Division of Health Policy and Management, School of Public Health, University of California, Berkeley, Berkeley, CA, USA.
Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA.
J Gen Intern Med. 2022 Nov;37(15):3885-3892. doi: 10.1007/s11606-022-07631-0. Epub 2022 Apr 28.
Patient-reported outcome measures (PROs) can help clinicians adjust treatments and deliver patient-centered care, but organizational adoption of PROs remains low.
This study examines the extent of PRO adoption among health systems and physician practices nationally and examines the organizational capabilities associated with more extensive PRO adoption.
Two nationally representative surveys were analyzed in parallel to assess health system and physician practice capabilities associated with adoption of PROs of disability, pain, and depression.
A total of 323 US health system and 2,190 physician practice respondents METHODS: Multivariable regression models separately estimated the association of health system and physician practice capabilities associated with system-level and practice-level adoption of PROs.
Health system and physician practice adoption of PROs for depression, pain, and disability.
Pain (50.6%) and depression (43.8%) PROs were more commonly adopted by all hospitals and medical groups within health systems compared to disability PROs (26.5%). In adjusted analyses, systems with more advanced health IT functions were more likely to use disability (p<0.05) and depression (p<0.01) PROs than systems with less advanced health IT. Practice-level advanced health IT was positively associated with use of depression PRO (p<0.05), but not disability or pain PRO use. Practices with more chronic care management processes, broader medical and social risk screening, and more processes to support patient responsiveness were more likely to adopt each of the three PROs. Compared to independent physician practices, system-owned practices and community health centers were less likely to adopt PROs.
Chronic care management programs, routine screening, and patient-centered care initiatives can enable PRO adoption at the practice level. Developing these practice-level capabilities may improve PRO adoption more than solely expanding health IT functions.
患者报告的结果测量（PROs）可以帮助临床医生调整治疗方案并提供以患者为中心的护理，但 PRO 的组织采用率仍然很低。
本研究考察了全国卫生系统和医生实践中 PRO 采用的程度，并考察了与更广泛的 PRO 采用相关的组织能力。
平行分析了两项全国代表性调查，以评估与残疾、疼痛和抑郁的 PRO 采用相关的卫生系统和医生实践能力。
共有 323 名美国卫生系统和 2190 名医生实践受访者
多元回归模型分别估计了与 PRO 的系统水平和实践水平采用相关的卫生系统和医生实践能力的关联。
抑郁、疼痛和残疾的 PRO 采用情况。
与残疾 PRO（26.5%）相比，所有医院和医疗集团内更普遍采用疼痛（50.6%）和抑郁（43.8%）PRO。在调整后的分析中，具有更先进的医疗信息技术功能的系统比具有较不先进的医疗信息技术的系统更有可能使用残疾（p<0.05）和抑郁（p<0.01）PRO。实践层面先进的医疗信息技术与抑郁 PRO 的使用呈正相关（p<0.05），但与残疾或疼痛 PRO 的使用无关。具有更多慢性护理管理流程、更广泛的医疗和社会风险筛查以及更多支持患者响应性的流程的实践更有可能采用这三种 PRO 中的每一种。与独立的医生实践相比，系统拥有的实践和社区卫生中心采用 PRO 的可能性较小。
慢性护理管理计划、常规筛查和以患者为中心的护理举措可以在实践层面实现 PRO 的采用。与仅扩大医疗信息技术功能相比，发展这些实践层面的能力可能会更有助于 PRO 的采用。
