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J Gen Intern Med. 2018 Aug;33(8):1245-1252. doi: 10.1007/s11606-018-4391-0. Epub 2018 Apr 5.

Incorporating PROMIS Symptom Measures into Primary Care Practice-a Randomized Clinical Trial.

Author information

1
Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN, USA. kkroenke@regenstrief.org.
2
Regenstrief Institute, Indianapolis, IN, USA. kkroenke@regenstrief.org.
3
Veterans Affairs Health Services Research and Development Center for Health Information and Communication, Indianapolis, IN, USA. kkroenke@regenstrief.org.
4
Regenstrief Institute, Indianapolis, IN, USA.
5
Department of Biostatistics, Fairbanks School of Public Health, Indianapolis, IN, USA.
6
University of Utah School of Medicine, Salt Lake City, UT, USA.
7
Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
8
Veterans Affairs Health Services Research and Development Center for Health Information and Communication, Indianapolis, IN, USA.

Abstract

BACKGROUND:

Symptoms account for more than 400 million clinic visits annually in the USA. The SPADE symptoms (sleep, pain, anxiety, depression, and low energy/fatigue) are particularly prevalent and undertreated.

OBJECTIVE:

To assess the effectiveness of providing PROMIS (Patient-Reported Outcome Measure Information System) symptom scores to clinicians on symptom outcomes.

DESIGN:

Randomized clinical trial conducted from March 2015 through May 2016 in general internal medicine and family practice clinics in an academic healthcare system.

PARTICIPANTS:

Primary care patients who screened positive for at least one SPADE symptom.

INTERVENTIONS:

After completing the PROMIS symptom measures electronically immediately prior to their visit, the 300 study participants were randomized to a feedback group in which their clinician received a visual display of symptom scores or a control group in which scores were not provided to clinicians.

MAIN MEASURES:

The primary outcome was the 3-month change in composite SPADE score. Secondary outcomes were individual symptom scores, symptom documentation in the clinic note, symptom-specific clinician actions, and patient satisfaction.

KEY RESULTS:

Most patients (84%) had multiple clinically significant (T-score ≥ 55) SPADE symptoms. Both groups demonstrated moderate symptom improvement with a non-significant trend favoring the feedback compared to control group (between-group difference in composite T-score improvement, 1.1; P = 0.17). Symptoms present at baseline resolved at 3-month follow-up only one third of the time, and patients frequently still desired treatment. Except for pain, clinically significant symptoms were documented less than half the time. Neither symptom documentation, symptom-specific clinician actions, nor patient satisfaction differed between treatment arms. Predictors of greater symptom improvement included female sex, black race, fewer medical conditions, and receiving care in a family medicine clinic.

CONCLUSIONS:

Simple feedback of symptom scores to primary care clinicians in the absence of additional systems support or incentives is not superior to usual care in improving symptom outcomes.

TRIAL REGISTRATION:

clinicaltrials.gov identifier: NCT02383862.

KEYWORDS:

clinical trial; feedback; patient-reported outcomes; primary care; symptoms

PMID:
29623512
PMCID:
PMC6082211
[Available on 2019-08-01]
DOI:
10.1007/s11606-018-4391-0

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