Columbia University School of Nursing, New York, New York, United States.
University of Washington School of Nursing, Seattle, Washington, United States.
Appl Clin Inform. 2023 Mar;14(2):227-237. doi: 10.1055/a-2008-4036. Epub 2023 Jan 5.
Health care systems are primarily collecting patient-reported outcomes (PROs) for research and clinical care using proprietary, institution- and disease-specific tools for remote assessment. The purpose of this study was to conduct a Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) evaluation of a scalable electronic PRO (ePRO) reporting and visualization system in a single-arm study.
The ePRO system was designed using gerontechnological design principles to ensure high usability among older adults. The system enables longitudinal reporting of disease-agnostic ePROs and includes patient-facing PRO visualizations. We conducted an evaluation of the implementation of the system guided by the RE-AIM framework. Quantitative data were analyzed using basic descriptive statistics, and qualitative data were analyzed using directed content analysis.
Reach-the total reach of the study was 70 participants (median age: 69, 31% female, 17% Black or African American, 27% reported not having enough financial resources). Effectiveness-half (51%) of participants completed the 2-week follow-up survey and 36% completed all follow-up surveys. Adoption-the desire for increased self-knowledge, the value of tracking symptoms, and altruism motivated participants to adopt the tool. Implementation-the predisposing factor was access to, and comfort with, computers. Three enabling factors were incorporation into routines, multimodal nudges, and ease of use. Maintenance-reinforcing factors were perceived usefulness of viewing symptom reports with the tool and understanding the value of sustained symptom tracking in general.
Challenges in ePRO reporting, particularly sustained patient engagement, remain. Nonetheless, freely available, scalable, disease-agnostic systems may pave the road toward inclusion of a more diverse range of health systems and patients in ePRO collection and use.
医疗保健系统主要通过专有的、机构和疾病特定的工具来收集患者报告的结果（PROs），用于远程评估，以进行研究和临床护理。本研究的目的是使用可扩展的电子 PRO（ePRO）报告和可视化系统在单臂研究中进行可及性、有效性、采用、实施和维持（RE-AIM）评估。
ePRO 系统采用老年技术设计原则设计，以确保老年人具有较高的可用性。该系统能够对疾病无关的 ePRO 进行纵向报告，并包括面向患者的 PRO 可视化。我们根据 RE-AIM 框架对系统的实施进行了评估。使用基本描述性统计分析对定量数据进行分析，使用定向内容分析对定性数据进行分析。
可及性-研究的总可及性为 70 名参与者（中位数年龄：69 岁，31%为女性，17%为黑人和非洲裔美国人，27%报告说没有足够的经济资源）。有效性-有一半（51%）的参与者完成了为期 2 周的随访调查，36%的参与者完成了所有随访调查。采用-增加自我认识的愿望、跟踪症状的价值和利他主义促使参与者采用该工具。实施-倾向因素是能够获得和使用计算机。三个促成因素是将其纳入常规、多模式提示和易于使用。维持-使用该工具查看症状报告的感知有用性以及总体上理解持续症状跟踪的价值是增强因素。
电子 PRO 报告仍然存在挑战，特别是患者的持续参与。尽管如此，免费、可扩展、与疾病无关的系统可能为纳入更广泛的医疗保健系统和患者参与电子 PRO 收集和使用铺平道路。
