The Agency for Healthcare Research and Quality (AHRQ) is requesting information to help inform a competition in the fall to develop and implement user-friendly technical tools for the collection of patient-reported outcome (PRO) data. The AHRQ is interested in learning about experiences with physical function PRO measures that are currently in use in ambulatory care settings, including primary and secondary care, as well as the methods used to collect these data. The information will be used to select physical function measures for the competition, which aims to bolster collection and integration of PRO data in the electronic health record by developing and piloting new, user-friendly tools. Responses can be emailed to Janey.firstname.lastname@example.org and are due April 1, 2018.
A recently released summary from the ADAPTABLE Roundtable Meeting explores ways to better understand the sets of circumstances and considerations that could guide when and how to gather and integrate patient-reported health data with other data sources in pragmatic trials.
For outcomes that represent subjective experiences, such as pain, symptoms, and physical functioning, the patient is the unique and privileged source of information. Other patient-reported health data may not have a clear source of truth, such as co-morbidities and hospitalizations. In such cases, patient-reported health data may supplement, contradict, or agree with EHR and claims data. For example, medication data reported by patients might be a more accurate reflection of what patients are actually taking than medication data in the EHR, especially for over-the-counter medications.
Patient-reported health data come from various sources and can be feasibly collected in the conduct of a pragmatic clinical trial, but the optimal approaches for capturing and analyzing these data are unclear. Questions include how to integrate this information with other data collected as part of a study, including data from the EHR.
To better understand patient-reported health data and how to use them in pragmatic trials, 18 experts from 8 institutions convened at the roundtable meeting, coming from a wide variety of backgrounds including biostatistics, epidemiology, oncology, nursing, psychiatry, health policy, and regulation. Representatives from the NIH Collaboratory included Drs. Lesley Curtis and Rachel Richesson from the EHR Core and Dr. Kevin Weinfurt from the Patient-Reported Outcomes Core.
In addition to the meeting summary, two white papers are forthcoming. For more information about using patient-reported data in pragmatic trials, see the Living Textbook Chapter on Endpoints and Outcomes.
This effort was funded by Office of the Assistant Secretary for Planning and Evaluation at the U.S. Department of Health and Human Services through a supplement provided to the NIH Collaboratory Coordinating Center.
Patient-reported outcome (PRO) data are critical for informing patient-centered care and patient-centered outcomes research, although they are not commonly collected in routine care, and are often not available for use in clinical care or research. To counter this problem, the Agency for Healthcare Research and Quality (AHRQ) announced an upcoming competition to develop tools to collect and integrate PRO data in electronic health records and other health IT products. During this multi-phase Challenge Competition in the fall of 2018, developers will be asked to create user-friendly application programming interfaces (APIs) and other tools that can be used to collect physical function data in ambulatory care settings based on specifications provided by AHRQ. The tools will enable PRO data to be shared more easily and regularly with clinicians and researchers.
We recently asked Dr. Kevin Weinfurt, Chair of the Patient-Reported Outcomes (PRO) Core, to reflect on the first 5 years of the Core’s work and the challenges ahead. He says the biggest impact of the Core has been working with national initiatives to improve inclusion of PROs in the electronic health record (EHR). Further, Core members have contributed to new knowledge through white papers and chapters in the Living Textbook. In the coming years, he’s hoping the Core will be able to identify the value proposition of PROs.
“Because there are costs associated with collecting PROs, we need to determine when PROS are essential, supporting, or not at all informative for the clinical questions. This gets at the value proposition: When are they of value and to whom?” —Dr. Kevin Weinfurt.
Read more from Dr. Weinfurt in the full interview (pdf).
Patient-reported outcome (PRO) measures are often used in pragmatic clinical trials to assess endpoints that are meaningful to stakeholders. These measures may also support patient care, although there is mixed evidence about effects of PROs on (1) improved patient-provider communication, clinical decision-making, and patient satisfaction; (2) enhanced patient outcomes; and (3) helped ensure better quality of care from a healthcare systems perspective. In a new white paper from the Collaboratory Patient-Reported Outcomes (PRO) Core, the available evidence in the literature is examined to determine when PROs have the potential to provide added value to patient care.
