During Sunday’s symposium Patient-Reported Outcomes (PROs)—Using Clinic-Based Screening and Intervention to Inform Diabetes Care, four experts will analyze the benefits and considerations of implementing PROs into routine clinical care. The two-hour session begins at 4:30 p.m. in room 5.
Sarah D. Corathers, MD, Assistant Professor of Internal Medicine and Pediatrics in the Division of Endocrinology at Cincinnati Children’s Hospital at the University of Cincinnati, will discuss implementation of a pediatric screening program that utilizes PROs. She will explore how a pediatric patient’s condition- and treatment-related thoughts and feelings are relevant to their clinical encounter.
“Life with diabetes goes far beyond an individual or specific clinical outcome,” Dr. Corathers said. “A1C is recognized as a standard bearer for glycemic outcomes, but there are a lot of limitations with that measure. It doesn’t reveal the day-to-day experience of a person with diabetes.”
Dr. Corathers has implemented electronic questionnaires, a common form of PRO administration, into her practice to screen for depression in adolescents with diabetes. She will discuss the use of PRO measurements, including quality of life measures and readiness for transition from pediatric to adult care. A care team can use PROs to promote an effective therapeutic interaction, she said.
“If we’re going to ask patients and families to provide additional information and effort, we owe it to them to acknowledge it, look at it, and respond to it in a meaningful way,” Dr. Corathers said. “We don’t want to add burden without adding value.”
Following Dr. Corathers’ presentation, Paul S. Ciechanowski, MD, MPH, Clinical Associate Professor in the Psychiatry and Behavioral Sciences Department at the University of Washington School of Medicine, will review specific tools used for adult psychosocial screening and intervention. He will offer practical ways PROs can be integrated into the clinical workflow in a busy office setting.
“We will not only look at validated measures for screening or assessment, but how these measures may be used over time for following patients’ statuses and for providing an opportunity to better engage individuals in three-dimensional care,” said Dr. Ciechanowski, a psychiatrist who has worked in diabetes clinical and research settings for more than two decades.
Dr. Ciechanowski will also explore how taking a biopsychosocial approach can be critical to achieving optimal health-care outcomes and reducing costs.
Julie A. Wagner, PhD, Associate Professor in the Division of Behavioral Sciences and Community Health at the University of Connecticut Health Center, will discuss cultural considerations for clinic-based screening and intervention.
And the session’s final presenter, Jeffrey S. Gonzalez, PhD, Associate Professor of Psychology, Medicine and Epidemiology and Population Health at Yeshiva University Albert Einstein College of Medicine, will address the indirect evidence and lack of direct evidence to support routine screening for depression.
Although routine screening, specifically for depression, is increasingly recommended in primary care and other practice settings, questions about the evidence supporting these recommendations remain, Dr. Gonzalez said. He will review some criticisms of routine screening for depression.
“There’s concern about whether screening programs may lead to over-treatment of those who do not actually have a clinical disorder without addressing the very real problem of under-treatment of psychological problems among those with more severe mental illness,” Dr. Gonzalez said. “I will be making a call for careful consideration before embarking on routine screening and will be making recommendations about how best to link screening to further assessment and referrals to appropriate interventions that can address the diversity of problems that may be uncovered by depression screening.”
Dr. Gonzalez said these considerations might help clinicians design screening protocols that will have the maximum impact on outcomes while controlling financial costs and time commitments.
“One thing is clear from the available research—screening on its own will not make much of a difference,” he said. “Resources must be in place to ensure follow-up assessment and appropriate care.”