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Feasibility Study of HIT-Enabled PROMs in Home Health

Session 175, February 13, 2019

Cynthia Sun, MSN, RN & Gary Rezek, Quality Insights

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Cynthia Sun and Gary Rezek:

• No real or apparent conflicts of interest to report

Conflict of Interest

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• Background

• Barrier / Solution

• Study Description

• Results

• Conclusion

• Considerations for Next Steps

Agenda

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• Describe the feasibility of

integrating HIT-enabled Patient

Reported Outcome Measures

(PROMs) in the home health

setting

• Explain three unique barriers and

possible solutions identified when

integrating HIT-enabled PROMs

in the home health setting

• Discuss impact on home health

patients and clinician workflow

with the integration of HIT-

enabled PROMs

Learning Objectives

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Quality Insights

• Offering health care quality solutions for systems, providers and

patients across the nation since 1973

• Not-for-profit organization that measures and improves health and

health care quality through contracts with federal and state

agencies, foundations and private payers

• More than 200 physicians, nurses, health services researchers,

statisticians, data analysts and educators bringing people and

information together to improve health

• Headquartered in Charleston, West Virginia with offices in

Delaware, Pennsylvania, New Jersey and Virginia

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Background

• Initial plan: Create evidence-based

patient and clinician resources to

improve the home health patient’s level

of self-efficacy

• Barrier: No studies to date have examined using HIT-

enabled Patient Reported Outcomes (PROMs) in skilled

home health care

• Solution: Study feasibility assessing practicality,

integration and acceptability (Bowen et al., (2009)) of

integration of HIT-enabled PROMs into the home health

setting

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Have you used PROMs?

1. Yes via HIT

2. Yes via paper & pencil

3. No, we’re planning to soon

4. Never heard of them

Polling Question

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PROMIS®

Patient-Reported Outcomes Measurement Information System

• Validated person-centered measures

• Multiple delivery formats

• Customizable bank of over 300 patient-focused

health outcome measures

• 3 major domains (physical health, mental health

and social health) & Global health

• www.nihpromis.org

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Method

• Pilot Sites: Two home health agencies

– Location: Pacific Northwest

– Patient populations: Urban & Rural

• Duration: Four months

• IRB Approved

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Instrument

• 10 Apple iPads

• PROMIS® app

– Self-efficacy for managing symptoms (four items)

– Self-efficacy for daily activities (four items)

– Self-efficacy for managing medications and

treatments (four items)

– Global health measures (10 items)

• Airwatch’s Mobile Device Management (MDM)

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Clinician Training

• Administer during scheduled

home visits

• Answer only by patient

• Inclusion criteria:

– Alert

– Willing

– Able to read English

• Repeat assessment in 2-4

weeks

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Feasibility Assessment

• Combination of surveys, interviews, and observations

– Patients

– Clinicians

– Administrators

– Information Technology (IT) staff

• Impact of tablet use on workflow

• Barriers and facilitators of PROM-data-collection using tablets

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# of elderly community-dwellers needing assistance by 2030

1. 1 million

2. 4 million

3. 12 million

4. 25 million

(Source: Bureau of Labor Statistics)

Polling Question

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Results

• 91 registered subjects with ages

ranging from 31 to 100 (mean 71.9,

median 74)

• Eighty-four patients completed the initial

assessment of tablet-based PROM tool

• Eight patients (9.5%) completed the

follow up assessment

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Results

• 64% of patients were female, 33% male

• 87% of patients were white and 92% non-

Hispanic

• 38% reported their level of education. Of

those patients 72% had at least a high

school education

• Mean assessment completion time was 8.3

minutes (median time 6.1 minutes)

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Results

Relationship between assessment duration (in minutes) and

patient characteristics (N=84)

F p df N*

Race 0.65 0.6917 6,70 71

Ethnicity 0.79 0.4593 2,68 69

Gender 0.00 0.9699 1,68 69

Education 1.37 0.2976 7,20 21

Pearson's r p N*

Age 0.30313 0.0107 70

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Results

Distribution of primary diagnosis for patients who

participated in the study

Primary Dx group Count Examples of Diseases Included

Percent

Total

Orthopedic 42

Fracture(s); Muscle weakness; Aftercare following

joint replacement surgery 52%

Cardiovascular 13

Heart failure; Atrial fibrillation; Myocardial

Infarction; Hypertensive heart disease 16%

Integumentary 8

Surgical wound dressings; Open wound; Pressure

ulcer 10%

Urologic 5

Malignant neoplasm of bladder; Urinary tract

infection 6%

Respiratory 6

Chronic obstructive pulmonary disease with (acute)

exacerbation; Pneumonia 7%

Neurologic 3

Hemiplegia and hemiparesis following cerebral

infarction, Diabetic neuropathy, Repeated falls 4%

Other 4 Sepsis, Injury of head 5%

N=81 (cases with non-missing diagnosis data)

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Results

• Clinician feedback pointed to areas for improvement of usability

– Preference for finger use rather than stylus

– Sharing of tablets was a logistical hurdle

– Suggestions for aesthetic enhancements to app

– Technical aspects such as security, update message

popups, power saving settings could be disruptive

• A perceived lack of clinical relevance (to the current clinical

process) led to low rate of repeat assessments

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Conclusion

• HIT-enabled PROMs in the home health

setting is suitable for the workflow

• No negative impact on goals of care

• Tablets were found to be practical and

generally accepted by both home health

clinicians and patients

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Considerations

• Patient functional capabilities at

the tool level of PROMIS®

• Ease of integration of app

collected data into existing EHR

• Future research:

– Test HIT enabled PROMs on

improvement of care quality

and outcomes

– Test on a larger scale

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References

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• Quality Insights: www.qualityinsights.org

• Cynthia Sun: cksun@qualityinsights.org

• Gary Rezek: grezek@qualityinsights.org

• Please remember to complete the evaluations

Questions