Paving the way for electronic patient-centered measurement in team-based primary care: an integrated knowledge translation approach (Preprint)

BACKGROUND Patient-centred measurement (PCM) aims to improve overall quality of care through the collection and sharing of patients’ values and perspectives. Yet, the use of PCM in care team decisions remains limited. Integrated knowledge translation (IKT) offers a collaborative, adaptive approach to explore best practices for incorporating PCM into primary care practices by involving knowledge users, including patients and providers, in the exploratory process. OBJECTIVE (i) test the feasibility of using patient-generated data (PGD) in team-based care; (ii) describe use of these data for team-based mental health care; and (iii) summarize patient and provider care experiences with PCM. METHODS We conducted a multi-methods exploratory study in a rural team-based primary care clinic using IKT to co-design, implement and evaluate use of PCM in team-based mental health care. Care pathways, workflows, and quality improvement activities were iteratively adjusted to improve integration efforts. Patient and provider experiences were evaluated using individual interviews relating use of PCM and patient portal in practice. All meeting notes, interview summaries, and emails were analyzed to create a narrative evaluation. RESULTS During co-design, a care workflow was developed for incorporating electronically-collected PGD from the patient portal into the electronic medical record (EMR), and customized educational tools and resources were added. During implementation, care pathways and patient workflows for PCM were developed. Patients found portal use easy, educational, and validating, but data entries were not used during care visits. Providers saw the portal as extra work and lack of portal/EMR integration was a major barrier. The IKT approach was invaluable for addressing workflow changes and understanding ongoing barriers to PCM use and quality improvement. CONCLUSIONS Although the culture towards PCM is changing, use of PCM during care was not successful. Patients felt validated and supported through portal use and could be empowered to bring these data to their visits. Training, modeling, and adaptable PCM methods are needed before PCM can be integrated into routine care.