Use of patient reported outcome data for improving patient care in primary care practices: The mohr trial

Background: The inclusion of patient reported outcome (PRO) data on health behaviors and mental health has the potential to improve patient care, patient outcomes and, ultimately, population health. Yet there is little agreement on how collection of PRO data can be successfully integrated into primary care practices, especially in low-resource settings. A web-based tool, My Own Health Report (MOHR) has been created to address the need for tools to systematically collect PRO data and use them to enhance patient care.

Methods: MOHR uses a participatory, iterative design process involving collaborative partnerships across government agencies, academic institutions, and clinics that are part of Federally Qualified Health Centers and Practice Based Research Networks. The NCI, AHRQ, and the NIH Office of Behavioral and Social Sciences Research are working with four participating Prevention Research Centers in California, North Carolina, and Texas, and two major networks in Virginia and Vermont. The trial, scheduled to begin in March 2013, includes 18 paired clinics randomly allocated to immediate and delayed intervention groups, each collecting patient experience data on a minimum of 150 adult primary care patients. This design will allow us to determine whether use of the MOHR influences: 1) clinician/patient discussion of behavioral and psychosocial issues; 2) patient goal-setting, 3) and provider assistance in meeting goals. We will also be collecting data on participant reach, practice adoption, context, and cost.

Results: Building on expert opinion in behavioral risk factor assessment and counseling, the MOHR includes 17 items measuring 10 topics related to mental health, substance use, and physical activity / nutrition. The MOHR includes an automated tool to assist patients in highlighting their areas of concern, and providers in delivering evidence-based feedback and referral for the ten health domains. In addition to a demonstration of the MOHR, implementation protocols will be shared, as well as lessons learned regarding the process of designing and conducting a pragmatic trial. Because of the diversity of settings in which we are testing systematic collection of patient-reported data, options for tailoring will be presented and will increase potential for widespread adoption.

Conclusion: The use of pragmatic models, methods and measures such as those demonstrated in the MOHR trial can inform policy makers and payers about the feasibility and impact of using PRO data in the clinical setting. The MOHR tool is designed to illuminate effective strategies for seeking and acting upon patient priorities in primary care settings.