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2019 HSR&D/QUERI National Conference Abstract

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1141 — Patient and Provider Perceptions about Implementation of the Veterans Affairs Patient-Reported Health Status Assessment (PROST) System

Lead/Presenter: Marina McCreight,  COIN - Seattle/Denver
All Authors: McCreight MS (COIN-Seattle/Denver), Ayele R (COIN-Seattle/Denver), Rohs CM (COIN-Seattle/Denver) Ho PM (COIN-Seattle/Denver) Bradley SM (Minneapolis Heart Institute Healthcare Delivery Innovation Center) Hess PL (COIN-Seattle/Denver)

Objectives:
Patient-reported health status (symptoms, functional status, and health-related quality of life) has not been previously quantified in routine clinical care. The Veterans Affairs (VA) Patient Reported Health Status Assessment (PROST) system was developed to capture, score, and report patient reported health status using interactive voice response (IVR) via telephone. The IVR survey captures the health status of patients undergoing elective procedures in cardiac catheterization laboratories. Data are captured pre-procedurally and at 1- and 6-months after the procedure. Prior to program roll-out, we sought to understand Veterans and providers perspectives on PROST implementation.

Methods:
We conducted semi-structured interviews and a focus group with 22 providers and 13 patients at 10 VA sites to: 1) inform the integration of the data capture system into routine clinical care; 2) obtain perceptions of the PROST impact on patient health, quality and appropriateness of care; 2) identify perceived barriers and facilitators to program adoption and implementation; and 3) inform intervention adaptations for purposes of tailoring intervention components to local context and culture. All interviews were recorded and transcribed verbatim. Data were analyzed using iterative matrices and reflexive analyses.

Results:
Most patients were receptive to PROST; some expressed mixed feelings about interacting with the IVR and wished to ensure that PROST data are given to their providers in a timely manner. Providers were receptive to PROST and described its potential to improve patient care. They indicated that it could be a useful tool for understanding procedural success from patients' perspectives and the sustainability of procedural success longitudinally. Providers offered suggestions to modify the pre-procedural patient notification process.

Implications:
PROST offers a standardized approach to capturing patient-reported health status in real-world clinical practice. Based on patients' and providers' feedback, we are adapting program implementation. Next steps include integrating PROST assessment data into clinical practice, planning for the national implementation and scale up to non-participating sites.

Impacts:
These findings have been used to modify program implementation at 10 VA sites. The overall project will provide insights for implementation of programs and interventions at the national level, informing policies that seek to improve health care delivery from patients' perspectives.