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Jayakumar P, Bozic KJ. Advanced decision-making using patient-reported outcome measures in total joint replacement. J Orthop Res 2020; 38:1414-1422. [PMID: 31994752 DOI: 10.1002/jor.24614] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 01/21/2020] [Indexed: 02/04/2023]
Abstract
Up to one-third of total joint replacement (TJR) procedures may be performed inappropriately in a subset of patients who remain dissatisfied with their outcomes, stressing the importance of shared decision-making. Patient-reported outcome measures capture physical, emotional, and social aspects of health and wellbeing from the patient's perspective. Powerful computer systems capable of performing highly sophisticated analysis using different types of data, including patient-derived data, such as patient-reported outcomes, may eliminate guess work, generating impactful metrics to better inform the decision-making process. We have created a shared decision-making tool which generates personalized predictions of risks and benefits from TJR based on patient-reported outcomes as well as clinical and demographic data. We present the protocol for a randomized controlled trial designed to assess the impact of this tool on decision quality, level of shared decision-making, and patient and process outcomes. We also discuss current concepts in this field and highlight opportunities leveraging patient-reported data and artificial intelligence for decision support across the care continuum.
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Affiliation(s)
- Prakash Jayakumar
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, Texas
| | - Kevin J Bozic
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, Texas
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Lam PPY, Sardana D, Ekambaram M, Lee GHM, Yiu CKY. Effectiveness of Pit and Fissure Sealants for Preventing and Arresting Occlusal Caries in Primary Molars: A Systematic Review and Meta-Analysis. J Evid Based Dent Pract 2020; 20:101404. [PMID: 32473795 DOI: 10.1016/j.jebdp.2020.101404] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 09/12/2019] [Accepted: 10/25/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The use of pit and fissure sealants have been well supported in permanent teeth, but no concrete evidence is available to support this procedure in primary molars. This review aims to systematically assess randomized controlled trials and summarize the evidence on the effectiveness of different sealants in prevention and arrest of the pit and fissure occlusal caries in primary molars of children. MATERIALS AND METHODS Four electronic databases were searched from inception to March 2018. Seven studies were included in the qualitative and quantitative syntheses. Two reviewers independently selected studies, extracted data, assessed risk of bias using the revised Cochrane risk of bias tool, and evaluated the certainty in the evidence adopting the Grading of Recommendations Assessment Development and Evaluation approach. Odds ratio and retention rate of different sealants were recalculated and analyzed. RESULTS This review identified no significant difference in the overall caries incidence and progression when evaluated over 24 months between (1) resin-based sealant (RBS) and glass ionomer sealants (GIS) or resin-modified GIS; (2) conventional and newly developed RBS; (3) autopolymerized and light-polymerized RBS; (4) RBS with topical fluoride application and topical fluoride alone; and (5) RBS with topical fluoride application and resin infiltration with topical fluoride application. The pooled estimates of the mean retention rates of RBS and GIS on primary molars over an 18-months period were 85.94% and 23.18%, respectively. The certainty in the evidence of each outcome was determined as low or very low mainly because of high risk of overall bias and imprecision. CONCLUSION There are currently insufficient well-controlled randomized controlled clinical trials to determine whether sealants are beneficial in preventing or arresting noncavitated occlusal caries in the primary molars.
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Affiliation(s)
- Phoebe P Y Lam
- Paediatric Dentistry, Faculty of Dentistry, The University of Hong Kong, Pokfulam, Hong Kong SAR, Hong Kong
| | - Divesh Sardana
- Paediatric Dentistry, Faculty of Dentistry, The University of Hong Kong, Pokfulam, Hong Kong SAR, Hong Kong
| | - Manikandan Ekambaram
- Paediatric Dentistry, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Gillian H M Lee
- Paediatric Dentistry, Faculty of Dentistry, The University of Hong Kong, Pokfulam, Hong Kong SAR, Hong Kong
| | - Cynthia K Y Yiu
- Paediatric Dentistry, Faculty of Dentistry, The University of Hong Kong, Pokfulam, Hong Kong SAR, Hong Kong.
