Purpose/Objectives: Patient-reported outcome (PRO) measures are standardized tools used for the assessment of symptoms associated with disease or disorder and for monitoring effectiveness of an intervention. PRO measures are increasingly utilized to foster patient-centered care in healthcare communities, as they encourage shared healthcare decisions with the opportunity for unfiltered patient response. In addition, PROs have been shown to improve care process, increase both patient and provider satisfaction, and ultimately improve health outcomes. The first aim of this study was to implement PRO measures in a developmental and behavioral pediatric (DBP) clinic where there is a high prevalence of autism spectrum disorder, ADHD, and anxiety symptoms. These conditions rely on patient/parent report to monitor a child’s progress over time, making PRO measures especially helpful. The second aim was to increase and sustain provider review and documentation of these measures within the electronic medical record (EMR) for at least 95% of eligible encounters. Design/Methods: The PRO measures utilized were the Vanderbilt Follow-Up Assessment and PROMIS-Anxiety Short Form. These measures were assigned to all patients, age 5-21 years, presenting for follow-up visit in the DBP clinic. Measures were assigned via the EMR; families completed the measures through the online patient portal. For the second aim, the project utilized an education campaign, documentation shortcuts, and provider performance metrics to improve provider review and documentation. The model of Plan-Do-Study-Act (PDSA) was used to assess tests of change. Data was collected using the QLIK Sense application within the EMR and analyzed using a Shewhart statistical process control chart, assessing for special cause variation. Results: Measures were successfully assigned to 6,990 encounters over a 58-week period. There has been a consistent rate of over and under assignment via the EMR; approximately 6% of eligible encounters have been missed and approximately 7% of encounters are inappropriately assigned questionnaires. The rate of provider documentation was less than 70% after the initial ten weeks of implementing the measures. Following five PDSA cycles, documentation rates improved and have remained around 88% for all encounters with completed measures since January 2021. If one outlying provider is removed from consideration, the documentation rate for the remaining 23 providers is 93%, nearing the targeted goal of 95%. Special cause variation was identified following the use of personal performance metrics. Conclusion/Discussion: This study suggests that it is feasible to implement PRO measures in a DBP clinic and can be achieved using virtual delivery only. Furthermore, it showed that provider documentation can be improved and sustained using quality improvement strategies, especially the use of personalized performance metrics.

Chart 1

Statistical Process Control Chart

The chart documents the rate of provider documentation over the course of 58 weeks. The chart has been annotated to reflect adjusted means based on special cause variation and timing of interventions.

Chart 1

Statistical Process Control Chart

The chart documents the rate of provider documentation over the course of 58 weeks. The chart has been annotated to reflect adjusted means based on special cause variation and timing of interventions.

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Table 1

Provider Documentation Rate

Provider Documentation Rate
Provider Documentation Rate