No date for the PROM: the association between patient-reported health events and clinical coding in primary care
Abstract Objective It is unclear whether data from patient-reported outcome measures (PROMs) are captured and used by clinicians despite policy initiatives. We examined the extent to which fall risk and urinary incontinence (UI) reported on PROMS and provided to clinicians prior to a patient visit a...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SpringerOpen
2020-03-01
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| Series: | Journal of Patient-Reported Outcomes |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s41687-020-0183-5 |
| _version_ | 1819158831764078592 |
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| author | Paul J. Barr Scott A. Berry Wendolyn S. Gozansky Deanna B. McQuillan Colleen Ross Don Carmichael Andrea M. Austin Travis D. Satterlund Karen E. Schifferdecker Lora Council Michelle D. Dannenberg Ariel T. Wampler Eugene C. Nelson Jonathan Skinner |
| author_facet | Paul J. Barr Scott A. Berry Wendolyn S. Gozansky Deanna B. McQuillan Colleen Ross Don Carmichael Andrea M. Austin Travis D. Satterlund Karen E. Schifferdecker Lora Council Michelle D. Dannenberg Ariel T. Wampler Eugene C. Nelson Jonathan Skinner |
| author_sort | Paul J. Barr |
| collection | DOAJ |
| description | Abstract Objective It is unclear whether data from patient-reported outcome measures (PROMs) are captured and used by clinicians despite policy initiatives. We examined the extent to which fall risk and urinary incontinence (UI) reported on PROMS and provided to clinicians prior to a patient visit are subsequently captured in the electronic medical record (EMR). Additionally, we aimed to determine whether the use of PROMs and EMR documentation is higher for visits where PROM data was provided to clinicians. Design We conducted a cross-sectional patient-reported risk assessment survey and semi-structured interviews with clinicians to identify themes related to the use of PROMs. Setting Fourteen primary care clinics in the US (eight intervention and six control clinics), between October 2013 and May 2015. Participants Primary care clinicians and older adult (≥66 years) patients completing a 46-item health risk assessment, including PROMs for fall risk and UI. Intervention Risk assessment results provided to the clinician or nurse practitioners prior to the clinic visit in intervention clinics; data was not provided in control clinics. Main outcome 1) Agreement between ICD-9 codes of fall risk or UI in the EMR and patient-reports, and 2) clinician experience of PROMs use and impact on coding. Results A total of 505 older adult patients were included in the study, 176 at control clinics and 329 at intervention clinics. While patient reports of fall risk and UI were readily captured by PROMs, this information was only coded in the EMR between 3% – 14% of the time (poor Kappa agreement). Intervention clinics performed slightly better than control clinics. Clinician interviews (n = 16) revealed low use of PROMs data with multiple barriers cited including poor access to data, high quantity of data, interruption to workflow, and a lack of training on PROMs. Conclusions Current strategies of providing PROMs data prior to clinic visits may not be an effective way of communicating important health information to busy clinicians; ultimately resulting in underuse. Better systems of presenting PROMs data, and clinician training on the importance of PROMs and their use, is needed. |
| first_indexed | 2024-12-22T16:30:55Z |
| format | Article |
| id | doaj.art-cbe9ba18586d4a1386ea21161f1e9ac5 |
| institution | Directory Open Access Journal |
| issn | 2509-8020 |
| language | English |
| last_indexed | 2024-12-22T16:30:55Z |
| publishDate | 2020-03-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Journal of Patient-Reported Outcomes |
| spelling | doaj.art-cbe9ba18586d4a1386ea21161f1e9ac52022-12-21T18:20:03ZengSpringerOpenJournal of Patient-Reported Outcomes2509-80202020-03-01411810.1186/s41687-020-0183-5No date for the PROM: the association between patient-reported health events and clinical coding in primary carePaul J. Barr0Scott A. Berry1Wendolyn S. Gozansky2Deanna B. McQuillan3Colleen Ross4Don Carmichael5Andrea M. Austin6Travis D. Satterlund7Karen E. Schifferdecker8Lora Council9Michelle D. Dannenberg10Ariel T. Wampler11Eugene C. Nelson12Jonathan Skinner13The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth CollegeThe Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth CollegeInstitute for Health ResearchInstitute for Health ResearchInstitute for Health ResearchThe Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth CollegeThe Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth CollegeThe Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth CollegeThe Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth CollegeThe Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth CollegeThe Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth CollegeGeisel School of Medicine at Dartmouth CollegeThe Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth CollegeThe Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth CollegeAbstract Objective It is unclear whether data from patient-reported outcome measures (PROMs) are captured and used by clinicians despite policy initiatives. We examined the extent to which fall risk and urinary incontinence (UI) reported on PROMS and provided to clinicians prior to a patient visit are subsequently captured in the electronic medical record (EMR). Additionally, we aimed to determine whether the use of PROMs and EMR documentation is higher for visits where PROM data was provided to clinicians. Design We conducted a cross-sectional patient-reported risk assessment survey and semi-structured interviews with clinicians to identify themes related to the use of PROMs. Setting Fourteen primary care clinics in the US (eight intervention and six control clinics), between October 2013 and May 2015. Participants Primary care clinicians and older adult (≥66 years) patients completing a 46-item health risk assessment, including PROMs for fall risk and UI. Intervention Risk assessment results provided to the clinician or nurse practitioners prior to the clinic visit in intervention clinics; data was not provided in control clinics. Main outcome 1) Agreement between ICD-9 codes of fall risk or UI in the EMR and patient-reports, and 2) clinician experience of PROMs use and impact on coding. Results A total of 505 older adult patients were included in the study, 176 at control clinics and 329 at intervention clinics. While patient reports of fall risk and UI were readily captured by PROMs, this information was only coded in the EMR between 3% – 14% of the time (poor Kappa agreement). Intervention clinics performed slightly better than control clinics. Clinician interviews (n = 16) revealed low use of PROMs data with multiple barriers cited including poor access to data, high quantity of data, interruption to workflow, and a lack of training on PROMs. Conclusions Current strategies of providing PROMs data prior to clinic visits may not be an effective way of communicating important health information to busy clinicians; ultimately resulting in underuse. Better systems of presenting PROMs data, and clinician training on the importance of PROMs and their use, is needed.http://link.springer.com/article/10.1186/s41687-020-0183-5Patient outcomesFalls and injuriesElderly, primary care/general practice |
| spellingShingle | Paul J. Barr Scott A. Berry Wendolyn S. Gozansky Deanna B. McQuillan Colleen Ross Don Carmichael Andrea M. Austin Travis D. Satterlund Karen E. Schifferdecker Lora Council Michelle D. Dannenberg Ariel T. Wampler Eugene C. Nelson Jonathan Skinner No date for the PROM: the association between patient-reported health events and clinical coding in primary care Journal of Patient-Reported Outcomes Patient outcomes Falls and injuries Elderly, primary care/general practice |
| title | No date for the PROM: the association between patient-reported health events and clinical coding in primary care |
| title_full | No date for the PROM: the association between patient-reported health events and clinical coding in primary care |
| title_fullStr | No date for the PROM: the association between patient-reported health events and clinical coding in primary care |
| title_full_unstemmed | No date for the PROM: the association between patient-reported health events and clinical coding in primary care |
| title_short | No date for the PROM: the association between patient-reported health events and clinical coding in primary care |
| title_sort | no date for the prom the association between patient reported health events and clinical coding in primary care |
| topic | Patient outcomes Falls and injuries Elderly, primary care/general practice |
| url | http://link.springer.com/article/10.1186/s41687-020-0183-5 |
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