Paper-based PROs were iteratively adapted to electronic forms (ePROs). Then, the usability of ePROSPER was assessed among 60 patients, their family members, and PRO and programming experts via questionnaires (eg, Systems Usability Scale), "think aloud" open-ended feedback, task completion times, and error rates.
Results:
Input from patients and their families was used to incorporate user-experience modifications into ePROSPER. This feedback also led to inclusion of automated reminders for questionnaire completion and real-time alerts for staff triggered by high symptom levels. Median usability scores increased over testing cycles from 40 to 73 to 95, nearing the maximum score and showing excellent usability. All users completed ePROSPER within 20 minutes; 87% preferred it to a written version. ePROSPER was then implemented in a clinical trial without data errors.
Conclusions:
Automated ePRO systems can be successfully integrated in a post-ICU clinical trial setting. The value of integrating such systems in direct clinical care should be assessed in future studies.
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