Utility and Impact of the Implementation of Same-Day, Self-administered Electronic Patient-Reported Outcomes Assessments in Routine HIV Care in two North American Clinics

Abstract

The PROgress study assessed the value and feasibility of implementing web-based patient-reported outcomes assessments (PROs) within routine HIV care at two North American outpatient clinics. People with HIV (PWH) completed PROs on a tablet computer in clinic before their routine care visit. Data collection included PROs from 1632 unique PWH, 596 chart reviews, 200 patient questionnaires, and 16 provider/staff questionnaires. During an initial setup phase involving 200 patients, PRO results were not delivered to providers; for all subsequent patients, providers received PRO results before the consultation. Chart review demonstrated that delivery of PRO results to providers improved patient-provider communication and increased the number of complex health and behavioral issues identified, recorded, and acted on, including suicidal ideation (88% with vs 38% without PRO feedback) and anxiety (54% with vs 24% without PRO feedback). In post-visit questionnaires, PWH (82%) and providers (82%) indicated that the PRO added value to the visit.

Keywords: HIV care; Implementation science; Patient-reported outcomes; Quality of life; Suicidal ideation.

Fig. 1

Example of patient-reported outcomes assessment provider feedback summary (based on a fictional patient). AUDIT-C Alcohol Use Disorders Identification Test for Consumption, DOB date of birth, HATQoL HIV/AIDS-Targeted Quality of Life, IPV intimate partner violence, MRN medical record number, PHQ-9 Patient Health Questionnaire 9

Fig. 2

PROgress study design and participants. PWH people with HIV, PRO patient-reported outcomes assessment. ^aReasons for not initiating the PRO were language barriers (n = 68), felt not needed/useful (n = 22), literacy barriers (n = 21), not in mood (n = 13), vision problems (n = 11), perceived length (n = 10), cognitive problems (n = 7), too sick (n = 3), tired of it (n = 1), other reason (n = 6), and no reason given (n = 19). ^b2 participants did not complete the PRO for unknown reasons. ^cIncluding 1102 completed Acceptability E-scales. ^dQualitative analysis of one-on-one interviews is part of planned future work and is not described here. ^eSetup phase = without PRO feedback to providers; delivery phase = with PRO feedback to providers

Fig. 3

Patient-reported outcomes assessment responses to HIV/AIDS-Targeted Quality of Life satisfaction with HIV medications questions

Fig. 4

Results of structured surveys carried out during the delivery phase with A providers (N = 11) and B clinic staff (N = 5) to assess the perceived impact of PROs. PRO patient-reported outcomes assessment

Fig. 5

Results of A PIPPI (N = 200) and B Acceptability E-scale (N = 1102) surveys to assess participants’ perceived impact and acceptability of PROs. ^aNumber of participants who responded to the question. ^bParticipants were asked to score the statements on a scale of 1 to 5. For panel A, 1 represented strong disagreement and 5 represented strong agreement. For panel B, 1 represented a low level of ease, satisfaction, and understanding and 5 represented a high level. *Mean scores significantly different between sites (P < 0.05, t test). MSCC Midway Specialty Care Center, PIPPI perceived impact of PROs on patient-provider interaction, PRO patient-reported outcomes assessment, SMH St Michael’s Hospital