Friedman Daphne R, Patil Vikas, Li Chunyang, Rassmussen Kelli M, Burningham Zachary, Hamilton-Hill Susan, Kelley Michael J, Halwani Ahmad S
Division of Medical Oncology, Duke University School of Medicine, Durham, NC.
Durham Veterans Administration Health Care System, Durham, NC.
JCO Clin Cancer Inform. 2022 Feb;6:e2100086. doi: 10.1200/CCI.21.00086.
There are growing efforts to integrate patient-reported outcome (PRO) data into electronic health records (EHRs) to bring together disparate sources of patient information and improve medical care. PRO measures can be used to assess cancer symptom presence and severity. Integrating PRO tools in EHRs can alert providers to address symptoms, which is an essential component of comprehensive oncology care.
We modified a PRO used to measure cancer and end-of-life symptoms, the Edmonton Symptom Assessment System to create the Veteran Symptom Assessment System (VSAS). VSAS was implemented as an integrated PRO as part of the Veterans Administration EHR system and was used at hematology-oncology clinics in Veteran Administration (VA) medical centers in the Southeast.
From 2013 to 2014, VSAS was introduced, underwent usability testing and modifications, and was finally implemented in the EHR. Between 2015 and 2019, VSAS was administered 43,883 times in 9,058 patients. Eighty-nine percent of Veterans were male, 11% were female, 52% identified as non-Hispanic White, and 43% identified as African American. Fatigue, shortness of breath with exertion, and pain were most frequently reported initially (68%, 48%, and 45%, respectively) and were most frequently rated as severe (27%, 16%, and 17%, respectively). In patients diagnosed with stage IV cancer, higher symptom burden was significantly associated with shorter overall survival. The majority of Veterans with longitudinal measurements experienced improvement in symptoms, most frequently in severe symptoms.
To our knowledge, this is the first large-scale implementation of a PRO system, integrated in the VA EHR, in ambulatory patients with cancer and blood disorders. The integration of VSAS within the VA EHR is a significant demonstration and a necessary requirement for current and future systemic initiatives in cancer symptom management.
将患者报告结局（PRO）数据整合到电子健康记录（EHR）中的努力日益增加，以汇集不同来源的患者信息并改善医疗护理。PRO 测量可用于评估癌症症状的存在和严重程度。将 PRO 工具整合到 EHR 中可以提醒医护人员处理症状，这是综合肿瘤护理的重要组成部分。
我们修改了一个用于测量癌症和临终症状的 PRO，即埃德蒙顿症状评估系统，以创建退伍军人症状评估系统（VSAS）。VSAS 作为集成的 PRO 作为退伍军人管理局 EHR 系统的一部分实施，并在东南部退伍军人管理局（VA）医疗中心的血液肿瘤诊所使用。
2013 年至 2014 年，VSAS 被引入，进行了可用性测试和修改，最终在 EHR 中实施。2015 年至 2019 年期间，VSAS 在 9058 名患者中使用了 43883 次。89%的退伍军人为男性，11%为女性，52%为非西班牙裔白人，43%为非裔美国人。疲劳、运动时呼吸急促和疼痛最初报告频率最高（分别为 68%、48%和 45%），且最常被评为严重（分别为 27%、16%和 17%）。在诊断为 IV 期癌症的患者中，较高的症状负担与较短的总生存期显著相关。大多数进行纵向测量的退伍军人症状有所改善，最常见于严重症状。
据我们所知，这是 PRO 系统在 VA EHR 中首次大规模应用于患有癌症和血液疾病的门诊患者。VSAS 在 VA EHR 中的整合是当前和未来癌症症状管理系统性举措的重要示范和必要条件。
