Assessing the feasibility of a web‐based outcome measurement system in child and adolescent mental health services – myHealthE a randomised controlled feasibility pilot study

Background: Interest in internet-based patient reported outcome measure (PROM) collection is increasing. The NHS myHealthE (MHE) web-based monitoring system was developed to address the limitations of paper-based PROM completion. MHE provides a simple and secure way for families accessing Child and Adolescent Mental Health Services to report clinical information and track their childs progress. This study aimed to assess whether MHE improves the completion of the Strengths and Difficulties Questionnaire (SDQ) compared with paper collection. Secondary objectives were to explore caregiver satisfaction and application acceptability. Methods: A twelve-week single-blinded randomised controlled feasibility pilot trial of MHE was conducted with 196 families accessing neurodevelopmental services in south London to examine whether electronic questionnaires are completed more readily than paper-based questionnaires over a 3-month period. Follow up process evaluation phone calls with a subset (n=8) of caregivers explored system satisfaction and usability. Results: MHE group assignment was significantly associated with an increased probability of completing an SDQ-P in the study period (adjusted hazard ratio, (HR) 12.1, 95% CI 4.7-31.0; p= <0.001). Of those caregivers who received the MHE invitation (n=68) 69.1% completed an SDQ using the platform compared to 8.8% in the control group (n=68). The system was well received by caregivers, who cited numerous benefits of using MHE, for example, real time feedback and ease of completion. Conclusions: MHE holds promise for improving PROM completion rates. Research is needed to refine MHE, evaluate large scale MHE implementation, cost effectiveness and explore factors associated with differences in electronic questionnaire uptake.

[1]  A. Stringaris,et al.  Moving from development to implementation of digital innovations within the NHS: myHealthE, a remote monitoring system for tracking patient outcomes in child and adolescent mental health services. , 2021, medRxiv.

[2]  A. Stringaris,et al.  Sociodemographic factors associated with routine outcome monitoring: a historical cohort study of 28,382 young people accessing child and adolescent mental health services. , 2020, Child and adolescent mental health.

[3]  Z. Niazkhani,et al.  Barriers to patient, provider, and caregiver adoption and use of electronic personal health records in chronic care: a systematic review , 2020, BMC Medical Informatics and Decision Making.

[4]  Tariq Osman Andersen,et al.  Large-scale and long-term co-design of digital health , 2019, Interactions.

[5]  M. Hotopf,et al.  An approach to linking education, social care and electronic health records for children and young people in South London: a linkage study of child and adolescent mental health service data , 2019, BMJ Open.

[6]  Kyle Taylor,et al.  Smartphone ownership is growing rapidly around the world, but not always equally , 2019 .

[7]  M. Loades,et al.  Routine outcome monitoring in CAMHS: how can we enable implementation in practice? , 2018, Child and adolescent mental health.

[8]  Lisa M. Nordan,et al.  Implementing electronic patient-reported outcomes measurements: challenges and success factors , 2018, BMJ Quality & Safety.

[9]  Linda Huibers,et al.  Paper- or Web-Based Questionnaire Invitations as a Method for Data Collection: Cross-Sectional Comparative Study of Differences in Response Rate, Completeness of Data, and Financial Cost , 2018, Journal of medical Internet research.

[10]  H. Maurice‐Stam,et al.  First experience with electronic feedback of the Psychosocial Assessment Tool in pediatric cancer care , 2017, Supportive Care in Cancer.

[11]  Christine Hamel,et al.  Social Health Inequalities and eHealth: A Literature Review With Qualitative Synthesis of Theoretical and Empirical Studies , 2017, Journal of medical Internet research.

[12]  Cheryl Cott,et al.  The Electronic Patient Reported Outcome Tool: Testing Usability and Feasibility of a Mobile App and Portal to Support Care for Patients With Complex Chronic Disease and Disability in Primary Care Settings , 2016, JMIR mHealth and uHealth.

[13]  Andrea C. Fernandes,et al.  Cohort profile of the South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLaM BRC) Case Register: current status and recent enhancement of an Electronic Mental Health Record-derived data resource , 2016, BMJ Open.

[14]  Cara C. Lewis,et al.  Capabilities and Characteristics of Digital Measurement Feedback Systems: Results from a Comprehensive Review , 2016, Administration and Policy in Mental Health and Mental Health Services Research.

[15]  Otto B. Walter,et al.  Implementation of the Kids-CAT in clinical settings: a newly developed computer-adaptive test to facilitate the assessment of patient-reported outcomes of children and adolescents in clinical practice in Germany , 2016, Quality of Life Research.

[16]  K. Lohr,et al.  Patient-Reported Outcomes in Performance Measurement , 2015 .

[17]  Scott D. Miller,et al.  Implementing routine outcome monitoring in clinical practice: Benefits, challenges, and solutions , 2015, Psychotherapy research : journal of the Society for Psychotherapy Research.

[18]  Jeffrey M. Halperin,et al.  Treatment of Children With Attention-Deficit/Hyperactivity Disorder (ADHD) and Irritability: Results From the Multimodal Treatment Study of Children With ADHD (MTA) , 2015, Journal of the American Academy of Child and Adolescent Psychiatry.

