Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois.
Cancer. 2019 Nov 15;125(22):4059-4068. doi: 10.1002/cncr.32172. Epub 2019 Aug 2.
Oncology practice can be enhanced by the integration of the assessment of patient-reported symptoms and concerns into the electronic health record (EHR) and clinical workflows.
Adult oncology outpatients (n = 6825) received 38,422 invitations to complete assessments through the EHR patient portal. Patient-Reported Outcomes Measurement Information System computer adaptive tests were administered to assess fatigue, pain interference, physical function, depression, and anxiety. Checklists identified psychosocial, nutritional, and informational needs. In real time, assessment results were populated in the EHR, and clinicians were notified of elevated symptoms and needs.
In all, 3521 patients (51.6%) completed 8162 assessments; approximately 55% of the responding patients completed 2 or more within 32 months. Fatigue, pain, anxiety, and depression scores were comparable to those of the general population (approximately 5% of assessments triggered clinical alerts across those domains); mean scores indicated a lower level of physical function (with severe scores prompting alerts in nearly 5% of assessments). More than half of assessments triggered an alert based on patient endorsement of supportive care needs, with the majority of those being nutritional (41.82% of assessments). Patient endorsement of supportive care needs was associated with significantly higher anxiety, depression, fatigue, and pain interference scores and lower physical function scores. Patients who triggered clinical alerts tended to be younger and more recently diagnosed, to have greater comorbidities, and to be a racial/ethnic minority. Patients who triggered clinical alerts had more health care service encounters in the ensuing month.
EHR integration facilitated the assessment and reporting of patient-reported symptoms and needs within routine oncology outpatient care.
通过将患者报告的症状和关注点的评估整合到电子健康记录（EHR）和临床工作流程中，可以增强肿瘤学实践。
成年肿瘤门诊患者（n=6825）通过 EHR 患者门户收到了 38422 次完成评估的邀请。通过患者报告的结果测量信息系统计算机自适应测试来评估疲劳、疼痛干扰、身体功能、抑郁和焦虑。检查表确定了心理社会、营养和信息需求。实时地，评估结果在 EHR 中填充，并且通知临床医生关注症状和需求的升高。
共有 3521 名患者（51.6%）完成了 8162 次评估；大约 55%的应答患者在 32 个月内完成了 2 次或更多次评估。疲劳、疼痛、焦虑和抑郁评分与一般人群相当（大约 5%的评估在这些领域触发了临床警报）；平均分数表明身体功能水平较低（近 5%的评估提示严重分数）。超过一半的评估根据患者对支持性护理需求的认可触发了警报，其中大多数是营养方面的（41.82%的评估）。患者对支持性护理需求的认可与明显更高的焦虑、抑郁、疲劳和疼痛干扰评分以及较低的身体功能评分相关。触发临床警报的患者往往更年轻、最近被诊断、合并症更多，并且是种族/民族少数群体。触发临床警报的患者在接下来的一个月中有更多的医疗保健服务接触。
EHR 集成促进了常规肿瘤门诊护理中患者报告的症状和需求的评估和报告。
