Kaiser Permanente, San Francisco, CA.
Kaiser Permanente, Santa Clara, CA.
JCO Clin Cancer Inform. 2021 Aug;5:842-848. doi: 10.1200/CCI.21.00058.
Patient-reported outcome (PRO) tools lead to clinical benefits, including improved overall survival for patients with cancer. However, routine implementation of PROs in clinical practice within the electronic medical record (EMR) by integrated health care delivery systems remains limited. We studied the use of a PRO tool for patients with head and neck cancer (HNC) integrated in an EMR at Kaiser Permanente in Northern California.
Between August 2017 and December 2019, patients with newly diagnosed HNC were surveyed at baseline, then every 3 months using the Functional Assessment of Cancer Therapy-General 7 and Functional Assessment of Cancer Therapy-Head and Neck (version 4). A medical assistant performed a baseline survey on diagnosis and then notified patients electronically per surveillance protocol. Patients who did not respond to online PRO surveys could complete them via telephone or in-person appointments with medical assistants. Abnormal findings on PRO surveys were referred to appropriate members of the care team or the treating Otolaryngology-Head and Neck Surgery physicians.
Two hundred ninety patients received baseline surveys. Patients received up to a maximum of eight subsequent surveys. Of a total of 597 electronic surveys, 585 (97.9%) were completed. The percentage of patients completing each interval survey ranged from 92% to 100%. Multivariate Poisson regression analysis showed patients with English as their primary language and an online secure account were the most likely to complete surveys compared with those patients with non-English as a primary language and without an online account.
PRO tools can be effectively used within the EMR for patients with HNC with a high response rate provided there is strong engagement from a dedicated member of the care team. This has important implications for designing clinical trials and symptom monitoring in clinical practices that incorporate EMRs.
患者报告的结局（PRO）工具可带来临床获益，包括提高癌症患者的总生存率。然而，在综合医疗服务系统中，通过电子病历（EMR）常规实施 PRO 仍受到限制。我们研究了在加利福尼亚州北部 Kaiser Permanente 的 EMR 中整合用于头颈部癌症（HNC）患者的 PRO 工具的使用情况。
在 2017 年 8 月至 2019 年 12 月期间，对新诊断为 HNC 的患者在基线时进行调查，然后使用癌症治疗功能评估一般量表 7 版（Functional Assessment of Cancer Therapy-General 7）和头颈部癌症治疗功能评估量表（Functional Assessment of Cancer Therapy-Head and Neck，版本 4）每 3 个月进行一次调查。医疗助理在诊断时进行基线调查，然后根据监测协议通过电子方式通知患者。对于未在线完成 PRO 调查的患者，他们可以通过医疗助理安排的电话或面对面预约来完成。PRO 调查中出现的异常情况将被转介给护理团队的适当成员或主治耳鼻喉科-头颈外科医生。
290 名患者接受了基线调查。患者最多可接受八次后续调查。在总共 597 份电子调查中，585 份（97.9%）完成。每个间隔调查的患者完成率从 92%到 100%不等。多变量泊松回归分析显示，与非英语为主要语言且没有在线账户的患者相比，英语为主要语言且拥有在线安全账户的患者最有可能完成调查。
如果有专门的护理团队成员积极参与，PRO 工具可以在 HNC 患者的 EMR 中有效使用，且具有较高的响应率。这对头颈癌临床试验设计和纳入 EMR 的临床实践中的症状监测具有重要意义。
