Examining Clinicians’ Perspectives on Computer-Based Adoption and Use of Patient-Reported Outcomes

Introduction: In The United States, patient care has faced many challenges that have affected care quality, efficiency, and delivery. Patient-centered care, which prioritizes positive outcomes has been validated as a strategy for improving patient care and delivery. Patient-reported outcomes (PROs) can support patient-centered care and when integrated into the electronic health record (EHR) can improve the delivery of care; however, the use of this technology is not widespread. Objective: The purpose of this mixed-method study is to determine the perspective of clinicians and other health professionals about the adoption and use of PROs in the EHR. Method: Q methodology, a research design for studying human subjectivity was used for this study. Purposive sampling was used to recruit clinicians and other health professionals affiliated with universities, hospitals, and research institutions, throughout the United States who have experience using PROs in the EHR. The 8-dimensional model (Sittig and Singh, 2010) was used to guide questions for building a concourse, a list of statements that represent the discourse on PROs in the EHR. After iterative thematic analysis, 49statements resulted for an online survey that participants sorted and ranked according to which ones were most important to them when choosing to adopt PROs. Data were analyzed using principal component analysis and varimax rotation. Excel Version16.4 was used to analyze the demographic data. Results: A total of 50 participants completed the Q sorts which resulted in eight distinct factors.The factors aligned with five dimensions of the 8-Dimensional model.  1) Personnel Dimension: to enable efficient and reliable use and to enable patient involvement for care quality;2) Workflow and Communication Dimension: to enable care process improvement and accountability; 3) User interface Dimension: to enable effective and better symptom assessment and to enable seamless use by all users; 4) Hardware & Software Dimension: to enable actionable and practical clinical decisions; 5) Measurement and Monitoring Dimension: to enable graphical review and interpretation of results and to enable use for holistic care planning to reflect patient’s needs. Other key findings include ideas that have not yet been published such as, using PROs to improve quality of care measures and surveillance; using PROs to encourage patient involvement in decision-making about their care, and developing ways to use PRO item results and cumulative scores in ways that are meaningful to clinicians. Other findings include issues that may create barriers to adopting PROs and include a need for standardized language for using PROs, financial compensation for PRO use, training and education, use of clinician champions, and a physician-centric view for PROsuse. Conclusion: Findings from this study provide insight into the potential challenges of successfully adopting PROs for clinical care. It also identifies areas for future research while highlighting the benefits of using PROs in the clinical setting.