Abstract
Background: Tracking of worrisome symptoms in primary care can provide a valuable safety-net for preventing missed or delayed diagnoses. However, few reliable symptom tracking systems exist within primary care, leading to potential patient harm and provider burnout. We combined systems engineering and userbased design to create and test a worrisome symptom tracking system at a community-based primary care practice in Boston.
Methods: Chart reviews of 86 patients established baseline rates of worrisome symptom follow-up in usual primary care. Based on findings from the chart review and input from a PCP survey, a team of systems engineers, PCPs, nurses, and software engineers met over a period of four months to iterate a semiautomated symptom tracking system prototype and to ensure feasibility within a busy primary care practice. The system was designed to provide a structured “test of time” through a referral template, timed nurse-led outreach, reminder flags, and communication back to the PCP. Work is ongoing to further automate the outreach through texting and embedding the system within the EHR.
Results: In usual care, only 60.5% of worrisome symptoms are followed up to diagnosis or resolution (i.e. diagnostic loop closed). Over a period of 10 months (1/10/2023-11/10/2023), 46 patients were referred by eight providers for worrisome symptom monitoring. Of these, 85% were successfully followed up (“closed”) and 33.3% required additional evaluation. The average time to documented resolution of symptoms using the symptom tracking system was 20 days compared to 103 days in usual care.
Conclusions: A symptom tracking system is feasible and highly effective in improving the rate of symptom follow-up and in reducing the time to symptom follow-up within a community-based primary care practice. Broader implementation and study of symptom tracking systems in diverse clinical settings is needed to further demonstrate their benefit as operationalized “tests of time”.