# Expansion, Implementation & Evaluation of Electronic Health Record-Integrated  Patient-Reported Symptom Screening in a Comprehensive Cancer Center

> **NIH AHRQ R18** · NORTHWESTERN UNIVERSITY · 2020 · $489,832

## Abstract

Cancer patients experience physical and psychological symptoms, and supportive care needs, which are often
under-recognized by clinicians. Unidentified symptoms and concerns can result in treatment interference, poor
satisfaction, compromised health-related quality of life (HRQoL), and taxed healthcare systems. Cancer care
organizations have emphasized the need for symptom assessment and management within quality cancer
care delivery. The Commission on Cancer requires that accredited centers (caring for >70% of U.S. cancer
patients) implement universal psychosocial distress screening and make appropriate referrals to psychosocial
services. With that impetus, we leveraged health information technology to pilot the Oncology Symptom
Screening Initiative (OSSI): a demonstration program where patients complete Patient Reported Outcomes
Measurement Information System computer adaptive tests assessing depression, anxiety, fatigue, pain, and
physical function, along with checklists of supportive care needs, within the electronic health record (EHR) in
select Medical Oncology clinics. Assessment results immediately populate the EHR; severe symptoms and
endorsed supportive care needs trigger notifications to clinicians who can then make necessary referrals and
care decisions in real time. This seamless EHR integration allows for assimilation into clinical workflows.
However, the OSSI is limited to (a) medical oncology patients at one Northwestern Medicine location, and (b)
patients who access the patient portal (~30% of our population). This study leverages our expertise in
measurement and implementation science, symptom screening and management, and cancer care delivery to
accomplish the following aims: Aim 1. Use the Framework for Spread to guide expansion and implementation
of the OSSI to reach patients at all Northwestern Medicine cancer clinics. Implementation outcomes will
include: acceptability, adoption, appropriateness, feasibility, fidelity, penetration, and sustainability; Aim 2.
Evaluate the impact of system-wide implementation of the OSSI on patient and system outcomes over 12
months via (a) a quality improvement study (estimated n=4,000 cases) to compare the impact of the OSSI
(versus usual care) on EHR-documented health care usage and patient satisfaction using a stepped wedge
design in which clusters of study sites will gradually and randomly be assigned to cross from serving as a
control to implementing the OSSI and (b) a human subjects substudy (n=1,000) with patients who will complete
the OSSI and PRO measures of health care usage and satisfaction at baseline, 6 & 12 months. We will
examine differences in PROs between participants whose OSSI responses trigger clinical alerts and those who
do not. We will also explore longitudinal trajectories of PRO scores; Aim 3. Identify implementation facilitators
and barriers to system-wide expansion of the OSSI. We will conduct qualitative research to gather feedback
from clinicians, administrators,...

## Key facts

- **NIH application ID:** 9928001
- **Project number:** 5R18HS026170-03
- **Recipient organization:** NORTHWESTERN UNIVERSITY
- **Principal Investigator:** Sofia F. Garcia
- **Activity code:** R18 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2020
- **Award amount:** $489,832
- **Award type:** 5
- **Project period:** 2018-08-01 → 2023-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9928001

## Citation

> US National Institutes of Health, RePORTER application 9928001, Expansion, Implementation & Evaluation of Electronic Health Record-Integrated  Patient-Reported Symptom Screening in a Comprehensive Cancer Center (5R18HS026170-03). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/9928001. Licensed CC0.

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