Macaron Gabrielle, Moss Brandon P, Li Hong, Baldassari Laura E, Rao Stephen M, Schindler David, Alberts Jay L, Weber Malory, Ayers Malissa, Bethoux François, Boissy Adrienne, Chizmadia Desiree, Conway Devon S, Fink Charlene, Fox Robert J, Gales Shauna, Green Bethany, Hara-Cleaver Claire, Jordan Neal, Mahajan Kedar R, McGinley Marisa P, Miller Deborah M, Namey Marie, Rae-Grant Alexander, Rensel Mary, Young Hilary, Willis Mary A, Ontaneda Daniel, Cohen Jeffrey A, Bermel Robert A
Mellen Center for Multiple Sclerosis (GM, BPM, LEB, MW, MA, FB, AB, DC, DSC, CF, RJF, SG, BG, CH-C, KRM, MPM, DMM, MN, AR-G, MR, HY, MAW, DO, JAC, RAB), Neurological Institute, Cleveland Clinic Foundation; Department of Quantitative Health Sciences (HL), Cleveland Clinic; Schey Center for Cognitive Neuroimaging (SMR), Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation; Department of Biomedical Engineering (DS, JLA), Lerner Research Institute, Cleveland Clinic Foundation, OH; and Epic Systems Corporation (NJ), Verona, WI.
Neurol Clin Pract. 2020 Jun;10(3):222-231. doi: 10.1212/CPJ.0000000000000710.
Comprehensive and efficient assessments are necessary for clinical care and research in chronic diseases. Our objective was to assess the implementation of a technology-enabled tool in MS practice.
We analyzed prospectively collected longitudinal data from routine multiple sclerosis (MS) visits between September 2015 and May 2018. The MS Performance Test, comprising patient-reported outcome measures (PROMs) and neuroperformance tests (NPTs) self-administered using a tablet, was integrated into routine care. Descriptive statistics, Spearman correlations, and linear mixed-effect models were used to examine the implementation process and relationship between patient characteristics and completion of assessments.
A total of 8022 follow-up visits from 4199 patients (median age 49.9 [40.2-58.8] years, 32.1% progressive course, and median disease duration 13.6 [5.9-22.3] years) were analyzed. By the end of integration, the tablet version of the Timed 25-Foot Walk was obtained in 89.0% of patients and the 9-Hole Peg Test in 94.8% compared with 74.2% and 64.3%, respectively before implementation. The greatest increase in data capture occurred in processing speed and low-contrast acuity assessments (0% prior vs 78.4% and 36.7%, respectively, following implementation). Four PROMs were administered in 41%-98% of patients compared with a single depression questionnaire with a previous capture rate of 70.6%. Completion rates and time required to complete each NPT improved with subsequent visits. Younger age and lower disability scores were associated with shorter completion time and higher completion rates.
Integration of technology-enabled data capture in routine clinical practice allows acquisition of comprehensive standardized data for use in patient care and clinical research.
全面而有效的评估对于慢性病的临床护理和研究至关重要。我们的目标是评估一种基于技术的工具在多发性硬化症（MS）诊疗中的应用情况。
我们分析了2015年9月至2018年5月期间从常规多发性硬化症（MS）就诊中前瞻性收集的纵向数据。多发性硬化症性能测试，包括患者报告结局测量（PROMs）和使用平板电脑自行完成的神经性能测试（NPTs），被纳入常规护理。使用描述性统计、Spearman相关性分析和线性混合效应模型来检查实施过程以及患者特征与评估完成情况之间的关系。
共分析了4199例患者的8022次随访就诊（中位年龄49.9[40.2 - 58.8]岁，32.1%为进展型病程，中位病程13.6[5.9 - 22.3]年）。到整合结束时，89.0%的患者获得了平板电脑版的25英尺计时步行测试结果，94.8%的患者获得了9孔插板测试结果，而实施前这两个比例分别为74.2%和64.3%。数据采集增加最多的是处理速度和低对比度视力评估（实施前分别为0%，实施后分别为78.4%和36.7%）。41% - 98%的患者完成了四项PROMs，而之前单一抑郁问卷的采集率为70.6%。随着后续就诊，每个NPT的完成率和完成所需时间都有所改善。年龄较小和残疾评分较低与完成时间较短和完成率较高相关。
在常规临床实践中整合基于技术的数据采集能够获取全面的标准化数据，用于患者护理和临床研究。