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Thomas A, Kuper A, Chin-Yee B, Park M. What is "shared" in shared decision-making? Philosophical perspectives, epistemic justice, and implications for health professions education. J Eval Clin Pract 2020; 26:409-418. [PMID: 32032468 DOI: 10.1111/jep.13370] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 12/12/2019] [Accepted: 01/25/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Drawing from the philosophical work of Hans-Georg Gadamer and the perspectives of theorists Mikhail Bakhtin and Kenneth Burke, the aim of this paper is to critically reflect on the meaning of the word "shared." METHOD The authors draw on the concept of epistemic justice, which they argue permeates the clinical encounter, to discuss how various forms of, and claims to, knowledge may influence the attainement of shared decision-making in health care contexts. The specific objectives are twofold: first, the authors draw key concepts from key Gadamerian, Burkean, and Bakhtinian philosophical perspectives to consider shared decision-making in relation to two types of epistemic injustice: testimonial and hermeneutic epistemic injustice. Second, building on philosopher Paulo Freire's critical pedagogy, the authors emphasize that major changes in educational structures and systems are required to promote the critical reflexivity required to address issues of epistemic justice, in the broader pursuit of authentic shared decision-making. RESULTS They propose three main areas of focus for helath professions education: (a) changes in content (moving from a focus on biomedical knowledge to more content on social sciences) and methods of teaching (more dialogue and the creation of moments of dissonance); (b) a re-examination of teachers' role in promoting epistemic justice; and (c) inclusion of patients as partners. CONCLUSIONS Without major transformation in what, how, and with whom we teach, future clinicians may be unprepared to enact shared decision-making in a manner that does justice to the various ways of knowing.
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Affiliation(s)
- Aliki Thomas
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Quebec, Canada.,Institute of Health Sciences Education, McGill University, Montreal, Quebec, Canada
| | - Ayelet Kuper
- Sunnybrook Health Sciences Centre, Toronto, Canada.,The Wilson Centre, University Health Network/University of Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Ontario, Canada
| | | | - Melissa Park
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Quebec, Canada.,Lady Davis Institute, Jewish General Hospital, Montreal, Québec, Canada
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Zidarov D, Zidarova-Carrié A, Visca R, Miller JM, Brecht K, Viens N, Ahmed S. Core patient-reported outcome domains for routine clinical care in chronic pain management: patients' and healthcare professionals' perspective. Qual Life Res 2020; 29:2007-2020. [PMID: 32125600 DOI: 10.1007/s11136-020-02459-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE To identify a core patient-reported outcome (PRO) domain set to be used in routine clinical care in settings offering specialized and supra-specialized multidisciplinary care to individuals with chronic pain (CP). METHODS Two online cross-sectional surveys were administered: one with healthcare professionals (HCPs) and one with individuals with CP. Both surveys included domains of health-related quality of life (HRQoL) from the Patient-Reported Outcomes Measurement Information System (PROMIS) framework. The patients' survey also included the Patient Generated Index (PGI). Areas affected by CP identified in the PGI were mapped to The International Classification of Functioning, Disability and Health (ICF). RESULTS According to HCPs, the five most relevant HRQoL domains to be assessed in routine clinical care were pain interference, pain intensity, physical function, anxiety and depression. The five areas that were the most valued by individuals with CP were recreation and leisure; global mental function; work and employment; household tasks and walking and moving. In total, these represented 74% of all nominated areas. When triangulating both frameworks (ICF/PROMIS) and perspectives (HCPs/patients), 10 core PRO domains were identified: pain interference, pain intensity, physical function, sleep disturbance, anxiety, depression, ability to participate in social roles and activities, fatigue, sleep-related impairments and self-efficacy. CONCLUSIONS This study identified 10 core PRO domains covering the physical, psychological and social consequences of CP on an individual's life from the perspective of individuals with CP and HCPs. The results can help identify appropriate PRO measures to assess the outcomes of multidisciplinary interventions.
