JMIR Publications

ABSTRACT

Background:

The Veteran Administration (VA) Office of Patient Centered Care and Cultural Transformation (OPCC&CT) is invested in improving veteran health through a whole-person perspective while taking advantage of the entire suite of electronic resources available through the VA. Currently there is no standardized process to collect and integrate electronic patient reported outcomes (ePROs) of complementary and integrative health (CIH) into national routine clinical care using an electronic survey platform. This quality improvement project enrolled veterans attending CIH appointments within VA facilities, using eHealth technologies (secure messaging and electronic surveys) to collect ePRO.

Objective:

The two objectives for this project were to: 1) determine a practical process for collecting ePRO using secure messaging and an electronic survey platform; and 2) conduct analyses of survey data using repeated measures to estimate effects of CIH on patient outcomes.

Methods:

100 veterans from one VA facility, comprising eleven cohorts, agreed to participate. VA patient email services [Secure Messaging (SM)] were used to manually send links to a 16-item electronic survey stored in a secure online platform survey storage (Qualtrics). Each survey included questions about patient reported outcomes from CIH programs. Each cohort was sent links to respond to surveys via SM at six-time points: weeks 1 through 4, and weeks 8 and 12. Process evaluation interviews were conducted with 5 primary care providers (PCPs), to assess potential implementation barriers and facilitators to using the PRO survey in usual care.

Results:

The quality improvement project demonstrated the usability of SM and online survey platforms for ePRO data collection. However, SM for ePRO was labor intensive for providers. Descriptive statistics on health competence (PHCS-2), physical and mental health (PROMIS Global-10), and stress (PSS-4) indicated scores collected from ePRO did not significantly change over time when participants engaged in CIH activities. Survey response rates varied (18%-43%) across each of the 12 weekly survey periods. Of those who responded, 74/100 participants provided >/= 1 survey and 90% of the study population were female. The majority (62.3%) of participants who reported any CIH modality use, reported use of 2 or more unique modalities. Interviews with PCPs highlighted specific challenges with secure messaging technology and offered solutions regarding staff involvement in PRO survey implementation.

Conclusions:

This quality improvement project informed our understanding of current available processes for using SM and electronic data platforms to collect ePRO. The project results indicated that while it is possible to use SM and online survey platforms for ePRO, having customizable features to automate administration on a schedule will be needed to reduce provider burden. The lack of significant change on ePRO in this project may be due to timing of measures around CIH use and/or the standard measures taking a biomedical approach to wellness. Future work should focus on identifying an ideal ePRO process that would include standardized whole person measures of wellness.