Patient-reported outcome (PRO) measurements in chronic and malignant diseases: ten years' experience with PRO-algorithm-based patient-clinician interaction (telePRO) in AmbuFlex.
Algorithm
Chronic disease
Decision support systems
Malignant diseases
Outpatient follow-up
Patient-reported outcome measures
Questionnaires
Journal
Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation
ISSN: 1573-2649
Titre abrégé: Qual Life Res
Pays: Netherlands
ID NLM: 9210257
Informations de publication
Date de publication:
Apr 2023
Apr 2023
Historique:
accepted:
06
12
2022
medline:
3
4
2023
pubmed:
14
1
2023
entrez:
13
1
2023
Statut:
ppublish
Résumé
Patient-reported Outcome (PRO) measures may be used as the basis for out-patient follow-up instead of fixed appointments. The patients attend follow-up from home by filling in questionnaires developed for that specific aim and patient group (telePRO). The questionnaires are handled in real time by a specific algorithm, which assigns an outcome color reflecting clinical need. The specific questionnaires and algorithms (named solutions) are constructed in a consensus process with clinicians. We aimed to describe AmbuFlex' telePRO solutions and the algorithm outcomes and variation between patient groups, and to discuss possible applications and challenges. TelePRO solutions with more than 100 processed questionnaires were included in the analysis. Data were retrieved together with data from national registers. Characteristics of patients, questionnaires and outcomes were tabulated for each solution. Graphs were constructed depicting the overall and within-patient distribution of algorithm outcomes for each solution. From 2011 to 2021, 29 specific telePRO solutions were implemented within 24 different ICD-10 groups. A total of 42,015 patients were referred and answered 171,268 questionnaires. An existing applicable instrument with cut-off values was available for four solutions, whereas items were selected or developed ad hoc for the other solutions. Mean age ranged from 10.7 (Pain in children) to 73.3 years (chronic kidney disease). Mortality among referred patients varied between 0 (obesity, asthma, endometriosis and pain in children) and 528 per 1000 patient years (Lung cancer). There was substantial variation in algorithm outcome across patient groups while different solutions within the same patient group varied little. TelePRO can be applied in diseases where PRO can reflect clinical status and needs. Questionnaires and algorithms should be adapted for the specific patient groups and clinical aims. When PRO is used as replacement for clinical contact, special carefulness should be observed with respect to patient safety.
Sections du résumé
BACKGROUND
BACKGROUND
Patient-reported Outcome (PRO) measures may be used as the basis for out-patient follow-up instead of fixed appointments. The patients attend follow-up from home by filling in questionnaires developed for that specific aim and patient group (telePRO). The questionnaires are handled in real time by a specific algorithm, which assigns an outcome color reflecting clinical need. The specific questionnaires and algorithms (named solutions) are constructed in a consensus process with clinicians. We aimed to describe AmbuFlex' telePRO solutions and the algorithm outcomes and variation between patient groups, and to discuss possible applications and challenges.
METHODS
METHODS
TelePRO solutions with more than 100 processed questionnaires were included in the analysis. Data were retrieved together with data from national registers. Characteristics of patients, questionnaires and outcomes were tabulated for each solution. Graphs were constructed depicting the overall and within-patient distribution of algorithm outcomes for each solution.
RESULTS
RESULTS
From 2011 to 2021, 29 specific telePRO solutions were implemented within 24 different ICD-10 groups. A total of 42,015 patients were referred and answered 171,268 questionnaires. An existing applicable instrument with cut-off values was available for four solutions, whereas items were selected or developed ad hoc for the other solutions. Mean age ranged from 10.7 (Pain in children) to 73.3 years (chronic kidney disease). Mortality among referred patients varied between 0 (obesity, asthma, endometriosis and pain in children) and 528 per 1000 patient years (Lung cancer). There was substantial variation in algorithm outcome across patient groups while different solutions within the same patient group varied little.
DISCUSSION
CONCLUSIONS
TelePRO can be applied in diseases where PRO can reflect clinical status and needs. Questionnaires and algorithms should be adapted for the specific patient groups and clinical aims. When PRO is used as replacement for clinical contact, special carefulness should be observed with respect to patient safety.
Identifiants
pubmed: 36639598
doi: 10.1007/s11136-022-03322-9
pii: 10.1007/s11136-022-03322-9
pmc: PMC10063508
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1053-1067Informations de copyright
© 2023. The Author(s).
