Optimizing Patient-Reported Outcome Collection and Documentation in Medical Music Therapy: An EMMPIRE Process Improvement Study (Preprint)

BACKGROUND To measure the effectiveness of nonpharmacologic interventions delivered during clinical care, investigators need to ensure robust and routine data collection without disrupting individualized patient care or adding unnecessary documentation burden. OBJECTIVE A process-improvement study was undertaken to improve documentation consistency and increase the capture of patient-reported outcomes (PROs) (i.e., stress, pain, anxiety, and coping) within a medical music therapy (MT) team. METHODS Two Plan-Do-Study-Act (PDSA) cycles were utilized to improve documentation processes among a MT team (13.3 clinical fulltime equivalent staff). Trainings focused on providing skills and resources for optimizing pre- and post-session PRO collection, specific guidelines for entering session data in the electronic health record (EHR), and opportunities for the team to provide feedback. Two comparisons of therapists’ PRO collection rates were conducted: 1) between the 6 months prior to PDSA Cycle 1 (T0) and PDSA Cycle 1 (T1), and 2) between T1 and PDSA Cycle 2 (T2). RESULTS Music therapists’ rates of capturing any PRO increased significantly (P < .001) from T0 to T1 and from T1 to T2 for all domains including stress (0.1%, 36.3%, 50.7%), pain (29.7%, 51.8%, 61.4%), anxiety (18.1%, 34.1%, 51.6%), and coping (0.0%, 20.5%, 41.2%) at T0, T1, and T2 respectively. Music therapists’ feedback and findings from a retrospective analysis were used to create an improved EHR documentation template. CONCLUSIONS Rates of PRO data collection improved within the medical MT team. Although the process-improvement in this study was applied to a nonpharmacologic, MT intervention, the principles are applicable to numerous inpatient clinical providers. As hospitals continue to implement nonpharmacologic therapies in response to the Joint Commission recommendations, routine PRO collection will provide future researchers with the ability to evaluate the impact of these therapies on pain relief and opioid utilization.