The novel Audit4 electronic patient-reported outcome (ePRO) system proved to be a valuable tool for incorporating PROs into a clinical care setting and helped to provide a better understanding of disease burden and the impact of interventions in a real-world setting, according to a new study published in Frontiers in Digital Health.
The Study
The objective of the study was to develop a simple and secure technological solution to incorporate electronic patient-reported outcomes (ePROs) into routine clinical care.
Validated questionnaires were sent from the electronic medical record (EMR) (Audit4) of patients with psoriatic arthritis (PsA), rheumatoid arthritis (RA), lupus, ankylosing spondylitis (AS), or giant cell arteritis (GCA) to either the patient’s email address or completed via a smart device in the clinic waiting room. These questionnaires were then encrypted and sent back to the patient’s Audit4 EMR. Clinical data was collected across all sites and analyzed.
A total of 221,352 questionnaires, including the Functional Assessment of Chronic Illness Therapy Fatigue (FACIT-F), HealthCare Resource Utilization (HCRU), and/or Patient Health Questionnaire-2 (PHQ-2) were sent between April 2016 and December 2020 from 39 contributing clinics. The PHQ-2 asks about the frequency of depressed mood and anhedonia in the last 2 weeks and the HCRU asks about medical events and treatments from the last 3 months.
The questionnaires were delivered by email (85%) and in practice (15%).
The Results
Most (85%) patients completed 1 or more questionnaires and 73% of all questionnaires were completed. Older patients (over 80 years of age) were slightly more likely to complete all questionnaires (≥50%) compared with patients under 70 years. Female patients were more likely to participate in the questionnaires when compared with men (87% vs 81%, respectively). Most patients, aged 80 years and younger, were more likely to complete all questionnaires if they were sent via email. However, patients 80 years and older were more likely to complete them in a clinical practice setting.
The rheumatologist was not able to decide to use ePRO technology, as well as which patients received the questionnaires, which may have resulted in selection bias.
Additionally, self-reported questionnaires run the risk of bias and misinterpretation, which may have hindered the validity of the findings. Future studies should evaluate fatigue levels, healthcare resource utilization, and mood disturbance in this patient population.
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