Background Patient-reported outcome measures (PROMs) have been at the forefront of the assessment of spondyloarthritis (SpA). With the increasing adoption of electronic health records (EHRs), collecting PROMs electronically (ePROMs) presents an opportunity for advancing patient care in SpA. ePROMs were incorporated into our SpA clinics at the Royal Berkshire Hospital since the start of 2018. Collecting patient data remotely brings the patients’ perspective into routine clinical care without delay. Moreover, connection to EHRs have led to a seamless integrated optimised care process.

Objectives The objective of this programme was to evaluate the clinical effectiveness and practicality of implementing a fully integrated ePROMs into the hospital EHR in real world clinic settings. The interoperability across different information technology (IT) modules was assessed. We also evaluated the interaction with the patients through the assessment of satisfaction and completion rates of ePROMs.

Methods AxSpA patients meeting the ASAS criteria completed the outcome measures BASDAI, BASFI, Spinal NPRS, and BASG. PsA patients meeting the CASPAR criteria completed patient assessed tender joint, swollen joint, global assessment and PSAID-12. The period of the data collection for this study was January 2021 to December 2022. Patients were sent reminders to complete ePROMs through email or text messaging before each appointment and every 6 months. Ad-hoc scores went sent out according to clinical need. Appointments were expedited or deferred depending on the values and trends in the ePROMS. Time saved in clinic was measured.

Results There were 1141 patients with AxSpA and PsA who were sent ePROMs over a 2 year period (2021-22). The mean (SD) age for AxSpA patients were 42.7(11.2) and PsA 52 (7.9) years. 536 (47%) patients were on biologics. At baseline, the completion of was 38% (437/1141). At month 12, it was 63% (722/1141) and at month 24, reached 73% (836/1141), Figure 1. Both AxSpA and PsA patients had similar rates of uptake of ePROMs between months 0 and 24 (40% to 72% in AxSpA and 35% to 73% in PsA). At group level, there was a trend to the reduction in mean (SD) ASDAS at months 0, 6, 12, 18 and 24 (3.8±1.2, 3.3±1.1, 3.0±1.5, 2.2±0.9, 1.9±1.0) and BASDAI (4.6±2.7, 4.5±1.9, 3.9±2.4, 3.8.±2.3, 3.6±1.2). In the PsA group, there was also a trend to the reduction in the mean (SD) PSAID-12 level (4.1±1.8, 3.8±0.8, 3.6±1.2, 3.4±1.1, 3.1±1.3). The reduction in ASDAS, BASDAI and PSAID-12 was most evident in patients on biologic treatments. In patients with an ASDAS of < 1.3 or PSAID-12 <2, appointments were moved from 6 to 12 monthly. In this group of patients, the appointments were also switched from face to face to teleclinics. This resulted in a saving of 280 hours of clinical time. Over 90% of clinician and patient user rated the ePROMs as good to excellent. In patients not completing ePROMS (308/1141, 27%) paper forms were used. Factors for not completing ePROMs include multiple forms, frequency of forms sent, lack of understanding of process, data safety concerns, lack of IT access and patient choice.

Conclusion The development of a clinician dashboard captured a range of multidimensional ePROMs that was used proactively to support patient management and patient-centric appointment scheduling. Using ePROMs increased the uptake and acceptability of completing patient outcomes. A trend based on ePROMs collated over a period of time was more informative, particularly when considered alongside interventions that were introduced into the clinics such as self-referral to physiotherapy, digital psychological therapy and biologic treatments. This enabled the clinical team use ePROMs as part of remote monitoring to implement patient-initiated follow up (PIFU) and schedule teleconsultations when clinically appropriate. The integrated ePROMS system allows clinical encounters where needed and more individualised care.

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Figure 1.

Number of AxSpA and PsA patients completing ePROMs at baseline (0), 6, 12, 18 and 24 months

REFERENCES: NIL.

Acknowledgements: NIL.

Disclosure of Interests Antoni Chan Grant/research support from: A non-promotional grant was received from Novartis for the initial set up of the digital software for this programme, Kathryn Rigler: None declared, Liz Van Rossen: None declare.d.