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Affiliation(s)
- Diana Zidarov
- Faculty of Medicine, School of Rehabilitation, Université de Montreal, Montreal, QC, Canada
- Institut universitaire sur la réadaptation en déficience physique de Montréal, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
- Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain, Montreal, QC, Canada
| | | | - Regina Visca
- McGill Integrated University Health Network (RUIS) Centre of Expertise in Chronic Pain, Montreal, Canada
| | - J Marc Miller
- Clinique d'adaptation à la douleur chronique, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Centre de réadaptation Lucie-Bruneau, Montreal, Canada
| | - Krista Brecht
- Alan Edwards Pain Management Unit, McGill University Health Centre, Montreal, QC, Canada
| | - Natacha Viens
- Direction du soutien de l'autonomie des personnes âgées, Centre intégré universitaire de santé et de services sociaux de l'Ouest-de-l'île-de-Montréal, Montreal, Canada
| | - Sara Ahmed
- Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain, Montreal, QC, Canada.
- McGill Integrated University Health Network (RUIS) Centre of Expertise in Chronic Pain, Montreal, Canada.
- Faculty of Medicine, School of Physical and Occupational Therapy, McGill University, 3654 Prom. Sir William Osler, Montreal, QC, Canada.
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Cross-cultural adaptation and validation of the RhinAsthma Patient Perspective (RAPP) in Spanish. Allergol Immunopathol (Madr) 2020; 48:165-169. [PMID: 31601503 DOI: 10.1016/j.aller.2019.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/15/2019] [Accepted: 07/26/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE the RhinAsthma Patient Perspective (RAPP) is the only available tool to assess HRQoL in daily practice. The aim of this study is to cross-culturally validate the RAPP in Spanish. METHODS The RAPP was translated into Spanish. Adult patients receiving usual care for asthma and allergic rhinitis (AR) were recruited consecutively and assessed twice with a four-week interval between visits to test the psychometric properties of the questionnaire. RESULTS 149 patients (62.8% female) with a mean age of 37.7 years completed the study. Exploratory and confirmatory factor analysis confirmed the uni-dimensional structure of the questionnaire. Internal consistency (0.73 at visit 1; 0.87 at visit 2), convergent and discriminant validity (p<.05 at both visits) were satisfactory. Reliability was confirmed by an ICC of 0.69 and a CCC of 0.74. Responsiveness was supported by a significant association with VAS (r=0.28, p<0.003) and ACT (r=-0.35, p<0.01). The minimal clinical difference (MID) value in the analyzed population was 2. CONCLUSIONS The Spanish version of RAPP was demonstrated to have satisfactory psychometric properties and is a valid, reliable and responsive tool for the assessment of asthma and AR HRQoL in clinical practice.
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Cohen ML, Hula WD. Patient-Reported Outcomes and Evidence-Based Practice in Speech-Language Pathology. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:357-370. [PMID: 32011905 DOI: 10.1044/2019_ajslp-19-00076] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose The patient's perspective of their health is a core component of evidence-based practice (EBP) and person-centered care. Patient-reported outcomes (PROs), captured with PRO measures (PROMs), are the main way of formally soliciting and measuring the patient's perspective. Currently, however, PROs play a relatively small role in mainstream speech-language pathology practice. The purpose of this article is to raise important questions about how PROs could be applied to EBP in speech-language pathology for individuals with communication disorders and to propose preliminary approaches to address some of these questions. Method Based on a narrative review of the literature, this article introduces relevant terminology and broadly describes PRO applications in other health care fields. The article also raises questions related to PRO-informed clinical practice in speech-language pathology. To address some of these questions, the article explores previous research to provide suggestions for clinical administration, interpretation, and future research. Conclusion More routine measurement of subjective health constructs via PROMs-for example, constructs such as effort, participation, self-efficacy, and psychosocial functioning-may improve EBP. More routine use of PROMs could significantly expand the information that is available to clinicians about individual clients and add to the evidence base for the profession of speech-language pathology. However, careful consideration and more research are needed on how to capture and interpret PROs from individuals with cognitive and language disorders.
