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Systemwide Implementation of Patient-Reported Outcomes in Routine Clinical Care at a Children's Hospital
Wendy E Gerhardt1, Constance A Mara2, Ian Kudel3
1is Director, Quality Outcomes and Evidence, James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center (CCHMC).
Insights
A standardized patient-reported outcomes (PROs) program provides a framework for consistent PRO use across clinics. This implementation guides effective PRO integration for improved patient-centered care.
Area of Science:
- Health Services Research
- Clinical Informatics
- Patient-Centered Care
Background:
- Limited guidance exists for developing systemwide patient-reported outcomes (PROs) programs across diverse clinical settings.
- A standardized PRO implementation program at Cincinnati Children's Hospital Medical Center offers a scalable model.
- This program addresses the need for consistent PRO integration in clinical practice.
Purpose of the Study:
- To outline the essential components for establishing a standardized, systemwide patient-reported outcomes (PROs) program.
- To demonstrate the practical application and value of PROs in promoting patient-centered care.
- To provide a framework for the successful implementation and spread of PRO initiatives.
Main Methods:
- Key components include identifying clinical leadership, selecting appropriate PRO instruments, and defining threshold scores for intervention.
- Establishing clear clinical interventions triggered by PRO scores is crucial.
- Provider training and ongoing monitoring of PRO use are essential for successful implementation.
Main Results:
- The program achieved a 75% overall combined completion rate for 68 unique PRO instruments.
- Individual instrument completion rates aimed for 80%.
- Case studies highlighted the value of PROs and their components in fostering patient-centered care.
Conclusions:
- Ongoing data collection is vital for program refinement and demonstrating value.
- Future research will focus on PROs' influence on patient-centered care coproduction and patient outcomes.
- The program serves as a foundation for collaborative research to enhance PRO implementation strategies.
Background:
Despite a growing literature on patient-reported outcomes (PROs), little has been written to guide development of a standardized, systemwide PRO program across multiple clinics and conditions. A PRO implementation program, which was created at Cincinnati Children's Hospital Medical Center, a large children's hospital, can serve as a standardized approach for the use of PROs in a clinical setting.
Methods:
Recommended standardized PRO implementation components include identification of a committed clinical leader and team, selection of an instrument that addresses the identified outcome of interest, specifying threshold scores that indicate when an intervention is needed, identification of clinical interventions to be triggered by threshold scores, provision of training for providers and staff involved in the PRO implementation process, and the measurement and monitoring of PRO use.
Results:
For each instrument, the completion goal is 80%, defined as the number of PRO measures that were actually completed divided by the number that should have been completed. The overall combined completion rate is 75% for the 68 unique instruments currently in use. Case studies of specific clinical team experiences demonstrate the value of using PROs and the implementation components and shows how PROs are used to promote patient-centered care.
Conclusion:
Data on PRO implementation are collected on an ongoing basis to confirm the value of the program, define ongoing improvement, and fuel collaborative research to further refine essential implementation components and successful spread. Next steps include measuring the influence of PRO use on coproduction of patient-centered clinical care and the impact PRO measurement has on patient outcomes.