Implementing electronic patient-reported outcome measures in psychiatric urgent care

Background

Patient-reported outcomes (PRO) have been shown to improve screening and assessment across health care. However, overall implementation of PROs is low in mental health care. Research on PRO implementation in psychiatric urgent care settings is particularly limited.

Objective

To analyze barriers and facilitators to the implementation of electronic PROs (ePROs) in psychiatric urgent care clinics.

Methods

This study examined ePRO implementation at two Maryland clinics with an average 6,000 patients treated annually. These clinics offer “walk-in” services for patients seeking immediate assessment for mental health conditions and referral to appropriate follow-up care. We used the Learning Evaluation (LE) and RE-AIM frameworks to guide and evaluate the implementation of PROs into administrative and clinical workflows using an ePRO system. Stakeholder feedback informed rapid iteration cycles, driving the development and deployment of technical and procedural modifications. Quantitative data were organized using RE-AIM metrics and analyzed through descriptive statistics and regression analyses. Qualitative data, derived from stakeholder feedback, were analyzed using deductive coding, inductive coding, and sentiment analysis.

Findings

22,610 care episodes were analyzed for the study. Annual ePRO completion increased from 9% in 2021 to 44% in 2023, averaging 63% post-implementation. ePRO completion varied across clinics and was lower among males, Black patients, and those with neurocognitive or substance use disorders, but higher for anxiety, ADHD, and insomnia diagnoses. Adoption increased in 2023, with 17% of care episodes including ePRO data in provider notes, averaging 59% post-implementation. Six iterative modifications were implemented, assisting with ePRO completion and documentation to varying degrees. Qualitative analyses revealed administrative, clinical, and technological factors associated with ePRO implementation and completion rates, as well as an overall positive sentiment towards ePROs.

Conclusion

The findings demonstrate the feasibility and sustainability of ePRO implementation in psychiatric urgent care settings.

Clinical Implications

Iterative strategies, informed by stakeholder feedback, assist with ePRO implementation in fast-paced clinical environments and can inform future quality improvement efforts for modernization of administrative workflows and clinical practice.

What is already known on this topic

• While research supports patient-reported outcomes (PROs) as effective in mental health treatment when used, multiple barriers have limited their implementation in clinical practice. Currently there is limited knowledge of implementation in psychiatric urgent care settings.

What this study adds

• Using established implementation and evaluation frameworks, we were able to identify and overcome individual and organizational barriers of PRO implementation in psychiatric urgent care.

• We found that continuous communication and feedback can help clinicians and staff with implementation. Iterative modification development based on feedback can improve patient reach and adoption of PROs in clinical practice.

How this study might affect research, practice or policy

• Our findings contribute to gaps in the literature about PRO implementation in psychiatric urgent care and expands on technological and administrative processes that can resolve known barriers to implementation. The methodology used in this study can be modified to numerous real-world healthcare settings for evidence-based quality improvement interventions.