Kwan Bethany M, Sills Marion R, Graham Deborah, Hamer Mika K, Fairclough Diane L, Hammermeister K E, Kaiser Alicyn, de Jesus Diaz-Perez Maria, Schilling Lisa M
From the Departments of Family Medicine (BMK), Pediatrics (MRS), and Emergency Medicine (MRS), and Divisions of Cardiology (KEH) and General Internal Medicine (LMS), Department of Medicine, and Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS) (BMK, MRS, MKH, DLF, KEH, LMS), University of Colorado School of Medicine, Aurora, CO; Children's Hospital Colorado, Aurora, CO (MRS); The DARTNet Institute, Aurora, CO (DG); Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO (DLF); Metro Community Provider Network, Englewood, CO (AK); Salud Family Health Centers, Fort Lupton, CO (MdJD-P).
J Am Board Fam Med. 2016 Jan-Feb;29(1):102-15. doi: 10.3122/jabfm.2016.01.150141.
Patient-reported outcome (PRO) measures offer value for clinicians and researchers, although priorities and value propositions can conflict. PRO implementation in clinical practice may benefit from stakeholder engagement methods to align research and clinical practice stakeholder perspectives. The objective is to demonstrate the use of stakeholder engagement in PRO implementation.
Engaged stakeholders represented researchers and clinical practice representatives from the SAFTINet practice-based research network (PBRN). A stakeholder engagement process involving iterative analysis, deliberation, and decision making guided implementation of a medication adherence PRO measure (the Medication Adherence Survey [MAS]) for patients with hypertension and/or hyperlipidemia.
Over 9 months, 40 of 45 practices (89%) implemented the MAS, collecting 3,247 surveys (mean = 72, median = 30, range: 0 - 416). Facilitators included: an electronic health record (EHR) with readily modifiable templates; existing staff, tools and workflows in which the MAS could be integrated (e.g., health risk appraisals, hypertension-specific visits, care coordinators); and engaged leadership and quality improvement teams.
Stakeholder engagement appeared useful for promoting PRO measure implementation in clinical practice, in a way that met the needs of both researchers and clinical practice stakeholders. Limitations of this approach and opportunities for improving the PRO data collection infrastructure in PBRNs are discussed.
患者报告结局（PRO）测量为临床医生和研究人员提供了价值，尽管优先级和价值主张可能存在冲突。临床实践中PRO的实施可能受益于利益相关者参与方法，以使研究和临床实践利益相关者的观点保持一致。目的是展示利益相关者参与在PRO实施中的应用。
参与的利益相关者代表了来自SAFTINet基于实践的研究网络（PBRN）的研究人员和临床实践代表。一个涉及迭代分析、审议和决策的利益相关者参与过程指导了针对高血压和/或高脂血症患者的药物依从性PRO测量（药物依从性调查[MAS]）的实施。
在9个月的时间里，45家诊所中的40家（89%）实施了MAS，收集了3247份调查问卷（平均 = 72份，中位数 = 30份，范围：0 - 416份）。促进因素包括：具有易于修改模板的电子健康记录（EHR）；可以整合MAS的现有工作人员、工具和工作流程（例如，健康风险评估、高血压专项就诊、护理协调员）；以及积极参与的领导和质量改进团队。
利益相关者参与似乎有助于在临床实践中促进PRO测量的实施，其方式满足了研究人员和临床实践利益相关者的需求。讨论了这种方法的局限性以及改善PBRN中PRO数据收集基础设施的机会。
