How You Feel Is Important: Making PROs Meaningful

Patient behaviors impact multiple chronic conditions

Originally developed for use in research, PROs collected via mobile health applications are increasingly being used by medical providers for patient care. However, PROs are often not used in real time by patients and clinicians, as information is not provided to clinicians in a meaningful way or integrated well into their workflow. Patients find recording their symptoms and sense of wellbeing to be labor intensive and of little perceived benefit, while clinicians have limited time during visits to discuss PROs in a meaningful way. This has resulted in PROs being difficult to incorporate into clinical practice. As the number of patients being treated in primary care settings for multiple chronic conditions with modifiable risk factors increases, a team of University of California at San Francisco (UCSF) researchers are thinking critically about how to integrate PROs into clinical practice in a way that will benefit the patient.

Using technology to capture PROs in real time

To address these issues, Dr. Ida Sim and her UCSF-based research team will develop, test, and evaluate Mobile Patient-Reported Outcomes for Value and Effectiveness (mPROVE). mPROVE will inform clinicians of a patient’s health experiences, such as pain or fatigue symptoms, between clinic visits to improve patient-centered, shared clinical decision making. Using a patient-facing iOS or Android smartphone app available in English, Spanish, and Chinese, PROs will be chosen by patients based on the symptoms most important to them. Providers will review and reflect on PRO data during clinic visits using a provider-facing dashboard.

Benefits for patients, benefits for clinicians

mPROVE will be integrated into UCSF’s clinical workflow at three internal medicine clinics. Its effectiveness will be examined in a primary care population of 120 internal medicine patients with multiple chronic conditions. By using Substitutable Medical Applications, Reusable Technologies on Fast Healthcare Interoperability Resources (SMART on FHIR®) technology, the tool may be used with any EHR, increasing its sustainability and potential for dissemination. Dr. Sim anticipates that collecting PROs in real time using a patient friendly format will result in increased self-efficacy for patients and better communication between patients and clinicians. Dr. Sim is confident mPROVE will enrich the patient-clinician relationship and help clinicians to understand what is important to patients, as well as how the patient feels between clinic visits. This will improve shared decision making and patients’ quality of life.