肿瘤环境中关键患者报告结局指标的管理：系统开发与回顾性研究
Managing Critical Patient-Reported Outcome Measures in Oncology Settings: System Development and Retrospective Study.
作者信息
Strachna Olga, Asan Onur, Stetson Peter D
机构信息
School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, NJ, United States.
Division of Digital Products and Informatics, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
出版信息
JMIR Med Inform. 2022 Nov 3;10(11):e38483. doi: 10.2196/38483.
BACKGROUND
Remote monitoring programs based on the collection of patient-reported outcome (PRO) data are being increasingly adopted in oncology practices. Although PROs are a great source of patient data, the management of critical PRO data is not discussed in detail in the literature.
OBJECTIVE
This first-of-its-kind study aimed to design, describe, and evaluate a closed-loop alerting and communication system focused on managing PRO-related alerts in cancer care.
METHODS
We designed and developed a novel solution using an agile software development methodology by incrementally building new capabilities. We evaluated these new features using participatory design and the Fit between Individuals, Task, and Technology framework.
RESULTS
A total of 8 questionnaires were implemented using alerting features, resulting in an alert rate of 7.82% (36,838/470,841) with 13.28% (10,965/82,544) of the patients triggering at least one alert. Alerts were reviewed by 501 staff members spanning across 191 care teams. All the alerts were reviewed with a median response time of 1 hour (SD 185 hours) during standard business hours. The most severe (red) alerts were documented 56.83% (2592/4561) of the time, whereas unlabeled alerts were documented 27.68% (1298/4689) of the time, signaling clinician concordance with the alert thresholds.
CONCLUSIONS
A PRO-based alert and communication system has some initial benefits in reviewing clinically meaningful PRO data in a reasonable amount of time. We have discussed key system design considerations, workflow integration, and the mitigation of potential impact on the burden of care teams. The introduction of a PRO-based alert and communication system provides a reliable mechanism for care teams to review and respond to patient symptoms quickly. The system was standardized across many different oncology settings, demonstrating system flexibility. Future studies should focus on formally evaluating system usability through qualitative methods.
背景
基于收集患者报告结局（PRO）数据的远程监测项目在肿瘤学实践中越来越多地被采用。尽管PRO是患者数据的重要来源，但文献中并未详细讨论关键PRO数据的管理。
目的
这项首创性研究旨在设计、描述和评估一个闭环警报与通信系统，该系统专注于管理癌症护理中与PRO相关的警报。
方法
我们采用敏捷软件开发方法，通过逐步构建新功能来设计和开发一种新颖的解决方案。我们使用参与式设计以及个体、任务和技术之间的适配框架对这些新功能进行评估。
结果
共使用警报功能实施了8份问卷，警报率为7.82%（36,838/470,841），13.28%（10,965/82,544）的患者触发了至少一次警报。来自191个护理团队的501名工作人员对警报进行了审查。在正常工作时间内，所有警报的审查中位响应时间为1小时（标准差185小时）。最严重（红色）警报的记录时间占56.83%（2592/4561），未标记警报的记录时间占27.68%（1298/4689），这表明临床医生与警报阈值一致。
结论
基于PRO的警报与通信系统在合理时间内审查具有临床意义的PRO数据方面具有一些初步益处。我们讨论了关键的系统设计考虑因素、工作流程整合以及减轻对护理团队负担的潜在影响。引入基于PRO的警报与通信系统为护理团队快速审查和应对患者症状提供了一种可靠机制。该系统在许多不同的肿瘤学环境中实现了标准化，展示了系统的灵活性。未来的研究应侧重于通过定性方法正式评估系统的可用性。
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