Ingham Institute for Applied Medical Research, Liverpool, NSW.
South Western Sydney Clinical School, The University of New South Wales, Sydney.
Med Care. 2019 May;57 Suppl 5 Suppl 1:S85-S91. doi: 10.1097/MLR.0000000000001094.
Patient-reported Outcomes for Personalized Treatment and Care (PROMPT-Care) is the first eHealth system in Australia that is fully electronically integrated into hospital oncology information systems, enabling real-time, routine collection of patient-reported outcomes (PROs) to support and enable cancer patients to achieve and maintain improved health, well-being, and cancer outcomes. Five previously published papers detail the impetus for developing this eHealth system, its development, and testing of its acceptability and feasibility, the development of algorithms to standardize the cancer care pathways which underpin patient care, and the protocol for evaluating the efficacy of PROMPT-Care.
This manuscript provides "how-to" guidance to inform future system development, focusing on selecting relevant PROs and measuring them in cancer patients, score interpretation, and determining recommended care in response to scores which are above the predetermined threshold.
Electronic PRO systems are increasingly used in cancer clinical care settings, with the potential to support timely patient-centered care when implemented appropriately.
PRO selection should consider patient response burden, and prioritizing PROs that are amenable to clinical intervention. Having clear, evidence-based, care pathways, and actionable recommendations in response to above-threshold PRO scores facilitate PRO integration into the clinical workflow. Centers should determine thresholds for clinical action for each PRO which provide an acceptable balance between false positives and false negatives; and develop care pathway recommendations which consider the availability of local services and resources, are feasible in the clinical setting, clear, concise, manageable, based on evidence-based guidelines, and adaptable to local environments.
个性化治疗和护理患者报告结局（PROMPT-Care）是澳大利亚第一个完全与医院肿瘤信息系统电子集成的电子健康系统，能够实时、常规地收集患者报告结局（PROs），以支持并使癌症患者改善健康、幸福感和癌症结局。此前发表的五篇论文详细介绍了开发这个电子健康系统的动力、它的开发、以及对其可接受性和可行性的测试，为支持患者护理的癌症护理路径制定算法的发展，以及评估 PROMPT-Care 疗效的方案。
本文提供了“如何做”的指导，以告知未来的系统开发，重点是选择相关的 PROs 并在癌症患者中进行测量、评分解释以及确定对超过预定阈值的分数的推荐护理。
电子 PRO 系统越来越多地用于癌症临床护理环境，当适当地实施时，有可能支持及时的以患者为中心的护理。
PRO 选择应考虑患者的反应负担，并优先考虑那些易于进行临床干预的 PROs。有明确的、基于证据的护理路径和针对超过阈值的 PRO 分数的可操作建议，有助于将 PRO 整合到临床工作流程中。中心应确定每个 PRO 的临床行动阈值，以在假阳性和假阴性之间取得可接受的平衡；并制定考虑当地服务和资源可用性、在临床环境中可行、清晰、简洁、可管理、基于循证指南和适应当地环境的护理路径建议。
