Computer Assisted Quality of Life and Symptom Assessment of Complex Patients

Hektoen Institute For Medical Research, Chicago IL

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Abstract

DESCRIPTION (provided by applicant): Patients who have multiple chronic medical conditions can be challenging for clinicians and health services researchers. Often, interventions are targeted for a specific condition and fail to address the overall health of a patient. These patients are particularly vulnerable during transitions from the hospital to ambulatory settings. Our long-term objective is to establish routine collection of physical and mental components of their health-related quality of life in the hospital and ambulatory settings through audio computer-assisted interviews (A-CASI). We will link these data to clinical data (e.g., visit history and medication receipt) from the electronic medical record. Our specific aims are to develop modular (instruments can be added or removed by clinical site) and bilingual (English and Spanish) A-CASI software;incorporate clinic specific instruments that will increase the likelihood of sustaining these assessments;join these data to clinical data stored in our clinical data warehouse;populate the electronic medical record with summary scores;and, provide these results to clinicians, administrators and health services researchers. We have established an Advanced Illness Management Clinic within our General Medicine Clinic for the consultative care of complex patients who have a high symptom burden. We will incorporate A-CASI assessments of symptom burden and quality of life for all Advanced Illness Clinic patients, for a specific team in our General Medicine Clinic and for a General Medicine Clinic patients who have been hospitalized and who have a high chronic disease score. For our pilot research project, we will randomize the hospital patients to usual care vs. initial evaluation and management recommendations by the Advanced Illness Management Clinic. We will follow these patients longitudinally as outpatients and administer follow-up A-CASI interviews 1, 3 and 6 months after their hospitalization-the baseline interview will be their hospital discharge interview. We will evaluate their change in health-related quality of life and symptom burden. For those patients who do not follow-up in the clinic, we will administer computer-assisted telephone interviews by research assistants. PUBLIC HEALTH RELEVANCE: Care of complex medical patients could be improved by comprehensive assessments of symptom burden and quality of life. It is challenging for providers to consistently perform these assessments. We propose routine administration of audio computer-assisted interviews during patient visits. We will transmit responses to a data warehouse and electronic medical record for use by clinicians and health services researchers.