THU0639 AUTOMATED CAPTURE AND HIGH UPTAKE RATES OF PATIENT REPORTED OUTCOME MEASURES IN ROUTINE RHEUMATOLOGY PRACTICE
Authors: Manjari Lahiri, James Yip
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Patient reported Outcome Measures (PROMs) are an integral part of value based healthcare and outcomes that matter to patients; however resource and time constraints are often barriers for routine collection in clinic. <h3>Objectives</h3> We piloted an automated, electronic collection of PROMs for patients attending an outpatient specialist rheumatology clinic. <h3>Methods</h3> All patients with a clinic appointment were sent an automated text message, one day before their scheduled doctor's appointment, with a hyperlink to fill in the Routine Assessment of Patient Index Data (RAPID3) [0-30, 30 being worst, calculated as the sum of physical function measured using the 10-item multidimensional health assessment questionnaire (mdHAQ), pain visual analogue scale (VAS), and patient global VAS questionnaire]. The text message was personalised with the attending physician's name and thumbnail photograph and the questionnaire was presented in the patient's preferred language (English or simplified Chinese) by detecting their phone configuration. RAPID3 responses flowed back to the electronic medical record and were available for the attending clinician to view during the clinic consult the next day. Patients who did not fill in the questionnaire within 6 hours were sent a reminder, and those still remaining were encouraged to fill it in the clinic waiting room. Hardcopy flyers were distributed to inform patients of the initiative and clinicians were encouraged to discuss the responses at the clinic visit. Patients were sent the survey only once during the study period. Weekly usdage reports were sent to the clinicians (Figure 1). <h3>Results</h3> 4078 patients [mean (SD) age 55.8 (16.3) years, 67.9% female, 70.6% Chinese] were sent the text message invitation over 6 months, of which 64.4% responded. Diagnosis data from SNOMED codes were available for 2262 patients. The most common primary diagnoses were rheumatoid arthritis (653, 29,5%), Spondyloarthritides (SpA), including psoriatic arthritis (318, 14.4%) and lupus (310, 14%). Data on disease duration, clinical features and medications were not available for this study. The mean (SD) mdHAQ score (range 0-3, 3 being the worst) was 0.3 (0.5), mean (SD) pain-VAS (0-10, 10 being worst) was 2.4 (2.3), patient global was 2.6 (2.2) and RAPID3 was 6.1 (5.2). On multivariable logistic regression, age (OR = 0.38, 95% CI 0.32, 0.44 for the top tertile), gender (OR 1.22, 95% CI 1.06, 1.4 for females), race (OR = 0.79, 95% CI 0.64, 0.98 for Indian vs. Chinese race) and treating physician (OR 0.7, 95% CI 0.61, 0.8 for junior vs. senior doctor) were independent predictors of survey response, while primary rheumatic disease was not (Figure 2). Ten of 11 clinicians (from 13 surveyed) found the information from PROMs useful, and 8/11 supported expansion of the pilot project to include more PROMs. Lack of time was cited as the biggest challenge to implementing PROMs routinely. <h3>Conclusion</h3> Automated collection of PROMs in routine clinical care is feasible with high uptake rates and minimal clinician burden. <h3>Acknowledgement</h3> Ramasamy Thirumugam from the Academic Informatics Office, National University Hospital, for setting up the system <h3>Disclosure of Interests</h3> Manjari Lahiri Grant/research support from: Grant support from Pfizer. I am the site PI for the Singapore National Biologics Register which is funded by multiple pharmaceutical companies; however I do not directly receive any funds for this., Consultant for: Advisory board for Elli Lilly, James Yip: None declared