Using Quality Improvement and Implementation Science to Identify Strategies That Foster Electronic Patient-Reported Outcome Submissions.

Background: Six cancer centers conducted a pragmatic type-II hybrid effectiveness-implementation study of eSyM, an electronic patient-reported outcomes (ePRO)-based symptom management program. Centers collected key performance indicators and recorded implementation strategies. To inform efforts to deploy ePROs as part of routine care, we sought to identify strategies associated with periods of special cause variation in weekly ePRO submission rates.

Methods: ePRO utilization rates and implementation strategies were collected from August 2019 to April 2022. Statistical process control (SPC) methodology was used to identify periods of non-random variation, known as special cause variation, for all six centers. Investigators identified implementation strategies that were temporally associated with periods of special cause variation across centers.

Results: For 714 weeks of ePRO reporting, the mean weekly response rate was 22.3% with wide variability by site. SPC charts detected multiple special cause variations at all sites. Direct patient outreach strategies to educate about and encourage use of ePROs were most associated with positive special cause variation.

Conclusions: These findings highlight the positive effect of direct patient outreach on ePRO responsiveness and identify opportunities for improving symptom management. Quality improvement techniques, such as SPC charting, could help facilitate implementation of complex interventions and tailor them to the needs of specific populations and health systems.