Music therapy team increases collection of patient-reported outcomes to improve clinical research and practice

A new study from University Hospitals (UH) Connor Whole Health describes a process-improvement study undertaken to improve documentation consistency and increase the capture of patient-reported outcomes (PROs) (i.e., stress, pain, anxiety, and coping) within the UH Connor Whole Health music therapy team.

The study, titled "Optimizing Patient-Reported Outcome Collection and Documentation in Medical Music Therapy: Process Improvement Study" is the first to describe a quality improvement initiative that combined trainings and electronic health record (EHR) modifications to improve PRO collection and documentation. The findings from this study were recently published in JMIR Human Factors.

For this quality improvement initiative conducted between July and December 2020, researchers from UH Connor Whole Health implemented two Plan-Do-Study-Act (PDSA) cycles to improve documentation processes among a music therapy team (13.3 clinical fulltime equivalent staff). Trainings focused on providing skills and resources for optimizing pre- and post-session PRO collection, specific guidelines for entering session data in the EHR, and opportunities for the team to provide feedback. The investigators then compared therapists' rates of PRO collection 1) between the 6 months prior to PDSA Cycle 1 (T0) and PDSA Cycle 1 (T1), and 2) between T1 and PDSA Cycle 2 (T2).

Following the PDSA cycles, music therapists' rates of capturing any PRO within music therapy sessions increased significantly (p < .001) from T0 to T1 and from T1 to T2 for all domains including stress (0.1% at T0, 36.3% at T1, and 50.7% at T2), pain (29.7% at T0, 51.8% at T1, and 61.4% at T2), anxiety (18.1% at T0, 34.1% at T1, and 51.6% at T2), and coping (0.0% at T0, 20.5% at T1, and 41.2% at T2). Music therapists' feedback were then used to create an improved EHR documentation template.

The current study is the fourth manuscript to come from the Effectiveness of Medical Music Therapy Practice: Integrative Research using the Electronic Health Record (EMMPIRE) project. Other recent publications from the EMMPIRE dataset have described the integration of music therapy throughout UH and supported the real-world clinical effectiveness of music therapy for addressing patients' symptoms within community hospitals and at an academic cancer center.

"An important innovation in this quality improvement initiative was our ability to use simple tools like acronym expansions and existing note templates to document patient-reported outcomes in the EHR without having to build new documentation templates. We were then able to extract each note and use text analytics procedures to extract outcome data from therapists' clinical narratives," said Samuel Rodgers-Melnick, MPH, MT-BC, co-investigator for EMMPIRE and the lead author of the study.

"Collecting clinical outcomes data allows our providers to communicate therapeutic progress directly with patients, providers, and stakeholders, making the process crucial from both a clinical and operational standpoint," said Seneca Block, The Lauren Rich Fine Endowed Director of Expressive Therapies at UH Connor Whole Health. UH Connor Whole Health manages the largest health system-based music therapy program in the US, with 11 board-certified music therapists who collaborate with providers across the system to help patients and their families manage the physical and emotional toll of an illness or hospitalization. Additionally, UH Connor Whole Health provides a diverse offering of integrative health and medicine modalities, including acupuncture, chiropractic, and integrative medicine consults, that are centered on patients' entire well-being.

"Consistent documentation in the electronic health record by the integrative health and medicine providers on these interventions and patient reported outcomes allow for future research to be aggregated across numerous health systems. We hope that EMMPIRE can serve as the impetus for future multi-site collaborations." said Jeffery A. Dusek Ph.D., Director of Research, UH Connor Whole Health and Principal Investigator of EMMPIRE as well as the BraveNet Practice-Based Research Network, the largest such network of integrative health and medicine centers in the world.

In addition to describing their methods and findings, the authors conclude with a series of practical tips for clinicians and researchers to use to improve PRO collection at their institutions. These include 1) requesting EHR documentation enhancements early, 2) providing clear and consistent training to clinicians, 3) monitoring documentation completion at regular intervals, 4) minimizing documentation burden by capturing all data within one form, 5) providing tools for therapists to document sessions in which PROs are unable to be assessed due to patient limitations, and 6) providing additional tools to facilitate therapists' data collection such as a field note and a laminated form for patients to complete.

"Patient-reported outcomes are vitally important for understanding patients' needs and delivering high quality compassionate care. When combined with clinically effective approaches such as music therapy, you get a patient-centered and data-driven approach to improving outcomes throughout health systems" said Peter Pronovost, MD, Ph.D., FCCM, Chief Quality & Clinical Transformation Officer for UH.