Implementing Electronic Patient-Reported Outcome Measures in Psychiatric Urgent Care

The authors analyzed methods to increase patient reach and clinical adoption of an electronic patient-reported outcome (ePRO) intervention, identified barriers and facilitators to ePRO implementation, and applied iterative modifications in psychiatric urgent care.

ePRO implementation was examined from August 2021 to December 2023 at two psychiatric urgent care clinics in Maryland. The authors used the learning evaluation and RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) frameworks to guide and evaluate the implementation of PROs via an ePRO system. Stakeholder feedback informed rapid iteration cycles, driving the development and deployment of technical and procedural modifications. Quantitative data were organized via RE-AIM metrics and analyzed with descriptive statistics and regression analyses. Qualitative data, derived from stakeholder feedback, were analyzed through deductive and inductive coding and sentiment analysis.

A total of 22,610 care episodes were analyzed. Monthly ePRO completion increased to 73% in 2023. ePRO completion varied across clinics and was lower among men, Black patients, and those with neurocognitive or substance use disorders and was higher for patients with anxiety diagnoses. ePRO adoption increased in 2023. Six modifications were iteratively implemented to assist with ePRO completion and documentation. Qualitative analyses revealed administrative, clinical, and technological factors associated with ePRO implementation and completion rates and with an overall positive sentiment toward ePROs.

Representing the largest known ePRO implementation in psychiatric urgent care, the study's findings suggest that a stakeholder-driven, iterative process can successfully integrate ePROs in fast-paced clinical environments and inform future quality improvement efforts.