Division of Health Management and Policy, School of Public Health, Georgia State University, Atlanta, GA, USA.
Kaiser Permanente Center for Clinical and Outcomes Research, Atlanta, GA, USA.
J Gen Intern Med. 2018 May;33(Suppl 1):31-37. doi: 10.1007/s11606-018-4326-9.
Chronic pain is highly prevalent, and the ability to routinely measure patients' pain and treatment response using validated patient-reported outcome (PRO) assessments is important to clinical care. Despite this recognition, systematic use in everyday clinical care is rare.
The aims of this study were to (1) describe infrastructure designed to automate PRO data collection, (2) compare study-enhanced PRO completion rates to those in clinical care, and (3) evaluate patient response rates by method of PRO administration and sociodemographic and/or clinical characteristics.
The Pain Program for Active Coping and Training (PPACT) is a pragmatic clinical trial conducted within three regions of the Kaiser Permanente health care system.
PPACT evaluates the effect of integrative primary care-based pain management services on outcomes for chronic pain patients on long-term opioid treatment. We implemented a tiered process for quarterly assessment of PROs to supplement clinical collection and ensure adequate trial data using three methods: web-based personal health records (PHR), automated interactive voice response (IVR) calls, and live outreach.
Among a subset of PPACT participants examined (n = 632), the tiered study-enhanced PRO completion rates were higher than in clinical care: 96% completed ≥ 1 study-administered PRO with mean of 3.46 (SD = 0.85) vs. 74% completed in clinical care with a mean of 2.43 (SD = 2.08). Among all PPACT participants at 3 months (n = 831), PRO completion was 86% and analyses of response by key characteristics found only that participant age predicted an increased likelihood of responding to PHR and IVR outreach.
Adherence to pain-related PRO data collection using our enhanced tiered approach was high. No demographic or clinical identifiers other than age were associated with differential response by modality. Successful ancillary support should employ multimodal electronic health record functionalities for PRO administration. Using automated modalities is feasible and may facilitate better sustainability for regular PRO administration within health care systems. Clinical Trials Registration Number: NCT02113592.
慢性疼痛的发病率很高，因此，使用经过验证的患者报告结局（PRO）评估工具来常规测量患者的疼痛和治疗反应，对临床护理非常重要。尽管已经认识到这一点，但在日常临床护理中系统使用 PRO 评估工具的情况仍然很少见。
本研究的目的是：（1）描述用于自动采集 PRO 数据的基础设施；（2）比较增强型研究中 PRO 完成率与临床护理中的完成率；（3）通过 PRO 管理方式和患者人口统计学及/或临床特征来评估患者的应答率。
Pain Program for Active Coping and Training（PPACT）是一项在 Kaiser Permanente 医疗保健系统的三个区域内进行的实用型临床试验。
PPACT 评估了基于综合初级保健的疼痛管理服务对长期接受阿片类药物治疗的慢性疼痛患者结局的影响。我们实施了一个分层的流程，每季度评估一次 PRO，以补充临床采集，并使用三种方法确保有足够的试验数据：基于网络的个人健康记录（PHR）、自动交互式语音应答（IVR）电话和现场外展。
在对 PPACT 参与者进行的亚组分析中（n=632），分层研究增强型 PRO 完成率高于临床护理：96%的参与者完成了≥1 项研究管理的 PRO，平均完成 3.46 次（SD=0.85），而在临床护理中，平均完成 2.43 次（SD=2.08）。在所有参加 3 个月研究的 PPACT 参与者中（n=831），PRO 完成率为 86%，对关键特征的应答分析发现，只有参与者年龄与对 PHR 和 IVR 外展的应答可能性增加有关。
使用我们增强的分层方法，对疼痛相关 PRO 数据采集的依从性很高。除年龄外，没有其他人口统计学或临床指标与不同的应答模式有关。成功的辅助支持应该采用多模态电子健康记录功能进行 PRO 管理。使用自动化模式是可行的，并且可能有助于在医疗保健系统内更可持续地进行常规 PRO 管理。临床试验注册号：NCT02113592。
