Departments of Psychology and Medicine and Sylvester Comprehensive Cancer Center, University of Miami, Coral Gables, FL.
Department of Public Health Sciences, University of Miami, Miami, FL.
JCO Oncol Pract. 2022 Jul;18(7):e1100-e1113. doi: 10.1200/OP.21.00706. Epub 2022 Mar 15.
Describe the feasibility and implementation of an electronic health record (EHR)-integrated symptom and needs screening and referral system in a diverse racial/ethnic patient population in ambulatory oncology.
Data were collected from an ambulatory oncology clinic at the University of Miami Health System from October 2019 to January 2021. Guided by a Patient Advisory Board and the Exploration, Preparation, Implementation, and Sustainment model, was developed to assess physical and psychologic symptoms and needs of ambulatory oncology patients before appointments to triage them to supportive services when elevated symptoms (eg, depression), barriers to care (eg, transportation and childcare), and nutritional needs were identified. Patients were assigned assessments at each appointment no more than once in a 30-day period starting at the second visit. Assessments were available in English and Spanish to serve the needs of the predominantly Spanish-speaking Hispanic/Latino population.
From 1,232 assigned assessments, more than half (n = 739 assessments; 60.0%) were initiated by 506 unique patients. A total of 65.4% of English and 49.9% of Spanish assessments were initiated. Among all initiated assessments, the majority (85.1%) were completed at home via the patient portal. The most common endorsed items were nutritional needs (32.9%), followed by emotional symptoms (ie, depression and anxiety; 27.8%), practical needs (eg, financial concerns; 21.7%), and physical symptoms (17.6%). Across the physical symptom, social work, and nutrition-related alerts, 77.1%, 99.7%, and 78.8%, were addressed, respectively, by the corresponding oncology health professional, social work team member, or nutritionist.
The results demonstrate encouraging feasibility and initial acceptability of implementing an EHR-integrated symptom and needs screening and referral system among diverse oncology patients. To our knowledge, this is the first EHR-integrated symptom and needs screening system implemented in routine oncology care for Spanish-speaking Hispanics/Latinos.
描述在门诊肿瘤学中，针对不同种族/族裔的患者人群，在电子健康记录 (EHR) 中集成症状和需求筛查及转介系统的可行性和实施情况。
数据来自迈阿密大学健康系统的一个门诊肿瘤学诊所，收集时间为 2019 年 10 月至 2021 年 1 月。在患者咨询委员会和探索、准备、实施和维持模型的指导下，开发了一种方法，用于在预约前评估门诊肿瘤患者的身体和心理症状和需求，以便在发现症状升高（例如抑郁）、护理障碍（例如交通和儿童保育）和营养需求时将其分诊至支持服务。患者在第二次就诊后的 30 天内，每次就诊最多可进行一次评估。评估提供英文和西班牙文两种版本，以满足主要讲西班牙语的西班牙裔/拉丁裔人群的需求。
从 1232 次分配的评估中，超过一半（n=739 次评估；60.0%）由 506 名独特患者发起。英语评估的启动率为 65.4%，西班牙语评估的启动率为 49.9%。在所有发起的评估中，大多数（85.1%）是在家通过患者门户完成的。最常被认可的项目是营养需求（32.9%），其次是情绪症状（如抑郁和焦虑；27.8%）、实际需求（如经济问题；21.7%）和身体症状（17.6%）。在身体症状、社会工作和营养相关的警报中，相应的肿瘤学健康专业人员、社会工作团队成员或营养师分别解决了 77.1%、99.7%和 78.8%的问题。
结果表明，在不同的肿瘤患者中实施 EHR 集成症状和需求筛查及转介系统具有令人鼓舞的可行性和初步可接受性。据我们所知，这是第一个在西班牙语裔/拉丁裔常规肿瘤护理中实施的 EHR 集成症状和需求筛查系统。
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