Study shows feasibility of paper-based patient-reported outcomes in integrative health and medicine

Led by a team of researchers at University Hospitals Connor Whole Health, a new study finds that collecting paper-based patient-reported outcome (PRO) measures of pain, anxiety, and stress is feasible – and that provider, operational, and clinical-level factors impact successful completion more so than patient factors.

Patients often seek integrative health and medicine (IHM) modalities such as acupuncture, chiropractic, and massage in the outpatient setting, most commonly for concerns of pain, anxiety, and stress. In contrast to laboratory measures, patient-reported outcomes offer a more wholistic picture of the effects of treatments, especially IHM modalities, on measures related to quality of life. But how can PRO collection be optimized – and what factors impact PRO questionnaire completion?

The study found that such a system can be implemented within a large IHM practice spanning multiple sites in Northeast Ohio, and that the nature of presenting complaint, clinic location, and timing of collection – e.g., prior to infection control concerns due to the COVID-19 pandemic – impact odds of pre- and post-session PRO collection.

While previous studies of PRO collection among outpatients seeking IHM have explored its feasibility, our study is among the first to investigate the specific factors associated with successful instrument completion– especially at this scale."

Roshini Srinivasan, MD, RYT-500, Research Intern and lead author of this study

The study

Published in PLOS ONE, this study explored the implementation of a low-tech, paper-based collection system for over 27,000 instances of patients receiving IHM care – across acupuncture, chiropractic, integrative medicine consultations, massage, and osteopathic manipulation – across multiple IHM clinics over 18 months. Following this time, they analyzed what factors were associated with successful pre- and post-session PRO completion.

Visits were analyzed in patients in patients who completed either a pre-encounter PRO questionnaire (n=21,798) or both pre- and post-encounter questionnaires (n=11,709).

The researchers found that being female, having a pain or anxiety complaint, having multiple IHM encounters, and being seen prior to Q2 2020 increased odds of questionnaire completion, while being seen at certain clinics and being seen after Q2 2020 were linked with reduced odds of completion.

Key innovations

"As we seek to understand how best to measure of the impact of our care, this study underscores key intervention points to optimize data collection in outpatient IHM," said Dr. Françoise Adan, Chief Whole Health and Well-being Officer and Director of UH Connor Whole Health. Co-author and Integrative Health Research and Data Specialist Samuel Rodgers-Melnick, MPH, MT-BC, shares that "in an era where data is increasingly leveraged for the benefit of our patients, this work provides a strong foundation for the strategic implementation of data collection efforts within IHM and across health systems."

Looking to the future, the authors write that research "will ideally explore routine electronic PRO collection and implementation in the outpatient IHM setting. Such efforts would align with current trends, especially in the post/chronic COVID-19 pandemic era, to move toward electronic data capture and potentiate real-time collection and visualization for both patients and providers."