Moreno Amy C, Peek Angela, Stein Toshiko S, Shook Kevin R, Ali Sara M, Humbert-Vidan Laia, Chen Aileen, Lango Miriam, Lee Anna, Spiotto Michael, Morrison William H, Garden Adam S, Phan Jack, Frank Steven J, Hutcheson Katherine A, Rosenthal David I, Clifton D Fuller, Brandon Gunn G
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Clinical & Access Applications, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
medRxiv. 2025 Apr 1:2025.03.31.25324980. doi: 10.1101/2025.03.31.25324980.
Patient-reported outcomes (PROs) contain valuable information that can be leveraged by providers to perform timely interventions and improve quality of life and survival. However, the implementation of electronic PROs (ePROs) remains a challenge from technical, behavioral, and evaluation perspectives. Our objective was to construct a robust electronic health record (EHR)-integrated ePRO information infrastructure founded on RE-AIM (Reach-Effectiveness-Adoption-Implementation-Maintenance) principles.
We used Epic Systems as our EHR platform to build the MD Anderson Symptom Index-Head and Neck Module (MDASI-HN) for release to all patients undergoing evaluation and/or treatment in our HN Radiation Oncology clinics. RE-AIM metrics were established and used to design patient-, provider-, and implementing facilitator information tools.
From January 2021 to July 2024, our ePRO program has collected 13,156 ePROs on 3,497 unique HN patients, with a 12-month sustained ePRO compliance rate of 82%. We also propose a dynamic clinical implementation-evaluation cycle. This model can be used to continuously (re)define, build, and adapt ePRO information tools for patients, providers, and program facilitators.
Our ePRO framework has several benefits including integrated clinical data for enhanced decision-making, potential scalability, and use of a common EHR system. Formative (i.e., mid-phase) evaluation and feedback were essential in our program, allowing for timely optimization of ePRO compliance, ePRO usage by clinical staff, and secondary use of high-quality ePRO data.
In this article, we provide a valuable roadmap towards developing a comprehensive, EHR-based ePRO information infrastructure simultaneously optimized for clinical utility and implementation evaluation founded on RE-AIM principles.
患者报告结局（PROs）包含有价值的信息，医疗服务提供者可利用这些信息进行及时干预，提高生活质量和生存率。然而，从技术、行为和评估角度来看，电子PROs（ePROs）的实施仍然是一项挑战。我们的目标是基于RE-AIM（覆盖范围-有效性-采用-实施-维持）原则构建一个强大的电子健康记录（EHR）集成ePRO信息基础设施。
我们使用Epic Systems作为我们的EHR平台，构建了MD安德森症状指数-头颈模块（MDASI-HN），以供我们头颈放射肿瘤学诊所所有接受评估和/或治疗的患者使用。建立了RE-AIM指标，并用于设计患者、医疗服务提供者和实施促进者信息工具。
从2021年1月到2024年7月，我们的ePRO项目已收集了13,156份针对3,497名独特头颈患者的ePRO，12个月的持续ePRO合规率为82%。我们还提出了一个动态临床实施-评估周期。该模型可用于持续（重新）定义、构建和调整面向患者、医疗服务提供者和项目促进者的ePRO信息工具。
我们的ePRO框架有几个优点，包括用于加强决策的集成临床数据、潜在的可扩展性以及使用通用EHR系统。形成性（即中期）评估和反馈在我们的项目中至关重要，有助于及时优化ePRO合规性、临床工作人员对ePRO的使用以及高质量ePRO数据的二次使用。
在本文中，我们提供了一条宝贵的路线图，用于开发一个全面的、基于EHR的ePRO信息基础设施，该基础设施同时基于RE-AIM原则针对临床效用和实施评估进行了优化。
