Feasibility of Tablet-Based Patient-Reported Symptom Data Collection Among Hemodialysis Patients

Jennifer E Flythe; Matthew J Tugman; Julia H Narendra; Adeline Dorough; Johnathan Hilbert; Magdalene M Assimon; Darren A DeWalt

doi:10.1016/j.ekir.2020.04.021

Feasibility of Tablet-Based Patient-Reported Symptom Data Collection Among Hemodialysis Patients

Kidney Int Rep. 2020 Apr 29;5(7):1026-1039. doi: 10.1016/j.ekir.2020.04.021. eCollection 2020 Jul.

Authors

Jennifer E Flythe^{1

2}, Matthew J Tugman¹, Julia H Narendra¹, Adeline Dorough¹, Johnathan Hilbert³, Magdalene M Assimon¹, Darren A DeWalt⁴

Affiliations

¹ University of North Carolina Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
² Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina, USA.
³ University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
⁴ Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.

Abstract

Introduction: Individuals receiving in-center hemodialysis have high symptom burdens but often do not report their symptoms to care teams. Evidence from other diseases suggest that use of symptom electronic patient-reported outcome measures (ePROMs) may improve outcomes. We assessed the usability of a symptom ePROM system and then implemented a quality improvement (QI) project with the objective of improving symptom communication at a US hemodialysis clinic. During the project, we assessed the feasibility of ePROM implementation and conducted a substudy exploring the effect of ePROM use on patient-centered care.

Methods: After conducting usability testing, we used mixed methods, guided by the Quality Implementation Framework, to implement a 16-week symptom ePROM QI project. We performed pre-, intra-, and postproject stakeholder interviews to identify implementation barriers and facilitators. We collected ePROM system-generated data on symptoms, e-mail alerts, and response rates, among other factors, to inform our feasibility assessment. We compared pre- and postproject outcomes.

Results: There were 62 patient participants (34% black, 16% Spanish-speaking) and 19 care team participants (4 physicians, 15 clinic personnel) at QI project start, and 32 research participants. In total, the symptom ePROM was administered 496 times (completion rate = 84%). The implementation approach and ePROM system were modified to address stakeholder-identified concerns throughout. ePROM implementation was feasible as demonstrated by the program's acceptability, demand, implementation success, practicality, integration in care, and observed trend toward improved outcomes.

Conclusions: Symptom ePROM administration during hemodialysis is feasible. Trials investigating the effectiveness of symptom ePROMs and optimal administration strategies are needed.

Keywords: hemodialysis; implementation; improvement; mixed methods; patient-reported outcomes; quality; symptoms.