Background/Purpose: The Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function-10a (PF10a) survey is a reliable and valid measure of function in patients with rheumatoid arthritis (RA). National quality measures recommend that patient-reported outcomes such as PROMIS PF10a be collected regularly in routine care. However, safety net health systems may face barriers in implementing PRO collection, including patients with low health literacy and limited English-language proficiency. Our objective was to increase collection and documentation of the PROMIS PF10a from 0% to 50% for all adult RA patient visits in our diverse, safety net clinic during a 9 month period.

Methods: We used the Institute for Healthcare ImprovementÕs Model for Improvement and Plan-Do-Study-Act (PDSA) methodology over 4 cycles. In cycle 1, PF10a surveys were administered to English-speaking patients, after vitals were taken. Staff offered to read the survey to all patients, an approach commonly used to ensure patients with low health literacy feel comfortable participating. Cycle 2 separated the process of collecting PROMIS PF10a scores into two steps: (1) administering the survey throughout clinic workflow rather than only after vitals were taken and (2) uploading the score into the electronic health record (EHR), which were delegated to a high school research volunteer and medical assistants. Cycle 3 created a folder for the volunteer and medical student team to communicate and track weekly progress. In the final PDSA cycle, the forms were administered to Spanish-speaking patients by language concordant staff.

Results: Our rheumatology clinic has approximately 96 RA encounters per month and 70% of the patient population speaks languages other than English (the majority speaking Cantonese or Spanish). The quality improvement project began in the fall of 2016 and PROMIS PF10a score collection percentage was 12.5% after the first PDSA cycle. During the second cycle, the proportion of visits with a completed PROMIS PF10a rose to 22.2%. After the 4th PDSA cycle, there was a sustained improvement over 6 months, with 35.5% of RA patient visits having the PROMIS PF10a collected and recorded in the EHR (Figure).

Conclusion: Using an interprofessional team approach and the Model for Improvement, we significantly improved collection and documentation of the PROMIS PF10a measure in a multilingual safety net rheumatology clinic. Although we fell short of our goal of 50% of our RA patient visits, we were able to record the PROMIS PF10a measure for 48.6% of the 212 individual patients seen throughout the course of our project. Efforts are ongoing to expand collection to further engage our clinic staff and volunteers to create a sustainable PRO collection workflow.

Figure. PROMIS PF10a Administration RA Quality Improvement Project Run Chart (Nov 2016 – Mar 2017). 1-4 correspond to PDSA cycles. A is when research intern was absent due to a 3-week vacation.