Implementation of Integrated Patient-Reported outcome collection in outpatient cranial neurosurgical Practice: Results of qualitative interviews.

Objective: Patient Reported Outcome Measures (PROMs) quantify the patient's quality of life and symptom burden. This study assesses the implementation of an automated PROM-capture system in an outpatient cranial neurosurgery clinic.

Methods: We conducted both quantitative and qualitative analyses of the implementation of a PROM tool in a single-center, dedicated brain tumor neurosurgery clinic. The primary measures were the PROMIS-10 and FACT-Br. The primary outcome of interest was PROM tool completion. For qualitative analysis, patients and providers were queried over a 6-month period to participate in a phone interview on their PROM tool experience.

Results: 2,211 patients completed the PROM tool. The quantitative analysis found that white race (OR 1.42, 95% CI 1.21 - 1.68), being of non-Hispanic ethnicity (OR 1.20, 95% CI 1.06 - 1.37), or having private insurance (OR 1.28, 95% CI 1.08 - 1.53) were all associated with higher odds of PROM tool completion. Having an inactive patient portal - My Health At Vanderbilt (MHAV [OR 0.62, 95% CI 0.42 - 0.90]), or appointment providers were associated with decreased odds of PROM tool completion. In-person visits for new patients or for follow-up care were less likely to complete PROM tools as compared to telehealth. Fifteen patients and two providers participated in the phone interview, and the demographics of this group matched the overall cohort. Both patients and providers felt the PROM tool was pertinent, beneficial to patient care, and focused communication between the patient and provider.

Conclusions: This implementation study identified several barriers to developing an automated PROM-collection system in an outpatient cranial neurosurgery practice. These findings have been used to refine this system at our institution and may inform similar implementations elsewhere.