Large integrative medicine center implements processes to measure and understand clinical effectiveness

CLEVELAND – Led by a team of researchers at University Hospitals Connor Whole Health, a new study finds that collecting paper-based patient-reported outcome (PRO) measures of pain, anxiety, and stress is feasible – and that provider, operational, and clinical-level factors impact successful completion more so than patient factors.

Patients often seek integrative health and medicine (IHM) modalities such as acupuncture, chiropractic, and massage in the outpatient setting, most commonly for concerns of pain, anxiety, and stress. In contrast to laboratory measures, patient-reported outcomes offer a more wholistic picture of the effects of treatments, especially IHM modalities, on measures related to quality of life. But how can PRO collection be optimized – and what factors impact PRO questionnaire completion?

The study found that such a system can be implemented within a large IHM practice spanning multiple sites in Northeast Ohio, and that the nature of presenting complaint, clinic location, and timing of collection – e.g., prior to infection control concerns due to the COVID-19 pandemic – impact odds of pre- and post-session PRO collection.

“While previous studies of PRO collection among outpatients seeking IHM have explored its feasibility, our study is among the first to investigate the specific factors associated with successful instrument completion– especially at this scale,” said Roshini Srinivasan, MD, RYT-500, Research Intern and lead author of this study.

The Study

Published in PLOS ONE, this study explored the implementation of a low-tech, paper-based collection system for over 27,000 instances of patients receiving IHM care – across acupuncture, chiropractic, integrative medicine consultations, massage, and osteopathic manipulation – across multiple IHM clinics over 18 months. Following this time, they analyzed what factors were associated with successful pre- and post-session PRO completion.

Visits were analyzed in patients in patients who completed either a pre-encounter PRO questionnaire (n=21,798) or both pre- and post-encounter questionnaires (n=11,709).

The researchers found that being female, having a pain or anxiety complaint, having multiple IHM encounters, and being seen prior to Q2 2020 increased odds of questionnaire completion, while being seen at certain clinics and being seen after Q2 2020 were linked with reduced odds of completion.

Key Innovations

“As we seek to understand how best to measure of the impact of our care, this study underscores key intervention points to optimize data collection in outpatient IHM,” said Dr. Françoise Adan, Chief Whole Health and Well-being Officer and Director of UH Connor Whole Health. Co-author and Integrative Health Research and Data Specialist Samuel Rodgers-Melnick, MPH, MT-BC, shares that “in an era where data is increasingly leveraged for the benefit of our patients, this work provides a strong foundation for the strategic implementation of data collection efforts within IHM and across health systems.”

Looking to the future, the authors write that research “will ideally explore routine electronic PRO collection and implementation in the outpatient IHM setting. Such efforts would align with current trends, especially in the post/chronic COVID-19 pandemic era, to move toward electronic data capture and potentiate real-time collection and visualization for both patients and providers.”

You can read the article by clicking here.

Reference:

Srinivasan R, Rodgers-Melnick SN, Rivard RL, Kaiser C, Vincent D, et al. (2024) Implementing paper-based patient-reported outcome collection within outpatient integrative health and medicine. PLOS ONE 19(5): e0303985. https://doi.org/10.1371/journal.pone.0303985

About University Hospitals / Cleveland, Ohio

Founded in 1866, University Hospitals serves the needs of patients through an integrated network of 21 hospitals (including five joint ventures), more than 50 health centers and outpatient facilities, and over 200 physician offices in 16 counties throughout northern Ohio. The system’s flagship quaternary care, academic medical center, University Hospitals Cleveland Medical Center, is affiliated with Case Western Reserve University School of Medicine, Northeast Ohio Medical University, Oxford University, the Technion Israel Institute of Technology and National Taiwan University College of Medicine. The main campus also includes the UH Rainbow Babies & Children’s Hospital, ranked among the top children’s hospitals in the nation; UH MacDonald Women’s Hospital, Ohio’s only hospital for women; and UH Seidman Cancer Center, part of the NCI-designated Case Comprehensive Cancer Center. UH is home to some of the most prestigious clinical and research programs in the nation, with more than 3,000 active clinical trials and research studies underway. UH Cleveland Medical Center is perennially among the highest performers in national ranking surveys, including “America’s Best Hospitals” from U.S. News & World Report. UH is also home to 19 Clinical Care Delivery and Research Institutes. UH is one of the largest employers in Northeast Ohio with more than 30,000 employees. Follow UH on LinkedIn, Facebook and Twitter. For more information, visit UHhospitals.org.