Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, P.O. Box 301402, Houston, TX 77230-1402, USA.
Support Care Cancer. 2012 Jan;20(1):167-74. doi: 10.1007/s00520-011-1086-z. Epub 2011 Jan 16.
This project sought to help palliative and hospice care practices improve patient care quality and operational efficiency by improving patient symptom status reporting and symptom management, reducing associated provider documentation workload, and enhancing patient-provider and provider-provider communication. We developed a user-friendly, electronic medical record-compatible, software prototype that allows typical clinical data and patient-reported outcomes (PRO) to be entered and stored. This data is immediately available during the clinical encounter with graphically depicted summaries for patient history and PRO assessments, a trending feature that links symptom behavior to interventions and the Edmonton Labeled Visual Information System.
A user-centered design approach allowed for iterative cycles of needs/usability feedback from providers and patients/caregivers to be incorporated into the development of our prototype's technical structure and features. To determine the needs and initial usability of the project's prototype, we interviewed eight providers and 18 patients/caregivers. Another usability test, consisting of patient/caregiver (n = 18) and provider (n = 9) interviews, assessed the functioning prototype's design, usability, and usefulness.
Patients/caregivers (n = 18) reported that the prototype was usable (100%), it would facilitate patient-provider communication, shared decision making, and self-management (100%), and they would be willing to try the system and recommend it to their providers (100%). The providers (n = 9) felt that the prototype encouraged better use of patient assessments in decision making and patient care (100%) and improved identification of cause/temporal relationship between care events and outcomes (100%), monitoring of patient status (100%), communication in a multi-disciplinary team (100%), and operational efficiency and patient care quality (88.9%).
Quality of patient care and operational efficiency can be improved with an effective assessment, evaluation, and communication tool. This project developed an electronic version of such a tool. Future efforts will hone its usability and integration across multiple hospice/palliative care settings.
本项目旨在通过改善患者症状报告和管理、减轻相关医务人员文书工作负担以及加强医患沟通和医护沟通，来帮助姑息治疗和临终关怀实践提高患者护理质量和运营效率。我们开发了一个用户友好、与电子病历兼容的软件原型，允许输入和存储典型的临床数据和患者报告的结果（PRO）。这些数据在临床就诊时可立即获得，以图形化的方式呈现患者病史和 PRO 评估的摘要，具有趋势分析功能，可将症状行为与干预措施以及埃德蒙顿标记视觉信息系统联系起来。
采用以用户为中心的设计方法，允许临床医生和患者/照护者反复提出需求/可用性反馈，将其纳入我们原型的技术结构和功能的开发中。为了确定项目原型的需求和初始可用性，我们采访了 8 名临床医生和 18 名患者/照护者。另一个可用性测试包括患者/照护者（n=18）和临床医生（n=9）访谈，评估原型的设计、可用性和实用性。
患者/照护者（n=18）报告称，原型是可用的（100%），它将促进医患沟通、共同决策和自我管理（100%），他们愿意尝试该系统并向其临床医生推荐（100%）。临床医生（n=9）认为，原型鼓励更好地利用患者评估进行决策和患者护理（100%），并改善了对护理事件与结局之间因果/时间关系的识别（100%）、患者状态监测（100%）、多学科团队沟通（100%）以及运营效率和患者护理质量（88.9%）。
有效的评估、评估和沟通工具可以提高患者护理质量和运营效率。本项目开发了这样一种工具的电子版本。未来的工作将完善其在多个姑息治疗和临终关怀环境中的可用性和整合。