The full text of the white paper can be found here: Impact of Patient-Reported Outcomes on Clinical Practice_V1.0
In recent health information technology news, the University of California, San Francisco (UCSF), has received a 5-year National Institutes of Health award to support its launch of a cardiovascular mHealth platform. The research platform, to be named Health ePeople, will build on the successes of UCSF’s Health eHeart Study, which began in 2013. That study, with more than 30,000 participants worldwide, uses the power of mobile technologies to collect cardiovascular data and patient-reported outcomes (PROs) from study participants.
The Health ePeople platform will advance mHealth by providing researchers with easy access to a large cohort of volunteers, along with a quick, affordable means for collecting their health data through mobile and wireless technologies. Though the platform will not be ready to enroll new participants for several months, people who want to participate in the cohort can sign up through the Health eHeart Study website.
For information and short videos on mHealth technologies, visit the Living Textbook’s chapter on mHealth and PROs.
In a study recently published in JAMA Oncology, researchers found that patient reporting of adverse events of cancer treatment using a new scale gave valid and reliable assessments that correlated with standard measures of functioning and quality of life. The National Cancer Institute (NCI) developed a patient-reported outcome (PRO) version of its Common Terminology Criteria for Adverse Events (CTCAE), which is the standard system for reporting toxicities of cancer treatment in clinical trials. The PRO-CTCAE was then tested among more than 900 patients undergoing treatment at 9 cancer centers. As described in a commentary by Benjamin Movsas, MD, these results are encouraging for PROs to be integrated in informing treatment recommendations, symptom management, and even labeling decisions.
Read more about PROs in the Living Textbook chapter on this topic.
In January of 2015, the NIH HCS Collaboratory’s Patient-Reported Outcomes (PRO) Core Group convened a 2-day workshop in Baltimore devoted to identifying barriers and possible solutions to the use of NIH-supported PRO tools in comparative-effectiveness research (CER).
Findings from the meeting, which include case study presentations and reflections from multiple stakeholders representing the research, clinical, and patient communities, were distilled into a summary document available from the NIH Collaboratory Knowledge Repository at the link below:
- Challenges and Opportunities for the Use of NIH-Supported PRO Tools in Comparative Effectiveness Research (PDF)
The National Patient-Centered Clinical Research Network (PCORnet) Patient-Reported Outcomes (PRO) Task Force has released a new white paper that delineates definitions for data contributed by patients. They hope to facilitate the incorporation of information provided by patients across the networks and to maximize data sharing and interoperability by operationalizing the terms within PCORnet.
The following three terms were adopted to describe the patient-contributed data collected across PCORnet:
PATIENT-REPORTED OUTCOME (PRO): a report that comes directly from the patient about the status of a patient’s health condition without amendment or interpretation of the patient’s response by a clinician or anyone else.
PATIENT-CENTERED OUTCOMES: outcomes that matter to patients
PATIENT-GENERATED HEALTH DATA: health-related data (such as health history, symptoms, biometric data, treatment history, lifestyle choices, and other information) that are created, recorded, gathered, or inferred by or from patients or their designees (i.e., care partners or those who assist them) to help address a health concern. Patient-generated health data include patient-reported outcomes.
Michael Bass and Maria Varela Diaz of the Department of Social Sciences, Feinberg School of Medicine, Northwestern University, have kindly given the Living Textbook permission to post their presentation (link opens as a PDF) about how to use an application programming interface (API) to create a computer adaptive testing (CAT) program that integrates patient-reported outcome (PRO) measures with an institution’s electronic health record (EHR) system.
With a CAT approach, PRO assessment can cover a wide range of question/response items with increased precision. In their CAT application, the authors describe a clinical use case for a mobile health solution, using measures from the NIH-sponsored PRO Measurement Information System (PROMIS®) domain framework, in which a health assessment is issued by a physician, administered to a patient via phone, and then sent back to the EHR.
You can read more about CAT in the Patient-Reported Outcomes chapter of the Living Textbook.