Feasibility of tablet-based patient-reported symptom data collection among hemodialysis patients

Abstract Introduction Individuals receiving in-center hemodialysis have high symptom burdens but often do not report their symptoms to care teams. Evidence from other diseases suggest that use of symptom electronic patient-reported outcome measures (ePROMs) may improve outcomes. We assessed the usability of a symptom ePROM system and then implemented a quality improvement (QI) project with the objective of improving symptom communication at a U.S. hemodialysis clinic. During the project, we assessed the feasibility of ePROM implementation and conducted a sub-study exploring the effect of ePROM use on patient-centered care. Methods After conducting usability testing, we used mixed methods, guided by the Quality Implementation Framework, to implement a 16-week symptom ePROM administration QI project. We performed pre-, intra-, and post-project stakeholder interviews to identify implementation barriers and facilitators. We collected ePROM system-generated data on symptoms, email alerts, and response rates, among other factors, to inform our feasibility assessment. We compared pre- and post-project outcomes. Results There were 62 patient participants (34% black, 16% Spanish-speaking) and 19 care team participants (4 physicians, 15 clinic personnel) at QI project start and 32 research participants. In total, the symptom ePROM was administered 496 times (completion rate =84%). The implementation approach and ePROM system were modified to address stakeholder-identified concerns throughout. ePROM implementation was feasible as demonstrated by the program’s acceptability, demand, implementation success, practicality, integration in care, and observed trend toward improved outcomes. Conclusions Symptom ePROM administration during hemodialysis is feasible. Trials investigating the effectiveness of symptom ePROMs and optimal administration strategies are needed.