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PROM used at patient level

Explore the potential benefits of Patient Reported Outcome Measures (PROM) at the patient level, including improved quality of care, patient involvement, and resource optimization. Discuss different PROM approaches and the potential for disruptive innovation in healthcare.

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PROM used at patient level

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  1. PROM used at patient level Niels Henrik Hjollund Consultant, Associate Professor, Ph.D.

  2. WestChronic • Hospital department • Collect PROM in chronic and malignant diseases • 18 diagnostic groups • Long-term follow-up • Repetitive data collection

  3. Demands now - and in the future • More patients! • Better quality of care! • Same resources (if lucky) • Can PROM provide solution?

  4. Disruptive vs incremental innovation1 • Incremental innovation • An added task • Business case difficult • Disruptive innovation • Changes microsystems, flows and roles • ”PROs - not the patient visit - are at the center of the model”Donaldson 2008 1) Christensen, C.M., Bohmer, R. & Kenagy, J. (2000). Will disruptive innovations cure health care? Harvard Business Review, 78(5), 102–112, 119.

  5. PROM potentials at patient level Quality of care • Flagging important symptoms • Better documentation Patient involvement • Patient education • Visits focused on patient’s need Resurce optimation • More efficient visits • Eliminate needless visits?

  6. Potential benefits in each PROM step

  7. Two PROM approaches • Hospital-PROM • Tele-PROM

  8. PROM potentials at patient level • Simple technology • High response-rate • Useful • However: • Resources for support • Patient has to show up

  9. Potential benefits in each PROM step

  10. Two PROM approaches • Hospital-PROM • Tele-PROM

  11. Potential benefits in each PROM step

  12. Flexible outpatient visits (AmbuFlex)

  13. Automated process: the algorithm Green: no need or wish of visit. Automatically scheduled a new PROM after a patient-specific interval (e.g. 3 months). Yellow: possible need of visit: a clinician should review the EHR and PROM – and decide. Red: definite need or wish of outpatient visit.

  14. Status 5 Sept 2013AmbuFlex/epilepsy *Estimated at 1th questionnaire

  15. What do the patients say? • Saves time and resources • Less interference with job • More comprehensive than visits • Paper PROM option acknowledged

  16. Tele-PROM diagnostic groups • Heart failure (2009-2010) • Screening for depression in IHD patients (2011-) • Knee and hip replacements (2011-2012) • Epilepsy (2012-) • Renal failure (2013-) • Sleep disorders (2013-) • Neuromuscular diseases (2013-) • Lung- and prostatic cancer (2014-)

  17. Receipt of a good AmbuFlex Diagnostic group • Out-patients • Many visits • Patient information essential, not hands-on • No need for visit, given OK PROM Organisation • Clinician ownership • Department management support

  18. Logistic demands for clinical use of tele-PROM • High response rate >80%

  19. Randomiserede studies of response-rates to paper- or web-based questionnaires I: Internet version P: Papir version

  20. Why? • Many patients prefer paper-PROMs • Advantages for data-collector, not the data-provider • Internet fatigue… • We cannot send nurse Ratched home to all the patients

  21. Response rates • ePRO will work: • If the patient have to show up anyway • ePRO will not work: • TelePROM Let the patient choose: use mixed mode!

  22. Mixed mode telePRO: let the patient choose • Initial response rate 92-93% • Total integration and automation (OCR) • 55-60% migrate to web/mail • Paper is not that expensive • And ePRO is not free!

  23. One-step creation of multi-mode PROMS

  24. Automatic dynamic switching between modes E-mail/texting with WWW instruction Letter with WWW instruction Postal paper form Q1 Response ? Access www ? Q2 Q2 Response ? Response ? Access www ? e-mail ? Q3 Q3 Q3 Response ? Response ? Response ? Access www ? e-mail ? Qn Qn Qn

  25. What do we need to achieve succes with clinical tele-PROM? • Relevant diagnostic groups • Many visits, PROM is essential • High coverage • Multimode, shared technology • Close cooperation with front-desk clinicians • Dedicated personnel at index-department • Models for development • Interactive: Clinicians do not know what they need • Flexibility • Generic configurable systems • Connectivity • EHR-system + population registers etc

  26. Disruptive vs incremental innovation1 • Incremental innovation • An added task • Business case difficult • Disruptive innovation • Changes microsystems, flows and roles • ”PROs - not the patient visit - are at the center of the model”Donaldson 2008 • Realistic business 1) Christensen, C.M., Bohmer, R. & Kenagy, J. (2000). Will disruptive innovations cure health care? Harvard Business Review, 78(5), 102–112, 119.

  27. Primary aims for data collection Projects (ad hoc) Daily operation (continously) Recruitment Aggregation Group-level Quality improvement Research Individual level Clinical use Prognosis

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