Doolin James W, Dias Samira L, Cronin Christine, Dizon Don S, Hazard-Jenkins Hannah W, Bian Jessica J, Wong Sandra L, Schrag Deborah, Paudel Roshan, Osarogiagbon Raymond U, Hassett Michael J
J Healthc Qual. 2025 Jul 24. doi: 10.1097/JHQ.0000000000000478.
Six cancer centers conducted a pragmatic type-II hybrid effectiveness-implementation study of eSyM, an electronic patient-reported outcomes (ePRO)-based symptom management program. Centers collected key performance indicators and recorded implementation strategies. To inform efforts to deploy ePROs as part of routine care, we sought to identify strategies associated with periods of special cause variation in weekly ePRO submission rates.
ePRO utilization rates and implementation strategies were collected from August 2019 to April 2022. Statistical process control (SPC) methodology was used to identify periods of non-random variation, known as special cause variation, for all six centers. Investigators identified implementation strategies that were temporally associated with periods of special cause variation across centers.
For 714 weeks of ePRO reporting, the mean weekly response rate was 22.3% with wide variability by site. SPC charts detected multiple special cause variations at all sites. Direct patient outreach strategies to educate about and encourage use of ePROs were most associated with positive special cause variation.
These findings highlight the positive effect of direct patient outreach on ePRO responsiveness and identify opportunities for improving symptom management. Quality improvement techniques, such as SPC charting, could help facilitate implementation of complex interventions and tailor them to the needs of specific populations and health systems.
六个癌症中心开展了一项关于eSyM的实用型II类有效性-实施混合研究，eSyM是一个基于电子患者报告结局（ePRO）的症状管理项目。各中心收集关键绩效指标并记录实施策略。为了为将ePRO作为常规护理一部分进行部署的工作提供信息，我们试图确定与每周ePRO提交率的特殊原因变异期相关的策略。
收集2019年8月至2022年4月期间的ePRO利用率和实施策略。采用统计过程控制（SPC）方法来识别所有六个中心的非随机变异期，即特殊原因变异期。研究人员确定了在各中心与特殊原因变异期在时间上相关的实施策略。
在714周的ePRO报告中，每周平均回复率为22.3%，各站点差异很大。SPC图表在所有站点检测到多个特殊原因变异。直接针对患者的外展策略，即对ePRO进行教育和鼓励使用，与积极的特殊原因变异最相关。
这些发现突出了直接针对患者的外展对ePRO响应性的积极影响，并确定了改善症状管理的机会。质量改进技术，如SPC图表，有助于促进复杂干预措施的实施，并使其适应特定人群和卫生系统的需求。