Références
BMC Health Serv Res. 2019 Sep 4;19(1):631
pubmed: 31484523
J Patient Rep Outcomes. 2019 Sep 13;3(1):61
pubmed: 31520247
JAMA Surg. 2017 Jul 1;152(7):622-627
pubmed: 28329223
Psychother Psychosom. 2015;84(3):167-76
pubmed: 25831962
J Med Internet Res. 2020 Oct 29;22(10):e19685
pubmed: 33118954
N Engl J Med. 2017 Oct 5;377(14):1309-1312
pubmed: 28976860
Acta Psychiatr Scand. 2004 Sep;110(3):225-9
pubmed: 15283743
Clin Rheumatol. 2016 Feb;35(2):467-71
pubmed: 25519219
BMJ Open. 2018 Jul 25;8(7):e021337
pubmed: 30049693
J Comp Eff Res. 2016 Aug;5(5):507-19
pubmed: 27427277
J Natl Cancer Inst. 2014 Sep 29;106(9):
pubmed: 25265940
Qual Life Res. 2020 May;29(5):1335-1347
pubmed: 31900763
Health Qual Life Outcomes. 2018 Sep 6;16(1):175
pubmed: 30189867
Med Care. 2019 May;57 Suppl 5 Suppl 1:S46-S51
pubmed: 30985596
BMC Health Serv Res. 2018 Jul 13;18(1):546
pubmed: 30001729
J Support Oncol. 2012 Jul-Aug;10(4):143-8
pubmed: 22609239
J Clin Epidemiol. 2020 Jun;122:153-159
pubmed: 32061828
Med Care. 2019 May;57 Suppl 5 Suppl 1:S59-S65
pubmed: 30985598
Br J Cancer. 2009 Mar 24;100(6):908-12
pubmed: 19240713
BMC Health Serv Res. 2017 Jan 26;17(1):83
pubmed: 28122609
Eur Respir J. 1999 Oct;14(4):902-7
pubmed: 10573240
Qual Life Res. 2015 Mar;24(3):757-68
pubmed: 25150708
J Bone Joint Surg Br. 1996 Mar;78(2):185-90
pubmed: 8666621
J Natl Cancer Inst. 2017 Sep 1;109(9):
pubmed: 28423407
Arthritis Care Res (Hoboken). 2018 Mar;70(3):353-360
pubmed: 28511288
J Clin Oncol. 2016 Feb 20;34(6):557-65
pubmed: 26644527
Health Qual Life Outcomes. 2020 Jul 11;18(1):225
pubmed: 32653005
J Bone Joint Surg Br. 1998 Jan;80(1):63-9
pubmed: 9460955
Ann Med. 2001 Jul;33(5):337-43
pubmed: 11491192
BMC Health Serv Res. 2013 Jun 11;13:211
pubmed: 23758898
Clin Exp Rheumatol. 2005 Sep-Oct;23(5 Suppl 39):S14-8
pubmed: 16273780
J Patient Rep Outcomes. 2019 Aug 22;3(1):56
pubmed: 31440865
Diabet Med. 2022 May;39(5):e14791
pubmed: 35028992
Qual Life Res. 2016 Mar;25(3):525-34
pubmed: 26790427
J Clin Oncol. 2021 Mar 1;39(7):734-747
pubmed: 33417506
J Med Internet Res. 2019 Sep 30;21(9):e15856
pubmed: 31573943
Clin Lung Cancer. 2021 Mar;22(2):e169-e179
pubmed: 33160899
Diabetes Care. 1997 May;20(5):760-6
pubmed: 9135939
J Med Internet Res. 2012 Oct 03;14(5):e126
pubmed: 23032363
Lancet. 2017 Sep 2;390(10098):959-968
pubmed: 28716313
Med Care. 1992 Jun;30(6):473-83
pubmed: 1593914
Interact J Med Res. 2014 Feb 11;3(1):e5
pubmed: 24518281
Dan Med J. 2016 Feb;63(2):
pubmed: 26836792
J Patient Rep Outcomes. 2021 Oct 16;5(1):107
pubmed: 34655365
Scand J Public Health. 2011 Jul;39(7 Suppl):22-5
pubmed: 21775345
J Eval Clin Pract. 2006 Oct;12(5):559-68
pubmed: 16987118
BMJ Open. 2020 Jun 17;10(6):e035673
pubmed: 32554725
J Clin Oncol. 2014 May 10;32(14):1480-501
pubmed: 24711559
Sleep. 1991 Dec;14(6):540-5
pubmed: 1798888
Med Care. 2019 May;57 Suppl 5 Suppl 1:S85-S91
pubmed: 30985601
J Patient Rep Outcomes. 2020 Oct 30;4(1):88
pubmed: 33125537
J Patient Rep Outcomes. 2018 Sep 05;2:38
pubmed: 30238083
BMJ. 2019 Jan 24;364:k5267
pubmed: 30679170