Barriers and Opportunities for Patient-Reported Outcome Implementation: A National Pediatrician Survey in the United States

Ming Chen; Conor M Jones; Hailey E Bauer; Onyekachukwu Osakwe; Pavinarmatha Ketheeswaran; Justin N Baker; I-Chan Huang

doi:10.3390/children9020185

Barriers and Opportunities for Patient-Reported Outcome Implementation: A National Pediatrician Survey in the United States

Children (Basel). 2022 Feb 2;9(2):185. doi: 10.3390/children9020185.

Authors

Ming Chen¹, Conor M Jones², Hailey E Bauer³, Onyekachukwu Osakwe⁴, Pavinarmatha Ketheeswaran⁵, Justin N Baker⁶, I-Chan Huang³

Affiliations

¹ College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA.
² Weill Medical College, Cornell University, New York, NY 10021, USA.
³ Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN 38105, USA.
⁴ School of Medicine, University of Mississippi, Jackson, MS 39216, USA.
⁵ Alpert Brown Medical School, Brown University, Providence, RI 02903, USA.
⁶ Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA.

Abstract

Purpose: To characterize pediatricians' perceived barriers and areas of confidence in assessing patient-reported outcomes (PROs) in the U.S., and to test associations of these factors with implementing PRO assessment.

Methods: Using a random sample from the members of American Medical Association, we recruited general pediatricians and pediatric subspecialists to complete a survey (July 2011 to December 2013). Perceived barriers and confidence in PRO assessment were compared by age, pediatric specialty (general pediatrics, seven subspecialties), practice settings (academic, private), and region of practice. Multivariable logistic regressions tested associations of demographic factors, barriers, and confidence factors with the implementation of PRO assessment.

Findings: The survey was completed by 458 participants (response rate 48.5%); of these, 40.4%, 15.9%, 15.5%, and 8.1% were general pediatricians, cardiology, hematology/oncology, and pulmonary specialists, respectively. PRO assessment was implemented by 29.0% of the pediatricians. The top five barriers for PRO assessment included limited time/manpower (79.0%), limited training (77.4%), lengthy PRO instruments (76%), lack of meaningful cut-offs on PRO scores (75.5%), and unavailable PRO instruments (75.0%). Limited knowledge of PROs (OR 4.10; 95% CI 2.21, 7.60) and unavailability of PRO instruments (OR 1.87; 95% CI 1.01, 3.49) increased the odds of not implementing the assessment, whereas confidence in PRO assessments compatible with norms (OR 0.41; 95% CI 0.23, 0.72) and perceived benefit over clinical judgment alone (OR 0.53; 95% CI 0.31, 0.93) decreased the odds of not implementing the assessment.

Interpretation: significant barriers to PRO assessment in pediatric settings suggest the need for providing training, resources, and practical guidance toward implementation. Patient or Public Contribution: healthcare service users contributed to this study by completing a survey and providing feedback about the barriers and areas of confidence in assessing PROs for pediatric populations.

Keywords: barrier; implementation; patient-reported outcomes; pediatrics; physician survey.

Abstract

Grants and funding