title: Implementation of an audio computer-assisted self-interview (ACASI) system in a general medicine clinic: patient response burden.
abstract: BACKGROUND
  Routine implementation of instruments to capture patient-reported outcomes could guide clinical practice and facilitate health services research. Audio interviews facilitate self-interviews across literacy levels.
  
  
  OBJECTIVE
  To evaluate time burden for patients, and factors associated with response times for an audio computer-assisted self interview (ACASI) system integrated into the clinical workflow.
  
  
  METHODS
  We developed an ACASI system, integrated with a research data warehouse. Instruments for symptom burden, self-reported health, depression screening, tobacco use, and patient satisfaction were administered through touch-screen monitors in the general medicine clinic at the Cook County Health & Hospitals System during April 8, 2011-July 27, 2012. We performed a cross-sectional study to evaluate the mean time burden per item and for each module of instruments; we evaluated factors associated with longer response latency.
  
  
  RESULTS
  Among 1,670 interviews, the mean per-question response time was 18.4 [SD, 6.1] seconds. By multivariable analysis, age was most strongly associated with prolonged response time and increased per decade compared to < 50 years as follows (additional seconds per question; 95% CI): 50-59 years (1.4; 0.7 to 2.1 seconds); 60-69 (3.4; 2.6 to 4.1); 70-79 (5.1; 4.0 to 6.1); and 80-89 (5.5; 4.1 to 7.0). Response times also were longer for Spanish language (3.9; 2.9 to 4.9); no home computer use (3.3; 2.8 to 3.9); and, low mental self-reported health (0.6; 0.0 to 1.1). However, most interviews were completed within 10 minutes.
  
  
  CONCLUSIONS
  An ACASI software system can be included in a patient visit and adds minimal time burden. The burden was greatest for older patients, interviews in Spanish, and for those with less computer exposure. A patient's self-reported health had minimal impact on response times.
authors.affiliation: Collaborative Research Unit, Department of Medicine, Cook County Health & Hospitals System , Chicago, Illinois.
authors.forename: W E
authors.initials: WE
authors.lastname: Trick
authors.affiliation: Division of General Medicine, Department of Medicine, Cook County Health & Hospitals System , Chicago, Illinois.
authors.forename: C
authors.initials: C
authors.lastname: Deamant
authors.affiliation: Collaborative Research Unit, Department of Medicine, Cook County Health & Hospitals System , Chicago, Illinois.
authors.forename: J
authors.initials: J
authors.lastname: Smith
authors.affiliation: Collaborative Research Unit, Department of Medicine, Cook County Health & Hospitals System , Chicago, Illinois.
authors.forename: D
authors.initials: D
authors.lastname: Garcia
authors.affiliation: Collaborative Research Unit, Department of Medicine, Cook County Health & Hospitals System , Chicago, Illinois.
authors.forename: F
authors.initials: F
authors.lastname: Angulo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003201:Computers; D005260:Female; D006801:Humans; D007388:Internal Medicine; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D012984:Software; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: Computers; patient-centered outcome research; quality of life; software; symptoms
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