Implementation of patient-reported outcome dashboards within the electronic health record to support shared decision-making in serious chronic illness
Background Attending to patient-reported outcomes (PROs) using data visualisation dashboards could enhance shared decision-making (SDM) and care delivery for serious chronic illnesses. However, few studies have evaluated real-world strategies and resulting implementation outcomes of PRO dashboards.M...
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BMJ Publishing Group
2025-01-01
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| Series: | BMJ Open Quality |
| Online Access: | https://bmjopenquality.bmj.com/content/14/1/e002837.full |
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| author | Glyn Elwyn Sheetal M Kircher Eugene Nelson David Cella Lisa Hirschhorn Cynthia Barnard Vikram Aggarwal Jeffrey Linder Sofia F Garcia Aricca Van Citters Mary O'connor Laura M Perry Nisha A Mohindra Ava Coughlin Katy Bedjeti Devin Peipert Melissa Weitzel Victoria Morken Elijah Patten Jissell Torres Susan Metzger Alesia O’daniel Ryan Chmiel Reena Modi Michelle Munroe Stavroula Xinos |
| author_facet | Glyn Elwyn Sheetal M Kircher Eugene Nelson David Cella Lisa Hirschhorn Cynthia Barnard Vikram Aggarwal Jeffrey Linder Sofia F Garcia Aricca Van Citters Mary O'connor Laura M Perry Nisha A Mohindra Ava Coughlin Katy Bedjeti Devin Peipert Melissa Weitzel Victoria Morken Elijah Patten Jissell Torres Susan Metzger Alesia O’daniel Ryan Chmiel Reena Modi Michelle Munroe Stavroula Xinos |
| author_sort | Glyn Elwyn |
| collection | DOAJ |
| description | Background Attending to patient-reported outcomes (PROs) using data visualisation dashboards could enhance shared decision-making (SDM) and care delivery for serious chronic illnesses. However, few studies have evaluated real-world strategies and resulting implementation outcomes of PRO dashboards.Method From June 2020 to January 2022, we implemented an electronic health record (EHR)-integrated PRO dashboard for advanced cancer and chronic kidney disease. Based on implementation science guidelines (eg, Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies, Reach, Effectiveness, Adoption, Implementation, Maintenance), we monitored use and captured adaptations in implementation strategies. Clinicians (n=7) and patients (n=30) responded to a 6-month survey that included appropriateness, acceptability, adoption and sustainability.Results Out of 1450 eligible patients, 748 (52%) completed at least one PRO invitation (reach). 37% of PRO questionnaire invitations (1421/3882) were completed (fidelity to PRO completion), with higher rates occurring when more implementation strategies were adopted. Among completed postvisit surveys from patients, 57% indicated that the dashboard was discussed at an eligible visit (fidelity to dashboard use). In the 6-month survey, patients endorsed the dashboard’s acceptability and appropriateness: 77% felt it frequently provided clear information and 63% felt it frequently met their needs. Most patients (77%) and clinicians (86%) valued the dashboard for increasing SDM, and 57% of clinicians endorsed the dashboard’s clinical sustainability.Discussion This pilot study demonstrated the clinical appropriateness, acceptability and feasibility of implementing an EHR-integrated PRO dashboard for advanced cancer and chronic kidney disease. Results also point to areas for improvement, including strategies to further support patient and clinician engagement, PRO completion and sustainability in real-world implementation. |
| format | Article |
| id | doaj-art-d17b0aa39ee4412fafb23ffbc6d7e84e |
| institution | Kabale University |
| issn | 2399-6641 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Quality |
| spelling | doaj-art-d17b0aa39ee4412fafb23ffbc6d7e84e2025-02-03T19:35:10ZengBMJ Publishing GroupBMJ Open Quality2399-66412025-01-0114110.1136/bmjoq-2024-002837Implementation of patient-reported outcome dashboards within the electronic health record to support shared decision-making in serious chronic illnessGlyn Elwyn0Sheetal M Kircher1Eugene Nelson2David Cella3Lisa Hirschhorn4Cynthia Barnard5Vikram Aggarwal6Jeffrey Linder7Sofia F Garcia8Aricca Van Citters9Mary O'connor10Laura M Perry11Nisha A Mohindra12Ava Coughlin13Katy Bedjeti14Devin Peipert15Melissa Weitzel16Victoria Morken17Elijah Patten18Jissell Torres19Susan Metzger20Alesia O’daniel21Ryan Chmiel22Reena Modi23Michelle Munroe24Stavroula Xinos25The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USADivision of Hematology/Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USAThe Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USADepartment of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USADepartment of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USADivision of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USADivision of Nephrology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USADivision