title: The role of technical advances in the adoption and integration of patient-reported outcomes in clinical care.
abstract: BACKGROUND
  Patient-reported outcomes (PROs) are gaining recognition as key measures for improving the quality of patient care in clinical care settings. Three factors have made the implementation of PROs in clinical care more feasible: increased use of modern measurement methods in PRO design and validation, rapid progression of technology (eg, touchscreen tablets, Internet accessibility, and electronic health records), and greater demand for measurement and monitoring of PROs by regulators, payers, accreditors, and professional organizations. As electronic PRO collection and reporting capabilities have improved, the challenges of collecting PRO data have changed.
  
  
  OBJECTIVE
  To update information on PRO adoption considerations in clinical care, highlighting electronic and technical advances with respect to measure selection, clinical workflow, data infrastructure, and outcomes reporting.
  
  
  METHODS
  Five practical case studies across diverse health care settings and patient populations are used to explore how implementation barriers were addressed to promote the successful integration of PRO collection into the clinical workflow. The case studies address selecting and reporting of relevant content, workflow integration, previsit screening, effective evaluation, and electronic health record integration.
  
  
  CONCLUSIONS
  These case studies exemplify elements of well-designed electronic systems, including response automation, tailoring of item selection and reporting algorithms, flexibility of collection location, and integration with patient health care data elements. They also highlight emerging logistical barriers in this area, such as the need for specialized technological and methodological expertise, and design limitations of current electronic data capture systems.
authors.affiliation: *Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC †Northwestern University Feinberg School of Medicine, Chicago, IL ‡Department of Pediatrics, Division of Rheumatology, University of Cincinnati College of Medicine, Cincinnati, OH §Division of Gastroenterology, Cedars-Sinai Medical Center ∥Cedars-Sinai Center for Outcomes Research and Education ¶Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA #College of Health Professions & Social Work, Temple University, Philadelphia, PA **Department of Medicine, School of Medicine, Division of Allergy & Infectious Diseases, University of Washington, Seattle, WA ††Children's Hospital of Philadelphia ‡‡Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA §§DP Department of Health Services, University of Washington ∥∥Seattle Quality of Life Group, Seattle, WA ¶¶Department of Neurology, University of Maryland School of Medicine, Baltimore, MD ##Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Washington, Seattle, WA.
authors.forename: Roxanne E
authors.initials: RE
authors.lastname: Jensen
authors.forename: Nan E
authors.initials: NE
authors.lastname: Rothrock
authors.forename: Esi M
authors.initials: EM
authors.lastname: DeWitt
authors.forename: Brennan
authors.initials: B
authors.lastname: Spiegel
authors.forename: Carole A
authors.initials: CA
authors.lastname: Tucker
authors.forename: Heidi M
authors.initials: HM
authors.lastname: Crane
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Forrest
authors.forename: Donald L
authors.initials: DL
authors.lastname: Patrick
authors.forename: Rob
authors.initials: R
authors.lastname: Fredericksen
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Shulman
authors.forename: David
authors.initials: D
authors.lastname: Cella
authors.forename: Paul K
authors.initials: PK
authors.lastname: Crane
mesh_terms: D003625:Data Collection / Q000379:methods*; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D057286:Electronic Health Records; D006801:Humans; D020407:Internet; D019982:Organizational Case Studies; D017063:Outcome Assessment, Health Care / Q000379:methods*; D063868:Patient Outcome Assessment; D017060:Patient Satisfaction; D011787:Quality of Health Care / Q000592:standards*; D057566:Self Report; D014481:United States