Implementation Challenges Using a Novel Method for Collecting Patient-Reported Outcomes After Injury

Graeme M Rosenberg; Emily J Shearer; Sean R Zion; Sean C Mackey; Arden M Morris; David A Spain; Thomas G Weiser

doi:10.1016/j.jss.2019.04.008

Implementation Challenges Using a Novel Method for Collecting Patient-Reported Outcomes After Injury

J Surg Res. 2019 Sep;241:277-284. doi: 10.1016/j.jss.2019.04.008. Epub 2019 Apr 28.

Authors

Graeme M Rosenberg¹, Emily J Shearer², Sean R Zion³, Sean C Mackey⁴, Arden M Morris⁵, David A Spain², Thomas G Weiser⁶

Affiliations

¹ Department of Surgery, Section of Trauma and Acute Care Surgery, Stanford University, Stanford, California. Electronic address: gmr87@stanford.edu.
² Department of Surgery, Section of Trauma and Acute Care Surgery, Stanford University, Stanford, California.
³ Department of Psychology, Stanford University, Stanford, California.
⁴ Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, California.
⁵ Department of Surgery, Stanford - Surgery Policy Improvement Research & Education Center, Stanford University, Palo Alto, California.
⁶ Department of Surgery, Section of Trauma and Acute Care Surgery, Stanford University, Stanford, California; Department of Surgery, Stanford - Surgery Policy Improvement Research & Education Center, Stanford University, Palo Alto, California; Department of Clinical Surgery, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, UK.

PMID: 31042606
DOI: 10.1016/j.jss.2019.04.008

Abstract

Background: Monitoring longitudinal patient-reported outcomes after injury is important for comprehensive trauma care. Current methodologies are resource-intensive and struggle to engage patients.

Materials and methods: Patients ≥18 y old admitted to the trauma service were prospectively enrolled. The following inclusion criteria were used: emergency operation, ICU length of stay ≥2 midnights, or hospital length of stay ≥4 d. Validated and customized questionnaires were administered using a novel internet-based survey platform. Three-month follow-up surveys were administered. Contextual field notes regarding barriers to enrollment/completion of surveys and challenges faced by participants were recorded.

Results: Forty-seven patients were eligible; 26 of 47 (55%) enrolled and 19 of 26 (73%) completed initial surveys. The final sample included 14 (74%) men and 5 (26%) women. Primary barriers to enrollment included technological constraints and declined participation. Contextual field notes revealed three major issues: competing hospital tasks, problems with technology, and poor engagement. The average survey completion time was 43 ± 27 min-21% found this too long. Seventy-four percent reported the system "easy to use" and 95% reported they would "very likely" or "definitely" respond to future surveys. However, 10 of 26 (38%) patients completed 3-mo follow-up.

Conclusions: Despite a well-rated internet-based survey platform, study participation remained challenging. Lack of email access and technological issues decreased enrollment and the busy hospitalization posed barriers to completion. Despite a thoughtful operational design and implementation plan, the trauma population presented a challenging group to engage. Next steps will focus on optimizing engagement, broadening access to survey reminders, and enhancing integration into clinical workflows.

Keywords: Implementation science; Patient-reported outcome measures; Patient-reported outcomes; Traumatic injury.

MeSH terms

Adolescent
Adult
Aged
Feasibility Studies
Female
Humans
Internet-Based Intervention*
Male
Middle Aged
Patient Participation / methods*
Patient Participation / statistics & numerical data
Patient Reported Outcome Measures*
Pilot Projects
Prospective Studies
Treatment Outcome
Wounds and Injuries / surgery*
Young Adult