of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USADepartment of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USAsenior research scientistDepartment of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USACenter for Health Outcomes, Implementation, and Community-Engaged Science (CHOICES), Tulane University School of Medicine, New Orleans, Louisiana, USADivision of Hematology/Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USADepartment of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USADepartment of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USADepartment of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USADivision of Nephrology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USANorthwestern Medicine, Chicago, Illinois, USADepartment of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USADepartment of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USANorthwestern Medicine, Chicago, Illinois, USANorthwestern Medicine, Chicago, Illinois, USANorthwestern Medicine, Chicago, Illinois, USANorthwestern Medicine, Chicago, Illinois, USANorthwestern Medicine, Chicago, Illinois, USANorthwestern Medicine, Chicago, Illinois, USABackground Attending to patient-reported outcomes (PROs) using data visualisation dashboards could enhance shared decision-making (SDM) and care delivery for serious chronic illnesses. However, few studies have evaluated real-world strategies and resulting implementation outcomes of PRO dashboards.Method From June 2020 to January 2022, we implemented an electronic health record (EHR)-integrated PRO dashboard for advanced cancer and chronic kidney disease. Based on implementation science guidelines (eg, Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies, Reach, Effectiveness, Adoption, Implementation, Maintenance), we monitored use and captured adaptations in implementation strategies. Clinicians (n=7) and patients (n=30) responded to a 6-month survey that included appropriateness, acceptability, adoption and sustainability.Results Out of 1450 eligible patients, 748 (52%) completed at least one PRO invitation (reach). 37% of PRO questionnaire invitations (1421/3882) were completed (fidelity to PRO completion), with higher rates occurring when more implementation strategies were adopted. Among completed postvisit surveys from patients, 57% indicated that the dashboard was discussed at an eligible visit (fidelity to dashboard use). In the 6-month survey, patients endorsed the dashboard’s acceptability and appropriateness: 77% felt it frequently provided clear information and 63% felt it frequently met their needs. Most patients (77%) and clinicians (86%) valued the dashboard for increasing SDM, and 57% of clinicians endorsed the dashboard’s clinical sustainability.Discussion This pilot study demonstrated the clinical appropriateness, acceptability and feasibility of implementing an EHR-integrated PRO dashboard for advanced cancer and chronic kidney disease. Results also point to areas for improvement, including strategies to further support patient and clinician engagement, PRO completion and sustainability in real-world implementation.https://bmjopenquality.bmj.com/content/14/1/e002837.full |
| spellingShingle | Glyn Elwyn Sheetal M Kircher Eugene Nelson David Cella Lisa Hirschhorn Cynthia Barnard Vikram Aggarwal Jeffrey Linder Sofia F Garcia Aricca Van Citters Mary O'connor Laura M Perry Nisha A Mohindra Ava Coughlin Katy Bedjeti Devin Peipert Melissa Weitzel Victoria Morken Elijah Patten Jissell Torres Susan Metzger Alesia O’daniel Ryan Chmiel Reena Modi Michelle Munroe Stavroula Xinos Implementation of patient-reported outcome dashboards within the electronic health record to support shared decision-making in serious chronic illness BMJ Open Quality |
| title | Implementation of patient-reported outcome dashboards within the electronic health record to support shared decision-making in serious chronic illness |
| title_full | Implementation of patient-reported outcome dashboards within the electronic health record to support shared decision-making in serious chronic illness |
| title_fullStr | Implementation of patient-reported outcome dashboards within the electronic health record to support shared decision-making in serious chronic illness |
| title_full_unstemmed | Implementation of patient-reported outcome dashboards within the electronic health record to support shared decision-making in serious chronic illness |
| title_short | Implementation of patient-reported outcome dashboards within the electronic health record to support shared decision-making in serious chronic illness |
| title_sort | implementation of patient reported outcome dashboards within the electronic health record to support shared decision making in serious chronic illness |
| url | https://bmjopenquality.bmj.com/content/14/1/e002837.full |
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