# Patient Preferences for Technology-Assisted Patient-Reported Outcomes Measurement of Mental Health Symptoms Among Veterans: Cross-Sectional Survey

## TL;DR

This study explores how veterans prefer to report their mental health symptoms using technology, finding that most prefer doing so between appointments via patient portals or during appointments verbally.

## Contribution

The study identifies specific veteran preferences for PROM administration and highlights the influence of ethnicity and socioeconomic status on these preferences.

## Key findings

- Most veterans prefer completing PROMs between appointments using a patient portal or during appointments verbally.
- Hispanic veterans are more likely to prefer completing PROMs at the medical center.
- Lower socioeconomic status is associated with a lower preference for completing PROMs between appointments.

## Abstract

The Veterans Health Administration is promoting patient-reported outcome measure (PROM) collection for measurement-based mental health care. Understanding veteran preferences about how and when to complete PROMs is critical to support their implementation.

We examined veteran preferences for timing and use of different technology platforms to complete mental health–related PROMs.

We invited a national sample of 1373 veterans to complete a survey; 858 (62.5%) responded. Surveys asked about veteran preferences for how and when to complete mental health–related PROMs. We characterized responses using descriptive statistics and estimated multiple logistic regression models to examine associations between veteran demographic and health characteristics and preferences for completing PROMs.

Most veterans preferred completing PROMs between appointments (607/801, 75.8%) using features of a patient portal (410/801, 51.2%), during appointments (589/801, 73.5%) verbally (413/801, 51.6%), and while at the medical center (480/801, 59.9%) on paper (189/801, 23.6%) or a tablet computer (180/801, 22.5%). Hispanic (vs non-Hispanic) veterans had 3.32 (95% CI 1.04-10.58) times higher odds of preferring to complete PROMs at the medical center, and veterans with lower (vs higher) socioeconomic status had lower odds (odds ratio 0.61, 95% CI 0.40-0.93) of preferring to complete PROMs in between appointments but 1.97 (95% CI 1.23-3.16) times higher odds of preferring to complete PROMs during appointments.

As the Veterans Health Administration and other health care systems seek to expand the integration of PROM data into health care services, adaptive and flexible approaches to PROM administration that align with patient preferences, including those that leverage technology platforms in the remote collection of these data, may bolster implementation. Our results indicate that such implementation efforts should consider patient ethnicity and socioeconomic status. Our findings further suggest that these efforts could benefit from incorporating PROM administration into online patient portals, developing mobile health apps that support PROM completion through patients’ personal devices in between clinical encounters, and engaging care team members in PROM administration during appointments.