Electronic Outcome Assessment in clinical trials

eCOA: Electronic clinical outcome assessment

What is eCOA and what does it mean in clinical research?

Electronic clinical outcome assessment (eCOA) is an electronic method for gathering self-reported health outcome information from patients, caregivers, and healthcare providers. eCOA is an umbrella term that typically encompasses the following outcome-collection instruments:

  • Electronic patient-reported outcomes (ePROs):  ePROs are the most frequently used type of eCOA in clinical trials. ePRO refers to  outcome data reported directly from patients electronically, typically via smartphones, tablets, or web platforms.
  • Electronic observer-reported outcomes (eObsRo): eObsRO are outcomes reported electronically by an observer, such as a parent, caregiver, or healthcare provider on behalf of a patient. eObsRo is typically employed in populations where study participants may have difficulty self-reporting their symptoms, behaviors or experiences, e.g. pediatric, behavioral or mental health, or rare disease or genetic disorder studies.
  • Electronic clinician reported outcome (eClinRo): eClinRO are outcome data that are reported by clinicians. 
  • Electronic performance outcomes (ePerfO): ePerfO refers to performance outcomes measured electronically through standardized tasks or assessments that evaluate a patient’s ability to perform specific physical or cognitive activities, e.g. a grip strength test or a gait analysis.
  • eDiary: An eDiary is one method to capture eCOA, specifically ePROs, as it elicits patients to report directly about their perception of their symptoms, quality of life, and other related domains.
 

In modern clinical trials, eCOA is a critical source of treatment efficacy data. Data for diverse clinical trial endpoints can be sourced from eCOA, giving researchers direct insight into changes in patient health status, symptomology, and functioning. 

What is the difference between ePRO and eCOA?

eCOA and ePRO differ primarily in their scope of data collection. 

ePRO is a subtype of eCOA. ePRO captures self-reported health outcome data directly from patients as opposed to caregivers, healthcare providers, or other observers. eCOA, as a broad term, encompasses other types of outcome data, such as eObsRO and ePerfO, which elicit outcome information from other parties involved in a clinical trial. 

In sum, ePROs are always a type of eCOA, but not all eCOA is an ePRO.

eCOA & ePRO vs. Paper

The benefits of eCOA and ePRO in clinical trials

eCOA and ePRO systems are designed to improve patient engagement, streamline data capture, reduce errors, and enhance data accuracy. Modern systems include features like automated email reminders and progress trackers to help patients stay on track with their assessments.

Additionally, ePRO systems can offer personalized questionnaires tailored to a patient’s condition or treatment, boosting compliance and the relevance of the data. Integration with mobile devices and wearables enables continuous monitoring, providing a more complete picture of the patient’s progress.

Characteristics of ePRO and eCOA

Objective & integrated

Patient-reported outcome measures for an objective assessment of a patients’ quality of life, can integrated into clinical workflows

Standardized & validated

Validated generic as well as disease specific questionnaires, available in different languages

Electronic & automated

Electronic recording and automated analysis of outcomes, reduces hospital visits and the administrative burden for clinic staff as well as researchers

How to integrate ePROs/eCOAs into your clinic

In our free checklist, we have summarized the most important requirements.

Learn more about the specifics of ePRO instruments

Selected instruments for patient-related health assessment:

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WHO-QOL-BREF

The World Health Organisation Quality of Life BREF is a validated tool for general quality of life assessment.

SF-12

The Short Form 12 Health Survey is a validated 12-item-tool for generic evaluation of patient physical and mental health status.

Physical Function Short Form (HOOS)

The HOOS of the HOOS-PS is a abbreviated version of the original that focuses on the functional assessment of hip-associated health problems.

EQ-5D-3L

The EQ-5D-3L is a validated generic measure instrument for patients health status which was developed in 1990 by the EuroQol Group.

Hip Disability and Osteoarthritis Outcome Score (HOOS)

The Hip Disability and Osteoarthritis Outcome Score (HOOS) is a validated tool for assessing patients hip associated health.

Neck Disability Index (NDI)

Developed on the basis of the Oswestry Disability Index, the NDI stands for a quick and intuitive assessment of neck pain of different etiologies.

Oxford Hip Score (OHS)

Making hip surgery-related quality of life measurable, especially used for outcome evaluation after hip surgery.

COMI-neck

EUROSPINE's specific tool for the evaluation of cervical back pain.

COMI-back

The COMI-back included in the "Spine-Tango" registry of EUROSPINE is used to assess low back pain due to various underlying diseases.
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Examples of eCOA

UNITY can seamlessly display diverse questionnaires (ePROs, ePREMs and eCRFs). With our questionnaire designer it is possible to define and create these yourself.

Arrhythmia-Specific Questionnaire in Tachycardia and Arrhythmia (ASTA)

A specific questionnaire to ask about symptoms of tachycardia and arrhythmias and their impact on patients' daily life.

Atrial Fibrillation Effect on QualiTy-of-life (AFEQT)

The Atrial Fibrillation Impact on Quality of Life Questionnaire (AFEQT) assesses symptoms, daily activities, and treatment concerns of patients related to atrial fibrillation.

Duke Activity Status Index (DASI)

The Duke Activity Status Index is a PROM for estimating functional capacity in patient populations with cardiovascular disease.

Generalized Anxiety Disorder (GAD-7)

A brief and specific measurement tool in patients with generalized anxiety disorder.

Hip Disability and Osteoarthritis Outcome Score (HOOS)

40 questions for a detailed overview of the health of patients with hip-related problems.

HOOS - Physical Function Short Form (HOOS-PS)

The short form of the HOOS, which is used for the brief and specific evaluation of functional hip-associated outcomes.

Hospital Anxiety and Depression Scale (HADS)

A questionnaire for the simultaneous evaluation of depression and anxiety disorder symptomatology.

KOOS - Physical Function Short Form (KOOS-PS)

The short form of the KOOS, which is used for the brief and specific evaluation of the functional knee-associated outcomes.

Lysholm-Score

A PROM developed for use in patients with ligament injuries and other disorders of the knee.

Oxford Knee Score (OKS)

Developed by Oxford University, the OKS aims to ensure that the results of knee operations are evaluated based on patient-related outcomes in addition to radiological and clinical data.

Patient Health Questionnaire-9 (PHQ-9)

The depression module of the Patient Health Questionnaire (PHQ) assesses the presence and severity of depression with 9 questions.

Rose Dyspnea Scale (RDS)

A four-item questionnaire that assesses the severity of patients' dyspnea during activities of daily living.

Seattle Angina Questionnaire (SAQ)

The Seattle Angina Questionnaire (SAQ) is a validated disease-specific instrument to assess the health status of patients with coronary artery disease.

SF-12

The little brother of the SF-36 questionnaire for assessing the general quality of life - fewer questions for a shorter processing time despite good statistical values.

Tegner Activity Scale (TAS)

A useful addition to the Lysholm score for assessing knee-related health.

WHOQOL-BREF

26 questions selected from the original 100-item questionnaire on overall health-related quality of life developed by the World Health Organization.

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