High Rates of Patient-Reported Outcome Measurements in Patients With Inflammatory Bowel Disease With Electronic Medical Record Implementation

Background: Patient-reported outcomes (PROs) including patient (pt) disease activity scores, quality of life, and depressive symptoms are increasingly being used for clinical care in pts with inflammatory bowel disease (IBD). It is important to understand how electronic medical record (EMR) implementation for PRO collection as well as patient characteristics and disease phenotypes may influence scores in a real world clinical setting. Methods: PROs were collected as part of clinical care from a tertiary care IBD center on an automated basis from the EMR from 2018-2020 (COVID pandemic affected workflows). Quality of life was measured by Short Inflammatory Bowel Disease Questionnaire (SIBDQ). Disease activity was measured using the Harvey Bradshaw Index (HBI) for Crohn’s disease (CD) and Simple Clinical Colitis Activity Index (SCCAI) for ulcerative colitis (UC). Depressive symptoms were measured using the validated Patient Health Questionnaire-8 (PHQ-8). EMR PRO collection included either online pt portal entry up to 72 hours prior to clinic visit or on a tablet at the time of clinic visit. Only pts new to clinic were evaluated to minimize confounding of subsequent multidisciplinary care. Statistical analysis included Pearson test and Kruskal-Willis tests. Results: Overall PRO collection rate from 1,373 pts was 88% (28.5% pt portal entry and 71.5% in-clinic tablet collection). Age was median 36 years (yrs) (75% IQR range 25, 52), 58% female, 66% with Crohn’s disease, 87% White, 7% Black, 6% other. 15% current smokers, 41% baseline corticosteroid use, 45% baseline biologic use, 23% baseline immunomodulator use, 32% baseline psychiatric medication use. In patients with UC, 71% had extensive disease. In patients with CD, 7% had perianal disease, 14% had penetrating and 29% had stricturing disease. PHQ and SIBDQ were highly correlated (Spearman correlation -0.718, P< 0.05). HBI and PHQ-9 (0.528, p < 0.05) and SIBDQ (-0.676, P< 0.05) were moderately correlated. For pts with CD, age range 40-65, baseline corticosteroid, and psychiatric medication use were associated with significantly higher HBI and PHQ scores and significantly lower SIBDQ scores. For patients with UC, corticosteroid use was associated with significantly higher SSCAI scores for UC, and corticosteroid and psychiatric medication use was associated with significantly lower SIBDQ and higher PHQ scores. Biologic and immunomodulator use was not associated with difference in PROs. Conclusions: PRO score collection was highly successful using EMR implementation in a tertiary care clinic setting for pts with inflammatory bowel disease. Different PRO measures are correlated. Pts with corticosteroid use reported worse disease activity, worse quality of life, and higher depressive symptoms scores. Pts with psychiatric medication use reported higher depressive symptom scores and lower quality of life scores.