[19]  A. McAuley,et al.  Digital health interventions: widening access or widening inequalities? , 2014, Public health.

[20]  Manjinder S. Sandhu,et al.  Open-source electronic data capture system offered increased accuracy and cost-effectiveness compared with paper methods in Africa , 2014, Journal of clinical epidemiology.

[21]  Paul O’Donohoe,et al.  Capturing Patient-Reported Outcome (PRO) Data Electronically: The Past, Present, and Promise of ePRO Measurement in Clinical Trials , 2014, The Patient - Patient-Centered Outcomes Research.

[22]  Jean Paty,et al.  PRO data collection in clinical trials using mixed modes: report of the ISPOR PRO mixed modes good research practices task force. , 2014, Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research.

[23]  Tim P Morris,et al.  The risks and rewards of covariate adjustment in randomized trials: an assessment of 12 outcomes from 8 studies , 2014, Trials.

[24]  C. Hollis,et al.  A qualitative process evaluation of electronic session-by-session outcome measurement in child and adolescent mental health services , 2014, BMC Psychiatry.

[25]  C. Hollis,et al.  The use of routine outcome measures in two child and adolescent mental health services: a completed audit cycle , 2013, BMC Psychiatry.

[26]  David Forman,et al.  Integrating Patient Reported Outcomes With Clinical Cancer Registry Data: A Feasibility Study of the Electronic Patient-Reported Outcomes From Cancer Survivors (ePOCS) System , 2013, Journal of medical Internet research.

[27]  M. Wolpert Uses and Abuses of Patient Reported Outcome Measures (PROMs): Potential Iatrogenic Impact of PROMs Implementation and How It Can Be Mitigated , 2013, Administration and Policy in Mental Health and Mental Health Services Research.

[28]  Angus Roberts,et al.  Development and evaluation of a de-identification procedure for a case register sourced from mental health electronic records , 2013, BMC Medical Informatics and Decision Making.

[29]  K. Søreide,et al.  Using Patient-Reported Outcome Measures for Improved Decision-Making in Patients with Gastrointestinal Cancer – the Last Clinical Frontier in Surgical Oncology? , 2013, Front. Oncol..

[30]  井田 博幸,et al.  Children's Global Assessment Scale , 2013 .

[31]  C. Hollis,et al.  Implementing routine outcome measures in child and adolescent mental health services: from present to future practice. , 2013, Child and adolescent mental health.

[32]  Nick Black,et al.  Patient reported outcome measures could help transform healthcare , 2013, BMJ.

[33]  E. Duncan,et al.  The barriers and facilitators to routine outcome measurement by allied health professionals in practice: a systematic review , 2012, BMC Health Services Research.

[34]  F. Zitman,et al.  Routine outcome monitoring and feedback on physical or mental health status: evidence and theory. , 2012, Journal of evaluation in clinical practice.

[35]  M. Hendriks,et al.  A Comparison of a Postal Survey and Mixed-Mode Survey Using a Questionnaire on Patients’ Experiences With Breast Care , 2011, Journal of medical Internet research.

[36]  L. Dixon,et al.  Use of the internet and other media for health information among clinic outpatients with serious mental illness. , 2009, Psychiatric services.

[37]  Graham Thornicroft,et al.  The South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLAM BRC) case register: development and descriptive data , 2009, BMC psychiatry.

[38]  James T. Miller,et al.  An Empirical Evaluation of the System Usability Scale , 2008, Int. J. Hum. Comput. Interact..

[39]  Mohan Jyoti Dutta,et al.  Understanding Health Literacy for Strategic Health Marketing: eHealth Literacy, Health Disparities, and the Digital Divide , 2008, Health marketing quarterly.

[40]  S. Lindsay,et al.  Enabling healthy choices: is ICT the highway to health improvement? , 2008, Health.

[41]  Gary G Bennett,et al.  Barriers and Facilitators to Home Computer and Internet Use Among Urban Novice Computer Users of Low Socioeconomic Position , 2007, Journal of medical Internet research.

[42]  Michael J. Lambert,et al.  Is It Time for Clinicians to Routinely Track Patient Outcome? A Meta‐Analysis , 2006 .

[43]  C. Johnston,et al.  Routine Outcome Measurement: A Survey of UK Child and Adolescent Mental Health Services. , 2005, Child and adolescent mental health.

[44]  J. V. Dijk,et al.  The Deepening Divide: Inequality in the Information Society , 2005 .

[45]  Eszter Hargittai,et al.  Second-Level Digital Divide: Differences in People's Online Skills , 2002, First Monday.

[46]  R. Jamison,et al.  Electronic diaries for monitoring chronic pain: 1-year validation study , 2001, Pain.

[47]  Tx Station Stata Statistical Software: Release 7. , 2001 .

[48]  M. Black,et al.  Computer-Administered Interviews With Children About Maltreatment , 2000 .

[49]  R. Goodman The Strengths and Difficulties Questionnaire: a research note. , 1997, Journal of child psychology and psychiatry, and allied disciplines.

[50]  J. B. Brooke,et al.  SUS: A 'Quick and Dirty' Usability Scale , 1996 .

[51]  James Robert Brašić,et al.  A children's global assessment scale (CGAS). , 1983, Archives of general psychiatry.