The document discusses implementing point-of-care patient-reported outcomes (PROs) in clinical settings, particularly focusing on the Asthma Control Test (ACT) as a tool for improving patient care. It outlines the necessity for data capture, workflow considerations, and the importance of patient-centered care alongside challenges such as clinician familiarity and patient literacy. The implementation plan includes resource allocation, patient identification, and evaluating the tool's effectiveness in practice.

1. Implementing Point-of-Care Patient
Reported Outcomes (PROs): Did
Someone Say This Would Be Easy?
SAFTINet Convocation
May 19th, 2011

2. Overview
• PRO definition and background
• Impact on workflow: In a busy, resource-drained
environment
• Electronic data capture: Within the
EMR? Outside of the EMR?
• Data coding: Making sense of the data
• Use of the data: Real-time data capture with
incorporation into decision tools

3. Overview
• PRO definition and background
• Impact on workflow: In a busy, resource-drained
environment
• Electronic data capture: Within the
EMR? Outside of the EMR?
• Data coding: Making sense of the data
• Use of the data: Real-time data capture with
incorporation into decision tools

4. PRO Definition
• A patient-reported outcome or PRO is a
questionnaire used in a clinical trial or a clinical
setting, where the responses are collected
directly from the patient.
• Example in SAFTINet: Asthma Control Test
(ACT, C-ACT)

5. Background: Process of Selecting ACT
• Assessed SAFTINet Partner Requirements for a
PRO tool
– Simplicity
– Does not interfere with workflow
– Appropriate for literacy level and language of patient
populations
– Alignment with other organizational efforts and
initiatives
• Assessed SAFTINet PRO experience
– Diverse
– 1 partner already uses an asthma PRO (ACT)

6. Background: Why use a PRO for
asthma?
• Clinical utility
– Screening tool
– Patient monitoring tool
– Patient centered care (feedback to patients)
– Decision aid
– Facilitating multidisplinary team communications
• Research utility
– Standardized evaluation of outcomes
• Why asthma?
– Effects of disease on functioning and quality of life not accounted for in
standard EHR data
– Severity of disease difficult to assess
– Patients experience symptoms (unlike hypertension or high cholesterol)

7. Background: ACT Format Examples

8. Background: ACT Proposed Timeline -
2011
Explore
options for
asthma PROs
Discuss PRO
with provider
groups
Select asthma
PRO tool
Make
implementation
plan for
asthma PRO
tool
Create
infrastructure
for PRO tool
deployment
(e.g., EHR
template, iPad
purchase &
configuration)
PRO tool
training
Begin using
asthma PRO
tool
March April May June July Sept Oct

9. Background: Process for making
implementation plan for asthma PRO
• PEC-led structured interviews with partners
• Topics covered in interviews are in following
slides

10. Resources
• Manpower
• Information systems and technical support
• Space
• Financial investment (SAFTINet funds available)

11. Selecting patients to complete the tool
• Ambulatory patients with asthma
– How would they be identified?
• How often would they complete the tool?
– Every ambulatory visit?
• When does the patient complete the tool?
– Beginning of visit?

12. Mode of administration
• Person completing the tool
• Self-administration
• Interviewer administration
• Medium for presentation of tool and data
collection
• Pencil and paper survey
• EHR template
• Portable devices (e.g., iPad)
• Web-based
• Telephony-based

13. Scoring
• Who will score the results?
• Patient
• Member of the health care team
• What tools are available to assist with scoring?

14. Presentation of results
• Are results presented to patient/provider?
• If yes:
• When are results presented?
• At time of visit?
• Where are results presented?
• Part of workflow?
• How are results presented?
• Numeric or graphical presentation

15. Data entry
• How will data be entered?
• Depends on mode of administration

16. Interpreting and responding to scores
• Algorithms (Asthma APGAR)
• Meaningful scores (ACT)
• Linking to clinical guidelines

17. Evaluation
• Plans for evaluating use of tool on:
• Process/workflow
• Quality of care

18. Barriers
• Clinicians
– Lack of familiarity with the instruments
– Doubt about the ability of pros to modify outcomes
– Time and resource constraints
– Disagreements over impact on patient-clinician relationship
• Patients
– Literacy
– Being too sick to complete questionnaires
– Concern about impact on relationship with clinician
• Health system
– Reimbursement
– Fit within the clinical workflow

19. Anticipated barriers
• Generate list of perceived barriers and potential
solutions

20. Process for selecting a tool and an
implementation strategy
• Provider meetings?
• IT conversations?
• Decision making?
• Trainings?

21. Overview
• PRO definition and background
• Impact on workflow: In a busy, resource-drained
environment
• Electronic data capture: Within the
EMR? Outside of the EMR?
• Data coding: Making sense of the data
• Use of the data: Real-time data capture with
incorporation into decision tools