Tsangaris Elena, Hyland Colby, Liang George, O'Gorman Joanna, Huerta Dany Thorpe, Kim Ellen, Edelen Maria, Pusic Andrea
Division of Plastic and Reconstructive Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA 02115, United States.
JAMIA Open. 2023 Dec 26;6(4):ooad108. doi: 10.1093/jamiaopen/ooad108. eCollection 2023 Dec.
imPROVE is a new Health Information Technology platform that enables systematic patient-reported outcome measure (PROM) collection through a mobile phone application. The purpose of this study is to describe our initial experience and approach to implementing imPROVE among breast cancer patients treated in breast and plastic surgery clinics.
We describe our initial implementation in 4 phases between June 2021 and February 2022: preimplementation, followed by 3 consecutive implementation periods (P1, P2, P3). The Standards for Reporting Implementation Studies statement guided this study. Iterative Plan-Do-Study-Act (PDSA) cycles supported implementation, and success was evaluated using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework.
Qualitative interviews conducted during the preimplementation phase elicited 4 perceived implementation barriers. Further feedback collected during each phase of implementation resulted in the development of brochures, posters in clinic spaces, and scripts for clinic staff to streamline discussions with patients, and the resolution of technical issues concerning patient login capabilities, such as compatibility with cell phone software and barriers to downloading imPROVE. Feedback also generated ideas for facilitating provider interpretation of PROM results. By the end of P3, 2961 patients were eligible, 1375 (46.4%) downloaded imPROVE, and 1070 (36.1% of those eligible, 78% of those who downloaded) completed at least 1 PROM.
Implementation efforts across 2 surgical departments at 2 academic teaching hospitals enabled collaboration across clinical specialties and longitudinal PROM reporting for patients receiving breast cancer care; the implementation effort also highlighted patient difficulties with mobile app-based PROM collection, particularly around initial engagement.
imPROVE是一个新的健康信息技术平台，可通过手机应用程序系统地收集患者报告的结局指标（PROM）。本研究的目的是描述我们在乳腺和整形外科诊所治疗的乳腺癌患者中实施imPROVE的初步经验和方法。
我们描述了2021年6月至2022年2月期间分4个阶段的初步实施情况：实施前阶段，随后是3个连续的实施期（P1、P2、P3）。报告实施研究的标准声明指导了本研究。迭代的计划-执行-研究-改进（PDSA）循环支持实施，并使用可及性、有效性、采用率、实施情况和维持情况框架评估成功与否。
在实施前阶段进行的定性访谈发现了4个可感知的实施障碍。在实施的每个阶段收集的进一步反馈导致制作了宣传册、在诊所空间张贴了海报，并为诊所工作人员编写了脚本，以简化与患者的讨论，还解决了与患者登录功能有关的技术问题，如与手机软件的兼容性以及下载imPROVE的障碍。反馈还产生了促进医疗服务提供者解读PROM结果的想法。到P3结束时，2961名患者符合条件，1375名（46.4%）下载了imPROVE，1070名（符合条件者的36.1%，下载者的78%）完成了至少1次PROM。
两所学术教学医院的两个外科部门的实施工作促进了临床专科之间的合作，并为接受乳腺癌治疗的患者进行了纵向PROM报告；实施工作还突出了患者在基于移动应用程序的PROM收集方面的困难，特别是在最初参与方面。
