Background:
Voxe is a novel, child- and healthcare provider (HCP)-friendly, electronic patient-reported outcome measure (ePROM) platform developed via a user-centric approach to create a digital platform that engages and empowers patients and HCPs.

Approach:
Iterative rounds of co-design and usability testing guided the rigorous, user-centered development of Voxe. During testing, end users (i.e., patients and HCPs) completed task-based activities on Voxe, such as creating a profile or navigating to PROM results. End users commented on the platform’s ease of use and functionality, shared their perspectives of the Voxe design, and, ultimately, informed Voxe’s integration into the electronic medical record system, Epic. This study evaluated the implementation and preliminary effectiveness of Voxe in the Renal Transplant Clinic at The Hospital for Sick Children (SickKids).

An implementation-effectiveness hybrid design was used. Eligible participants included patients (12-17 years old; minimum three months post-transplant) and HCPs who provided care to participating patients. HCPs received training on Voxe and integrating PROM data into clinical encounters. Patient participants received a text or email seven days before their clinic appointment to request completing PROMs through Voxe. HCPs were alerted in Epic following patient completion. PROM data was discussed during the patient’s clinic visit and integrated into their care plan as needed. Semi-structured interview data and quantitative metrics were collected and analyzed to assess outcomes.

Results:
Twenty patients aged 13.8 ±1.4 years and seven healthcare providers participated. Implementation Outcomes: The frequency of PROM completion correlated with patients’ clinic visits during the study, and the rate of ePROM completion was 95%, higher than most pediatric ePROM completion rates reported internationally (adoption). Patients described Voxe as "easy to use," and many HCPs shared that they were satisfied with the ease of reviewing PROM data (feasibility). Voxe participation increased satisfaction with the clinic appointment for both HCPs and patients, with several patients sharing a preference for completing ePROMs in Voxe since they did not have to verbalize how they were feeling: “I prefer this more, instead of having to say how I’m feeling out loud” (acceptability). Patient participants preferred a text notification requesting PROMs completion, and HCPs highlighted how Voxe integration “fit” within their clinic (appropriateness). Effectiveness Outcomes: Voxe encouraged communication between patients and HCPs about quality of life (QoL) and mental health concerns. Several patients shared that completing ePROMs in Voxe allowed them to share their perspectives and participate in conversations about QoL: “…it helped me talk about things that I wouldn't necessarily speak about...I feel Voxe would help other patients”. Outcomes reflect participants’ perception of Voxe as adoptable, feasible, acceptable, and appropriate and demonstrate its effectiveness at fostering patient-provider communication.

Implications:
Findings support Voxe’s implementation and preliminary effectiveness as a novel digital health approach to capture patient voices and enhance the capacity of patient-provider partnerships to provide holistic, patient-centred care. Next steps include evaluating mental health measurement-based care (MBC) implementation using Voxe across SickKids and developing an Implementation Roadmap to enable broader dissemination of MBC across pediatric institutions.

Background:
Trillium Health Partners (THP), one of Canada’s largest leading academically-affiliated health centres in Ontario, Canada, recognized a critical gap in patient experience (PE) data collection methods. Traditionally reliant on paper-based and telephone surveys, THP's approach was increasingly seen as insufficient in capturing the full diversity of patient feedback. This limitation was particularly significant within the context of integrated care, where timely, comprehensive, and accurate patient feedback is essential for informed decision-making and continuous quality improvement. As healthcare systems globally move towards more integrated models of care, the ability to gather diverse and actionable PE data becomes even more crucial. Without it, hospitals risk missing vital insights that could enhance patient care.

Approach:
THP embarked on a project to overhaul its PE data collection system. The goal was to develop a more efficient and inclusive approach to capture a broader range of patient experiences and facilitate rapid quality improvements across different care settings. The new system integrated multiple data collection formats, including email, QR codes, and tablets, making it easier for patients to provide feedback. The transition to this new system resulted in a substantial increase in response rates while also expanding the scope and diversity of the feedback collected. Using PE survey data collected and stored on Qualtrics, we conducted a pilot study to develop an approach to mining PE data for rapid quality improvements. This approach leveraged advanced tools such as the Qualtrics dashboard, StatsIQ for statistical analysis, TextIQ for qualitative analysis via natural language processing, and N-Vivo for open-ended response analysis.

Results:
The pilot study analysis focused on four medicine units—two with the highest and two with the lowest overall PE scores based on patient ratings of their overall experience on a 0-10 scale. The team identified critical enablers and barriers to PE, such as emotional support (fears, anxieties, worries) and engagement for units with high and low overall PE scores. Regression models were created for each medicine unit to provide more nuanced insight into the drivers of PE in each unit. Analysis of open-ended responses revealed that positive experiences were related to effective communication and humane treatment, while negative experiences were due to a lack of communication and operational inefficiencies. This presentation will discuss how the PE data mining approach was developed and the findings of this pilot on promoting collaborative, rapid, data-driven quality improvement.

