title: AmbuFlex: tele-patient-reported outcomes (telePRO) as the basis for follow-up in chronic and malignant diseases.
abstract: OBJECTIVE
  A tele-patient-reported outcome (telePRO) model includes outpatients' reports of symptoms and health status from home before or instead of visiting the outpatient clinic. In the generic PRO system, AmbuFlex, telePRO is used to decide whether a patient needs an outpatient visit and is thus a tool for better symptom assessment, more patient-centred care, and more efficient use of resources. Specific PROs are developed for each patient group. In this paper we describe our experiences with large-scale implementations of telePRO as the basis for follow-up in chronic and malignant diseases using the generic PRO system AmbuFlex.
  
  
  METHODS
  The AmbuFlex concept consists of three generic elements: PRO data collection, PRO-based automated decision algorithm, and PRO-based graphical overview for clinical decision support. Experiences were described with respect to these elements.
  
  
  RESULTS
  By December 2015, AmbuFlex was implemented in nine diagnostic groups in Denmark. A total of 13,135 outpatients from 15 clinics have been individually referred. From epilepsy clinics, about 70 % of all their outpatients were referred. The response rates for the initial questionnaire were 81-98 %. Of 8256 telePRO-based contacts from epilepsy outpatients, up to 48 % were handled without other contact than the PRO assessment. Clinicians as well as patients reported high satisfaction with the system.
  
  
  CONCLUSIONS
  The results indicate that telePRO is feasible and may be recommended as the platform for follow-up in several patient groups with chronic and malignant diseases and with many consecutive outpatient contacts.
authors.affiliation: AmbuFlex/WestChronic, Regional Hospital West Jutland, Herning, Denmark. livschou@rm.dk.
authors.forename: Liv Marit Valen
authors.initials: LM
authors.lastname: Schougaard
authors.affiliation: AmbuFlex/WestChronic, Regional Hospital West Jutland, Herning, Denmark.
authors.forename: Louise Pape
authors.initials: LP
authors.lastname: Larsen
authors.affiliation: AmbuFlex/WestChronic, Regional Hospital West Jutland, Herning, Denmark.
authors.forename: Anne
authors.initials: A
authors.lastname: Jessen
authors.affiliation: Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Per
authors.initials: P
authors.lastname: Sidenius
authors.affiliation: The Danish Cancer Society, Copenhagen, Denmark.
authors.forename: Liv
authors.initials: L
authors.lastname: Dorflinger
authors.affiliation: Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.|Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
authors.forename: Annette
authors.initials: A
authors.lastname: de Thurah
authors.affiliation: AmbuFlex/WestChronic, Regional Hospital West Jutland, Herning, Denmark.|Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Niels Henrik
authors.initials: NH
authors.lastname: Hjollund
mesh_terms: D000553:Ambulatory Care / Q000379:methods*; D002908:Chronic Disease; D003718:Denmark; D005500:Follow-Up Studies; D006305:Health Status Indicators; D006801:Humans; D009369:Neoplasms; D063868:Patient Outcome Assessment; D011788:Quality of Life; D011795:Surveys and Questionnaires; D063189:Symptom Assessment; D017216:Telemedicine / Q000379:methods*
keywords: Clinical practice; Outpatient clinic; Outpatient follow-up; Patient-reported outcomes; ePRO; telePRO