Overview

Between February 2018 and February 2019, a regional, Italian hospital launched a pilot project in which they recruited chronic heart failure patients to provide longitudinal patient reported outcome measures (PROMs) and patient reported experience measures (PREMs) with digital questionnaires. This helped the hospital define its role in chronic disease case management.

Organization Name

Fondazione Toscana Gabriele Monasterio (FGTM)

Organization Type

• Public Health System

Tech Involved

• Electronic medical record
• Email
• Telephone
• Web-Based Portal

Team Members Involved

• Primary Care Physicians
• Specialists

Workflow Steps

• Innovators at Fondazione Toscana Gabriele Monasterio (FTGM) sent chronic heart failure patients (n =162) PROM and PREM surveys at one month, seven months, and one year after the patients began treatment by phone or email. The PROM surveys utilized existing methods, the Kansas City Cardiomyopathy Questionnaire and the Self Care Heart-Failure index, while the PREM surveys were customized to reflect the type of care provided to patients at each iteration of the survey. The KCCQ-12 was not included in the baseline survey
  • Following the program, two internal and local presentations addressed the efficacy of the patient reported measures program and plans to introduce the program to connected health facilities.

Outcomes

• Innovators tracked survey completion at each iteration and retained between 30-60% of participating patients at each interval. Nine patients completed all three rounds of surveys.
• For PROM, patients reported improved scores at each survey interval, demonstrating improved management of CHF symptoms. Between month one and month seven, average Kansas City Cardiomyopathy Questionnaire Scores improved two points, while the greatest improvement in Self Care Heart-Failure Index scores was observed in the Management section of the survey, a 13 point increase from discharge to seven months.

Unique Challenges

• Innovators report that buy-in was an initial challenge for team members involved in the intervention. Team members advocated for introducing the program to additional facilities at the program’s exit meetings, demonstrating innovators overcame this initial challenge. 
• An additional challenge innovators faced was enrolling a regionally representative sample given that patient response rate was around 50%. Participants were significantly different from the hospital’s EHR reference group by gender and education level.

Sources

• Pennucci F, De Rosis S, Passino C. Piloting a web-based systematic collection and reporting of patient-reported outcome measures and patient-reported experience measures in chronic heart failure. BMJ Open 2020;10:e037754. doi:10.1136/ bmjopen-2020-037754