Implications:
The lessons learned from this pilot study underscore the importance of leveraging PE data (both closed and open-ended text data) for rapid and evidence-based quality improvement. We developed a PE data mining approach to learn from a broad range of patient experiences and facilitate rapid, actionable insights that could be immediately applied to improve care. The following steps involve refining the tools, protocols, and processes developed during this project to guide rapid quality improvement efforts across other clinical programs and functions.

Background:
Digital solutions offer the possibility to improve the management of patient care by increasing and facilitating the communication within the multidisciplinary care team. However, integrating digital medical devices and services into integrated care models, such as those for Parkinson’s disease (PD), comes with several challenges such as the reservations to change by the healthcare professionals (HCPs), the disruption of the care pathway workflows, the management of highly sensitive information and the lack of systems interoperability, among others.

Approach:
Taken this into consideration, we aim to improve the communication between the multidisciplinary care team and patients of ParkinsonNet Luxembourg by leveraging the use of digital management solutions and the Luxembourgish Electronic Health Records known as the Dossier de Soins Partagé (DSP). This initiative was co-designed with local stakeholders, including an expert group in PD (n=6), PD patient representatives, and members from the Luxembourgish eHealth agency (eSanté). To test feasibility and engage users, we conducted an anonymous online survey among HCPs of ParkinsonNet Luxembourg (n=85) to understand their perspectives on the usage of digital solutions to collect, store and exchange clinical information.

Results:
In total 45 out of 85 invited HCPs answered the online survey. 82.2% of participants confirmed that they would like to use a medical software to document clinical information, and among these, 78.4% are willing to collect clinical information in a structured way. Furthermore, 72.7% of HCPs agreed that clinical information should be stored in the DSP. However, 51.16% believe that the lack of time during a consultation or the complexity of the DSP will be the biggest barriers to integrate DSP into their daily work. These results demonstrate that the planned initiative to exchange structured clinical information via the DSP is feasible within ParkinsonNet Luxembourg, provided that enough guidance is given to the HCPs and that the integration of DSP into their daily work is done without major adjustments to the care pathway and related workflows.

Implications:
Addressing potential challenges of the integration of digital solutions into integrated and managed healthcare models requires a strategic planning that considers the local context, the existing resources and the preferences of the care teams. This can be achieved through the integration of different stakeholders very early in the planning stage, the investigation of the preferences of the local care teams, the continuous education of HCPs and the availability of robust funding models to ensure that digital solutions can be seamlessly and sustainably integrated into such comprehensive healthcare models.

I. BACKGROUND
SIGA as an IT platform supported by clinical referrals monitors National Health Service (NHS) waiting and response times, and optimises patient access to healthcare, serving as the foundation for GOOD INTEGRATED CARE DELIVERY.
II APPROACH:
The Portuguese (NHS) has a main priority: To create adequate responses to citizens' needs, by reducing patient inequalities, improving access to healthcare and clinical information, and colaboration between the health sectors and key stakeholders.
To meet these needs, the Integrated Access Management System (SIGA) is being developed in several phases. It is an innovative measurement for national coverage and contributes to accessible interaction with the NHS.
SIGA is supported by clinical referrals, that will grant information to determine and monitor patients' NHS actions. This information will be provided regardless of whether it is a single clinical event or multiple ones for the same pathology; independently of the type of care involved (primary care, secondary care, tertiary care). It allows for an active monitoring of performance and degree of compliance with “Maximum Guaranteed Response Times” by care typology (general, oncology, cardiology and chronic viral disease) and by priority. Patients can also track their own referrals and care activity.
SIGA is the key stone for integrated monitoring of patient waiting times and delivery of care, to decrease inefficiency and for faster identification of healthcare “bottlenecks”. By producing a timely response and creating an assertive resolution, SIGA guarantees the fulfillment of the NHS.
The design of SIGA involved close collaboration with the SNS Executive Directorate, SPMS (Shared Services of the Ministry of Health), and the institutions, as pilot units in an initial phase.

III RESULTS:
SIGA has already completed three phases of the project, providing significant advances in the management of access and continuity of care in the SNS. Through SIGA’s dematerialized referrals, we obtain a range of indicators: number of patients on waiting lists, patient order of priority, median and average waiting time, the clinical referral diagnoses, the percentage of clinical events attended to within a timely manner, among others.
The system also allows for early intervention in suspected cases of oncological pathologies, chronic viral diseases and heart disease (based on the 129889 referrals made with this attribute)

IV IMPLICATIONS:
SIGA has proved essential for crisis management, as it assured the continuity of care, through dematerialized referrals that reduced the need for face-to-face appointments and increased the use of teleconsultations.
This approach showed the value of an integrated and flexible system for tackling public health challenges.
The next stages are the development of the remaining phases of the SIGA, and the implementation of the transversal SIGA, which will support, the effective monitoring of the integrated care.
In its future complete form, it will emphasise the following:
- Adjusted health policies;
- Patient empowerment;
- Integrating the monitoring, control and management of access to the NHS.
- A global and transversal vision of patient access and will be possible to understand whether or not a patient with a particular pathology has received the appropriate care.