| Description |
With the rise of clinical informatics, questionnaires (also called instruments) have been used to collect data straight from the source - from patients themselves (Porter, Larsson, & Lee, 2016). These measures are called Patient Reported Outcome Measures, or PROMs. PROMs are defined as any information about a patient's condition directly from the patient. Questionnaires from PROMs are nationally and internationally validated questions that help to gather meaningful data (National Quality Forum, 2020). PROMs are meant to better gauge patient functionality, well-being, and capture more than just diagnosis-specific outcomes. In spite of this, they are only used regularly by about twenty percent of hospitals in the U.S. as of 2016 (Bresnick, 2017). When data from PROMs is used systematically, patients and clinicians communicate better and participate in more robust conversations about the care being provided as clinicians can participate in a more focused conversation based on patient's feedback and prioritize their concerns (Nelson, Eftimovska, Lind, Hager, Wasson, & Lindblad, 2015). Not only can patients feel more satisfied with their care, clinicians may also be more satisfied with patient interactions as well (Rotenstein, Huckman, & Wagle, 2017). PROMs are important to the nursing profession since it encourages a more holistic approach to patient outcomes. New models of healthcare delivery promote patient centeredness and advocacy. Nurses are critical to promoting this patient-centeredness by being the individual who interacts with and participates in a bulk of the care many patients receive. Since nurses also carry the role of facilitating collaboration within the interdisciplinary team (which includes the patient), PROMs can help nurses work more efficiently individually and with their team. The Patient Reported Outcomes (PRO) program at a large hospital system's outpatient clinics have been implemented for anywhere from 1-5 years, depending on the clinic location. The system itself is the first in Utah to initiate use of PROMs. Over 150 instruments were built for specific patient demographics with data collected for the past five years. Initially, the instruments were developed using a "home grown" system that tied into the electronic health record (EHR). These instruments contained questions regarding the patient's physical function, mental health, and specific to the care they were receiving through the specialty clinic they were visiting. Since then, the EHR vendor has developed instruments directly tied to their platform. This change created a need to develop a system-wide transition plan to the EHR platform. Six months ago, a change in operational team (to the Ambulatory Quality Team) occurred with goals of a future state including increased engagement and understanding of PROMs among end-users. With the many moving components of the PROMs program make transition more complex, the team recognized the necessity of analyzing gaps in the current state of the program to drive their goals for the future state of their program. Patient engagement is a characteristic of quality improvement and has been identified as the next steps toward advancing the delivery of healthcare (Manafo, Petermann, Mason-Lai, & Vandall-Walker, 2018). Patients at this health system understood the basics of how to answer questions, but not anything more about the instruments, based on a previously conducted patient focus group. The system team concluded that there may be similar gaps in the understanding of the frontline staff. The PRO team understood that it would be imperative that patients and frontline staff are engaged and have meaningful understanding of what PROMs are in order to be successful. While there were many obvious barriers to making PRO meaningful and well-integrated into this healthcare system, some were more subtle and would only be identified through including the voice of the end-users. Therefore, the team opted to gather feedback from super user clinical sites from the users themselves. Evidence-based interventions already exist to improve PROM implementation and may greatly improve PROMs within this healthcare system. The purpose of this project was to evaluate the current levels of engagement, attitudes, and knowledge base within the University of Utah's ambulatory care clinics, and analyze gaps in the current state to inform future development plans in the transition from a home-grown system to a new platform for PROMs. |
