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2023 HSR&D/QUERI National Conference Abstract

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1163 — Veteran Preferences for the Timing and Modality of Completing Patient Reported Outcome Measures

Lead/Presenter: Eric Richardson,  COIN - Bedford/Boston
All Authors: Richardson E (Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston), Etingen B (Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines VA Hospital) Ndiwane N (Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston) Smith BM (Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines VA Hospital) Bixler FR (Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines VA Hospital) Shimada, SL (Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System) Hogan TP (Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System)

Objectives:
To support initiatives such as measurement-based care, the Veterans Health Administration (VA) is promoting the collection of a wide range of patient reported outcome measures (PROMs) from Veterans as part of clinical care. Understanding Veteran preferences about how and when to complete PROMs is critical to support their implementation within VA. The objective of this analysis was to characterize Veteran preferences about the timing and modality of completing PROMs related to their behavioral and physical health.

Methods:
We mailed surveys to a national sample of Veterans who were known technology users (i.e., users of VA secure messaging). Surveys asked about Veteran demographics and preferences for how and when to complete PROMs about (1) physical and (2) behavioral health. We estimated multiple logistic regression models to examine associations between Veteran demographics and preferences for completing PROMs.

Results:
We invited 1,358 Veterans to complete the survey and received responses from 858 Veterans (response rate = 63%). Among the n = 801 survey respondents with complete data on our model covariates, most preferred completing PROMs related to behavioral and physical health, respectively, in between appointments when not at VA (76% and 73%) and/or during appointments with their VA providers (74% and 77%). They endorsed to a lesser degree the option to complete PROMs at the VA, before an appointment (60% and 59%). Veterans aged 65 years or older (vs. under 65) had greater odds of preferring to complete PROMs related to physical health in between appointments when not at VA (OR = 1.5, 95%CI: [1.0,2.3]) and had lesser odds of preferring reporting via mobile app (on smartphone, tablet, or computer) vs completing PROMs over secure messaging or a mailed paper-and-pencil assessment (OR = 0.6, 95%CI: [0.4,0.9]). Latinx (vs. non- Latinx) Veterans had greater odds of preferring to complete PROMs while at VA before an appointment (OR = 3.8, 95%CI: [1.2,12.1] for physical, OR = 3.3, 95%CI: [1.0,10.6] for behavioral), and had greater odds of preferring to use a kiosk in the waiting room over tablets or paper (OR = 3.9, 95%CI: [1.4,11.3]). Veterans reporting difficulties paying for basics such as food and heating/cooling (vs. those not reporting such financial difficulties) had lesser odds of preferring to complete PROMs related to behavioral health in between appointments when not at VA (OR = 0.6, 95%CI: [0.4,0.9]) and greater odds of preferring to complete these PROMs during appointments with their VA providers (OR = 2.0, 95%CI: [1.2,3.2]) with greater odds of preference for verbal reporting over other modalities (OR = 1.6, 95%CI: [1.1,2.4]).

Implications:
Veterans endorsed completing PROMs related to behavioral or physical health at the VA (before or during a visit) and at home. Factors such as age, ethnicity, and socio-economic status are associated with varying Veteran preferences regarding where, when and how to complete PROMs.

Impacts:
VA is committed to increasing the use of PROM data in clinical care. Initiatives to improve PROM administration should focus on leveraging Veteran preferences, for example, administering PROMs using VA’s online patient portal, developing mobile health applications that support Veteran completion of PROMs using their personal devices in between VA clinical encounters, and engaging providers in the administration of PROMs during appointments.