Clinical Case Studies
Neuro-QoL™ Measures Collected at Cleveland Clinic
Researchers at Cleveland Clinic developed a suite of iPad-based assessments that are now shared across MS PATHS (Multiple Sclerosis Partners Advancing Technology and Health Solutions) centers. In addition to patient history, the assessments include Neuro-QoL measures. The measures are self-administered prior to routine appointments and, over time, document individuals’ trajectories on important health-related quality of life outcomes.
Previous work documented the validity of using the Neuro-QoL measures in samples of persons with MS. In a sample of persons with MS, the scales demonstrated good reliability, concurrent validity, known groups validity and responsiveness.
PROMIS Measures Collected in Routine Clinical Care at a Children’s Hospital
The Cincinnati Children’s Hospital Medical Center (CCHMC) implemented system-wide assessment with PROMIS and other PRO measures. Across clinics, their completion rate is 75%. Their experience resulted in a publication (Gerhardt et al., 2018) describing recommendations for successful implementation including identification of a physician or nurse champion, matching measures with clinical need, knowing the meaning of scores including when and how to intervene, training providers and staff, and monitoring completion rates. Further discussion by (Lavallee et al, 2018) highlighted the need for such case studies.
PROMIS CATs Collected at University of Utah Health (mEVAL)
The University of Utah integrated PROMIS computer adaptive tests (CATs) in their electronic health record (EHR) as part of their mEVAL initiative. Patients are asked to complete an assessment through the EHR's patient portal or on a tablet computer at an appointment. CATs are automatically scored and results are available to care providers within the EHR. Biber and colleagues (2018) described the barriers and facilitators for this implementation.
PROMIS CATs Collected at Michigan Medicine
Within Orthopaedic Surgery at Michigan Medicine, patients are asked to complete a battery of PROMIS computer adaptive tests (CATs) at each visit. Administration, scoring, and reporting is integrated in the electronic health record using the Epic PROMIS CAT Application. Patient engagement efforts have focused on increasing enrollment and utilization of the electronic health record’s patient portal as well as providing standardized scripts for staff to convey the rationale and importance of the assessment. For more information, contact Michigan Medicine’s Quality Department.
PROMIS Global Health Collected in Routine Clinical Care at a Tertiary Academic Cancer Center
The PROMIS Global Health scale was integrated into the electronic health record (EHR) at a tertiary academic cancer center. Patients are asked to complete the measure through the EHR patient portal prior to an appointment. PROMIS Global is also available in a paper format within the clinic. Seneviratne and colleagues (2018) reported that 24% of patients with prostate cancer and 37% of patients with breast cancer completed at least one measure. Completion rates varied by treatment, age, ethnicity, and insurance. Their publication presents average PROMIS Global Physical Health and PROMIS Global Mental Health scores for demographic and clinical subgroups.
PROMIS Emotional Distress and Sleep Disturbance Short Forms used in DSM-5 Field Trials
PROMIS adult, pediatric, and parent-proxy Depression, Anxiety, Anger, and Sleep Disturbance banks were selected as Level 2 cross-cutting symptom measures for inclusion in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders – Fifth edition (DSM-5).
The selection of these measures highlights the utility of self- and proxy-report measurement tools in a clinical context. Measures can be used to identify areas of mental health requiring clinical investigation and likely intervention, as well as systematically tracking changes in symptom levels over time.
The inclusion of these measures in a clinical context further supports the applicability of PROMIS within both the clinical and research communities, facilitating a stronger relationship between clinical practice and health outcomes research.
Pediatric and Parent Proxy PROMIS Collected at Shriners Hospitals for Children
Patients receiving care at Shriners Hospitals for Children were asked to complete PROMIS Pediatric (ages 8-17) or Parent Proxy (ages 5-7) short forms for Pain Interference, Peer Relationships, Upper Extremity Function, and Mobility on iPads. In real-time, results were scored and available immediately in the electronic health record through an interface with Tonic for Health. Real-time availability to the patients’ physicians provided valuable information and insights on issues that may need to be addressed. The combined data was available for statistical purposes.
PROMIS scores alerted physicians that certain patients were having additional problems that the providers were previously unaware of, prompting providers to integrate other professionals, such as physical therapists, in the patient's care. At Shriners, providers noted that often times children are more comfortable and forthcoming answering questions on the iPad than responding verbally to their physician.
10 Shriners Hospitals for Children locations (Salt Lake City, Greenville, Northern California, St. Louis, Lexington, Chicago, Twin Cities, Portland, Shreveport, Erie) are participating in the program, and have collected over 36,500 PROMIS Pediatric assessments, using more than 100 iPads. Over a 15-month period from April 2017 through July 2018, these hospitals saw a completion rate of 93%. With these achievements, PROMIS has been implemented as a standard of care tool and will be rolled out to all remaining Shriners Hospitals for Children locations.
To facilitate education with their Spanish-speaking patients, the Shriners team created this two-minute video in Spanish explaining the data collection process. Watch the data collection video in Spanish here>>
Systematic Literature Review of Implementations in Oncology
In a 2018 review, Anatchkova and colleagues conducted a systematic literature review of implementation of patient-reported outcomes in oncology care. Using the 2015 ISOQOL User’s Guide for Implementing Patient-Reported Outcomes Assessment in Clinical Practice to create a framework for evaluation, they reviewed 36 publications. Most (n=29, 81%) were reports on intervention or feasibility research. Only three studies described ongoing routine PRO assessment to manage patient care outside of the scope of a research study. Aims for PRO collection were varied including improving symptom monitoring, patient-provider communication, patient-centeredness of care, and quality of care. Only about half of the studies reported intervention results on patient outcomes. The authors also reported a need for guidelines for interpreting PRO scores and for strategies to address concerning PRO scores “...particularly when the identified needs of patients extend beyond the expertise or training found in a routine oncology clinical practice such as depression or lack of social support.” Learn more>>
Screening with PROMIS CATs in Oncology
Garcia et al (2019) used PROMIS computer adaptive tests (CATs) for anxiety, depression, fatigue, physical function, and pain interference to screen and monitor patients receiving care in an oncology clinic. Results were integrated within the electronic health record. Approximately 5% of scores generated alerts for follow-up with clinical or supportive care needs.
Epic PROMIS App in Clinical Practice
Multiple healthcare organizations are successfully collecting HealthMeasures through the PROMIS Epic app. Assessments including computer adaptive tests (CATs), profiles, and short forms can be triggered by scheduled appointments with scores available in real time. Learn more>>