Real-time symptom monitoring using electronic patient-reported outcomes: A prospective study protocol to improve safety during care transitions for patients with multiple chronic conditions

IF 2.4 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of hospital medicine Pub Date : 2025-02-16 DOI:10.1002/jhm.70013

Savanna Plombon BS, MPH, Robert S. Rudin PhD, Jorge Rodriguez MD, MPH, Pamela Garabedian MS, Stuart Lipsitz PhD, Maria Edelen PhD, Marie Leeson BS, Madeline Smith BS, MPH, Kaitlyn Konieczny BS, Anuj K. Dalal MD

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引用次数: 0

Abstract

Introduction

Adverse events (AEs) during transitions from hospitals to ambulatory settings occur in 19%–28% of cases, posing a significant threat to patient safety. Early screening for worrisome symptoms and deterioration in overall health is critical for older adult patients with multiple chronic conditions (MCCs). Clinically integrated apps that remotely monitor symptoms and collect patient-reported outcomes (PROs) can predict AEs when combined with electronic health record (EHR) data. This innovative intervention may enable more timely detection, escalation, and mitigation of harm from AEs for patients with MCCs during transitions.

Methods

This remote monitoring intervention leverages evidence-based frameworks for care transitions and health technologies. We will develop and validate a prediction model of postdischarge AEs using validated symptoms, PRO questionnaires, and EHR data. Existing digital infrastructure will be adapted to facilitate remote monitoring. We will employ a user-centered approach to identify patient and clinician requirements to guide the design and development of our intervention. Interoperable data exchange standards and application programming interfaces will be utilized to integrate the intervention with vendor EHRs and patient portals. A randomized controlled trial will be conducted to compare the effect of our intervention versus usual care on postdischarge AEs in MCC patients transitioning from the hospital. A mixed-methods evaluation will be performed to generate best practices for disseminating this intervention at institutions with different EHRs.

Discussion

A patient-centric, digitally enabled surveillance strategy that monitors symptoms and electronic PROs, educates patients about risks, and ensures communication with clinicians has the potential to transform care for patients with MCCs during transitions.

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使用电子患者报告结果的实时症状监测：一项前瞻性研究方案，以提高多种慢性疾病患者在护理过渡期间的安全性。

从医院转到门诊的不良事件（ae）发生率为19%-28%，对患者安全构成重大威胁。早期筛查令人担忧的症状和整体健康状况的恶化对患有多种慢性疾病（mcs）的老年患者至关重要。远程监控症状和收集患者报告结果（PROs）的临床集成应用程序可以结合电子健康记录（EHR）数据预测ae。这种创新的干预措施可能使mcc患者在过渡期间更及时地发现、升级和减轻ae的危害。方法：这种远程监测干预利用循证框架进行护理转换和卫生技术。我们将使用经过验证的症状、PRO问卷和电子病历数据，开发并验证出院后ae的预测模型。现有的数字基础设施将进行调整，以方便远程监控。我们将采用以用户为中心的方法来确定患者和临床医生的需求，以指导我们干预措施的设计和开发。可互操作的数据交换标准和应用程序编程接口将用于将干预与供应商电子病历和患者门户集成。将进行一项随机对照试验，比较我们的干预与常规护理对MCC患者出院后不良事件的影响。将进行混合方法评估，以产生最佳做法，以便在具有不同电子病历的机构中传播这一干预措施。讨论：以患者为中心的数字化监测策略，监测症状和电子诊断，教育患者风险，并确保与临床医生的沟通有可能改变mcc患者在过渡期间的护理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of hospital medicine 医学-医学：内科

CiteScore

4.40

自引率

11.50%

发文量

233

审稿时长

4-8 weeks

期刊介绍： JHM is a peer-reviewed publication of the Society of Hospital Medicine and is published 12 times per year. JHM publishes manuscripts that address the care of hospitalized adults or children. Broad areas of interest include (1) Treatments for common inpatient conditions; (2) Approaches to improving perioperative care; (3) Improving care for hospitalized patients with geriatric or pediatric vulnerabilities (such as mobility problems, or those with complex longitudinal care); (4) Evaluation of innovative healthcare delivery or educational models; (5) Approaches to improving the quality, safety, and value of healthcare across the acute- and postacute-continuum of care; and (6) Evaluation of policy and payment changes that affect hospital and postacute care.