Accepted for/Published in: JMIR Medical Informatics
Date Submitted: Jul 23, 2019
Date Accepted: Apr 27, 2020
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Assessing Utilization of eHealth Resources to Increase Clinical Communication
ABSTRACT
Background:
The 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 Veteran Administration (VA). Currently there is no standardized process to collect electronic patient reported outcomes (ePRO) of complementary and integrative health (CIH) into national routine clinical care using an electronic survey platform. This one-year pilot project enrolled veterans attending CIH appointments within Veteran Administration (VA) facilities, using electronic surveys to collect ePRO.
Objective:
The two objectives for this project were to: 1) determine a process for collecting ePRO using 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, 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.
Results:
The project demonstrated the usability of SM 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 patients engaged in CIH activities.
Conclusions:
This project informed our understanding of veterans’ use of VA CIH healthcare, while moving to an automated component of routine clinical care. The project results indicated that while it is feasible to use SM for ePRO, having customizable features to automate administration on a schedule was 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 system that would include standardized whole person measures to wellness.
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