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Patient Reported Outcome Measures (PROM)

By Advocate, Caregiver, Clinician, ePatient, Informaticist, Researcher

When I first heard about Patient Reported Outcome Measures (PROM) I thought they were talking about pulse, blood pressure, weight, pain, anxiety. I didn’t start exploring further until 2012 when I was on the federal government’s Blue Button Initiative – clicking a button in your electronic medical record to download information from that record into human or machine readable form. I was on the Content Task Force. I cared about what information was to be downloaded. Based on comments I had received from you readers, I tried to get the Task Force to add what works and what doesn’t, when I’m scared or in pain. No luck, as if I was speaking Klingon. That started my exploration of PROM in England’s National Health Service. The National Quality Forum published a report in January 2013 about PROM. PROM’s have been developed for depression, pain, sleep, joint replacement. You can see an example on a Dartmouth web site called https://howsyourhealth.org/ where you can do a checkup of your general health and health risks.

PROM can be used for an individual or for populations, just like any research.  For people, the challenges is having the chat with your primary care provider. Will they have time? Will they engage with you? For populations, the challenge is the methodology.  Will everyone do it the same? Is it filled out only by people who have the knowledge, language, motivation to enter data? What about people who need their parent, neighbor, caregiver, child to fill it out? This is an exciting puzzle. I need to learn more.

Health Literacy Month

By Advocate, Caregiver, Clinician, Consumer, ePatient, Family man, Researcher
Last week I was describing a mutual friend to my son as pathologically optimistic. Overhearing us, my seven-year old grandson asked me what that meant.  I started in with glass half full, glass half empty. Oh, Opa, he interrupted me, I know what optimistic means, what does pathologically mean?  I was using language my grandson didn’t understand and he questioned me. I attend a weekly conference call of OpenID HEART, that I’ve written about here before, and I understand about a quarter of the discussion – very technical.  I am not as ready as my grandson to interrupt and question, even though when I have, my very basic language questions are respected and welcome.  Rather I usually take notes and ask the questions on the list offline. I often facilitate meetings. I try to pay attention to the language people use and explain acronyms or jargon.  If I see a furrowed brow, I ask the furrower if they have a question. As a direct care nurse, I made sure I created teach back moments when helping people at the center of care prepare to manage without me.
Often I have the sense that people consider literacy as a dumbing down – write to the fifth grade level, eighth grade – whatever. Many colleagues in any gig I’ve worked, say, communication sucks! I, however, am continually amazed that we can communicate at all. My friend, Helen Osborne at www.healthliteracy.com tells me that literacy is about language, age, culture, disability, emotion, and cognition (genetic and evolving).  That’s a lot to consider when communicating. My communication usually just falls out of my mouth.

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The jumble of research

By Advocate, Caregiver, Clinician, Consumer, ePatient, Researcher
Next week, I’ll be attending PCORI’s (Patient Centered Outcomes Research Institute) Communication and Dissemination Advisory Team meeting in DC. Research is ink on paper until people at the center and clinicians receive the results in an understandable and useable form: communication, translation, dissemination. I speak with many of you  about what matters to you. I hear you ask:
  • How does research apply to me? For example, a study reports that one treatment is likely to result in improvement 40% of the time. This treatment  results in 10% fewer people dying within 5 years than that treatment. 20% of people taking drug A are likely to have some nasty side effect.  If research is about groups of people (populations), how do I know whether to take one path or another, based on research?
  • Health care seems to be a Tower of Babel – communication is tough in the best of circumstances. How can we best communicate complex information from clinicians to people at center, from people at center to clinicians, or between specialists?
  • How do my personal values, religion, or culture affect research results?
  • The person I care for has changing ability to understand (getting older, more confused, etc.). How do I best share research results?
  • What about research that isn’t published, doesn’t prove the hypothesis? It all seems so uncertain.  How is that communicated.
  • What about word of mouth, popular media, or social media?  How do I know what to believe?
  • If I am one of the people who is a subject in research, how do I protect my privacy?
I’m hoping that we begin to assemble a framework for understanding communication and dissemination of research. Right now it seems like such a jumble.
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