应用实施科学评估临床心力衰竭护理环境中患者报告结果措施（PROMs）的实施情况。

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open Pub Date : 2024-12-01 DOI:10.1016/j.cjco.2024.09.012

Sarah V.C. Lawrason MSc, PhD , Heather Ross MSc, MD , Michael McDonald MD , Juan Duero Posada MD , Samantha Engbers BAH , Anne Simard MHSc

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引用次数: 0

摘要

背景：心力衰竭（HF）患者的生活质量（QOL）较差，反复住院，疾病症状进行性发展。患者报告结果测量（PROMs）通过评估患者的症状、功能和生活质量，将患者的声音整合到临床护理中。2022年，prom被纳入加拿大安大略省多伦多一家大型学术医院的电子健康记录系统（Epic）。本研究的目的是使用实施科学框架系统地评估PROMs在临床心衰护理中的吸收和整合情况。方法：在Reach， Effectiveness, Adoption, Implementation, and Maintenance （RE-AIM）框架下指导这个混合方法，为期一年的质量改进项目。数据来源包括：临床医生对PROMs的使用；完成prom的患者层面数据；以及与临床医生的半结构化访谈。PROM是堪萨斯城心肌病问卷-12，它捕获了与hf症状频率、身体限制、社会限制和生活质量相关的4个领域（KCCQ-12被用作一般PROM的例子）。定量资料采用描述性统计分析；定性数据分析使用行为变化框架和潜在内容分析。结果：在1年的过程中，更多的患者被分配到PROMs，完成PROMs的患者比例更高，大约80%的患者在问卷上获得高分。临床医生经历了与注意力和决策过程、环境背景和他们的专业角色相关的障碍，以将PROMs整合到实践中。改善PROM吸收的建议包括增加PROM翻译的语言许可，减少在Epic系统中分配和解释PROM的临床医生的认知负荷，以及支持在实践中使用PROM的建模。结论：本研究证明了使用实施科学框架的好处，以评估实践中的PROMs实施并为卫生系统提供可操作的建议。

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Using Implementation Science to Evaluate the Implementation of Patient-Reported Outcome Measures (PROMs) in a Clinical Heart Failure Care Setting

Background

Patients with heart failure (HF) can experience a poor quality-of-life (QOL), recurring hospitalizations, and progressive disease symptoms. Patient-reported outcome measures (PROMs) integrate patients’ voices into clinical care, by assessing patient symptoms, function, and QOL. In 2022, PROMs were incorporated into the electronic health record system (Epic) at a large academic hospital in Toronto, Ontario, Canada. The purpose of this study was to use implementation-science frameworks to systematically evaluate the uptake and integration of PROMs into clinical HF care.

Methods

The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework guided this mixed-methods, 1-year, quality-improvement project. Data sources included the following: clinician use of PROMs; patient-level data on completed PROMs; and semistructured interviews with clinicians. The PROM was the Kansas City Cardiomyopathy Questionnaire-12, which captures 4 domains related to HF—symptom frequency, physical limitations, social limitations, and QOL (KCCQ-12 is used as an example case of PROMs in general). Quantitative data were analyzed using descriptive statistics; qualitative data were analyzed using behaviour-change frameworks and latent content analysis.

Results

Over the course of 1 year, more patients were assigned to PROMs, a higher proportion of patients completed PROMs, and approximately 80% of patients had high scores on the questionnaire. Clinicians experience barriers—related to attention and decision processes, the environmental context, and their professional role—to integrating PROMs into practice. Suggested changes to improve PROM uptake include adding language licenses for PROM translations, reducing cognitive load for clinicians who are assigning and interpreting PROMs in the Epic system, and championing modelling of use of PROMs in practice.

Conclusions

This study demonstrates the benefit of using implementation science frameworks, to evaluate the implementation of PROMs in practice and provide actionable recommendations to health systems.

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