Article Figures & Data
Figures
- Figure 1.
Cascading hub-and-spokes model of implementation. IT, information technology; PCOR, patient-centered outcomes research; QI, quality improvement.
Tables
Implementation Step Decisions 1: Determine PRO content and select a measurement tool 1a: Identify stakeholder goals, available resources and barriers for collecting PRO measures 1b: Determine which questionnaire(s) to use 2: Establish local implementation plans 2a: Select the patients to be assessed 2b: Determine the setting and timing of assessments 2c: Choose a mode for administering and scoring the questionnaire 2d: Design processes for reporting results to providers and/or patients 2e: Identify aids to facilitate score interpretation 2f: Develop strategies for responding to issues identified by the questionnaires 2g*: Identify local champions and key personnel, and prepare tools and materials for training and implementation across practices 2h*: Establish systems for electronic data capture of the PRO results in structured, discrete fields 3: Implementation and evaluation of the PRO measure 3a*: Facilitate and track implementation across practices to ensure adequate data quality, and assess and address barriers 3b: Evaluate the impact of the PRO implementation on the practice ↵* SAFTINet project additions to the International Society for Quality of Life Research patient-reported outcome guidance.39
PRO, patient-reported outcome.
Research Partner Goals Clinical Partner Goals • Relevant to patients with condition of interest (eg, hypertension and hyperlipidemia) • Align with the clinical partners' current reporting requirements and quality improvement initiatives, such as PCMH and MU • Potentially influenced by the care in a PCMH • Brief (≤4 items), valid measure exists in both English and Spanish and at an appropriate reading level • Valid and reliable measure exists • Is of utility to the providers (ie, related to a common patient issue, amenable to intervention) • Content should not be redundant with existing data sources (eg, the EHR) • Informs day-to-day interactions with patients EHR, electronic health record; MU, meaningful use; PCMH, patient-centered medical home.
PRO Planning Worksheet Sections Research Team Request Decisions Organization 1 Organization 2 Organization 3 Organization 4 Patients targeted All adult patients with hypertension or hyperlipidemia All adult patients with hypertension or hyperlipidemia All patients with hypertension or hyperlipidemia All adult patients All patients with hypertension Identification of patients No request made Data query and list generation by IT staff Medical assistant checks medication list, gives the tool to anyone taking blood pressure or cholesterol medications All adult patients asked to complete the tool upon check-in for visit Rooming medical assistant reviews problem list and reason for visit Frequency of administration At least annually; all visits preferred Annually At all visits At all visits At hypertension visits (2 times/year) Mode of administration (by whom, in what setting, with what materials) No request made Care coordinators administered by telephone as part of larger patient survey Administered by medical assistant; responses recorded on paper upon check-in for visit Administered as part of written survey before the appointment upon check-in for visit Electronic survey; provider asked the questions verbally and recorded the answers in the EHR template Data capture Responses recorded in structured fields in an EHR or other database Care coordinators entered responses directly into discrete fields in the EHR template Responses manually entered into ancillary database; paper forms scanned into the EHR Medical assistant entered results in the EHR template Responses entered into the EHR template for hypertension visits Presentation and interpretation of results (to whom, when, in what form?) Recent/timely patient responses are available to the provider at the time of the visit Care coordinators scheduled an appointment with a provider for patients with barriers; patient responses are available to the provider in the EHR summary Paper form is available to the provider at the time of the visit Available to the provider at the point of care through the EHR Part of the provider interview with patients during hypertension visits Training PowerPoint presentation made available Medical providers, nurses, and care coordinators trained in administration, utilization, and interpretation; led by clinician champions Clinician champions trained other providers; practice manager trained the medical assistants Training at provider meeting on purpose of tool, interpretation, process/workflow; Web-based training for medical assistants Business analyst trains medical assistants on workflow for hypertension template; medical director trained providers on use of the template; training done remotely with ancillary in-person support for troubleshooting Required resources Time for local site coordination Care coordinator time; EHR team time to build template; IT staff time to generate a contact list of eligible patients Time for training; time for manual data entry Time for modifications to the EHR; time for training Time for EHR template building; personnel time for training and monitoring progress EHR, electronic health record; IT, information technology; PRO, patient-reported outcome.
- Table 4. Participating Organizations and Clinical Practices and Data Collection Results over the 9-Month Study Period
Organization 1 Organization 2 Organization 3 Organization 4 Clinical practice representative Director of behavioral health Internal medicine physician Associate medical director Research and data manager Participating practices, n 14 9 13 9 Practice specialties, n IMH 0 0 5 0 FM 6 4 7 9 IM 1 2 1 0 FM + IM 0 3 0 0 FM + IM + pediatrics 7 0 0 0 Practice location (urban/rural), n* 6/8 9/0 5/8 7/2 Medical providers per practice, median (range) 4 (1–9) 8 (6–15) 2 (1–5) 7 (2–15) Patients per practice, median (range) 2,925 (554–10,359) 6,644 (5,539–10,199) 2,765 (1,869–16,237) 8,689 (2,375–15,058) Practices implementing MAS, n (%) 10 (71) 8 (89) 13 (100) 9 (100) Surveys per practice Median (range) 24 (0–136) 23 (0–149) 69 (3–416) 164 (16–311) ↵* Based on 2010 census designation; some practices designated “rural” by the census are better characterized as suburban.
FM, family medicine; IM, internal medicine; IMH, integrated mental health; MAS, Medication Adherence Survey.
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