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Affiliation(s)
- Matthew L Cohen
- Department of Communication Sciences and Disorders and Center for Health Assessment Research and Translation, University of Delaware, Newark
| | - William D Hula
- Geriatric Research, Education, and Clinical Center, VA Health Care System, and Department of Communication Sciences and Disorders, University of Pittsburgh, PA
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van der Willik EM, Hemmelder MH, Bart HAJ, van Ittersum FJ, Hoogendijk-van den Akker JM, Bos WJW, Dekker FW, Meuleman Y. Routinely measuring symptom burden and health-related quality of life in dialysis patients: first results from the Dutch registry of patient-reported outcome measures. Clin Kidney J 2020; 14:1535-1544. [PMID: 34285801 PMCID: PMC8286800 DOI: 10.1093/ckj/sfz192] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 12/16/2019] [Indexed: 12/22/2022] Open
Abstract
Background The use of patient-reported outcome measures (PROMs) is becoming increasingly important in healthcare. However, incorporation of PROMs into routine nephrological care is challenging. This study describes the first experience with PROMs in Dutch routine dialysis care. Methods A pilot study was conducted in dialysis patients in 16 centres. Patients were invited to complete PROMs at baseline and 3 and 6 months. PROMs consisted of the 12-item short-form and Dialysis Symptom Index to assess health-related quality of life (HRQoL) and symptom burden. Response rates, HRQoL and symptom burden scores were analysed. Qualitative research methods were used to gain insight into patients’ views on using PROMs in clinical practice. Results In total, 512 patients (36%) completed 908 PROMs (24%) across three time points. Response rates varied from 6 to 70% among centres. Mean scores for physical and mental HRQoL were 35.6 [standard deviation (SD) 10.2] and 47.7 (SD 10.6), respectively. Patients experienced on average 10.8 (SD 6.1) symptoms with a symptom burden score of 30.7 (SD 22.0). Only 1–3% of the variation in PROM scores can be explained by differences between centres. Patients perceived discussing their HRQoL and symptom scores as insightful and valuable. Individual feedback on results was considered crucial. Conclusions The first results show low average response rates with high variability among centres. Dialysis patients experienced a high symptom burden and poor HRQoL. Using PROMs at the individual patient level is suitable and may improve patient–professional communication and shared decision making. Further research is needed to investigate how the collection and the use of PROMs can be successfully integrated into routine care to improve healthcare quality and outcomes.
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Affiliation(s)
- Esmee M van der Willik
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Marc H Hemmelder
- Nefrovisie Foundation, Utrecht, The Netherlands.,Department of Internal Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Hans A J Bart
- Dutch Kidney Patients Association, Bussum, The Netherlands
| | - Frans J van Ittersum
- Department of Nephrology, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Willem Jan W Bos
- Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands.,Department of Internal Medicine, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Yvette Meuleman
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
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Lamb CC, Wang Y, Lyytinen K. Shared decision making: Does a physician's decision-making style affect patient participation in treatment choices for primary immunodeficiency? J Eval Clin Pract 2019; 25:1102-1110. [PMID: 31115958 PMCID: PMC6900116 DOI: 10.1111/jep.13162] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/01/2019] [Accepted: 04/08/2019] [Indexed: 12/22/2022]
Abstract
Overall health care spending in the United States is equivalent to more than 15% of GDP, yet outcomes rank below the top 25 in most quality categories when compared with other Organization for Economic Cooperation and Development (OECD) countries. The majority of spending is consumed by small patient populations with chronic diseases. Experts believe increased patient-physician shared decision making (SDM) should result in better overall longitudinal care but understanding the physician's role in facilitating SDM is limited. Structural equation modelling was applied to results of a 2016 questionnaire-based survey of 330 US physicians who treat approximately 55% of primary immune deficiency requiring immune globulin therapy; it tested the relationship between slow/rational vs fast/intuitive decision-making styles and SDM as mediated by patient-centric care and moderated by physician's trust in the patient. The results showed a statistically significant relationship between slow/rational decision making and SDM. The results also suggest differences related to age, gender, education, and race but no differences related to trust.
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Affiliation(s)
- Christopher C Lamb
- BioSolutions Services LLC, Cambridge, Massachusetts.,Weatherhead School of Management, Case Western Reserve University, Cleveland, Ohio
| | - Yunmei Wang
- Case Cardiovascular Research Institute, Case Western Reserve University School of Medicine and Harrington Heart &Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Kalle Lyytinen
- Weatherhead School of Management, Case Western Reserve University, Cleveland, Ohio
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van Leeuwen LM, Pronk M, Merkus P, Goverts ST, Anema JR, Kramer SE. Developing an intervention to implement an ICF-based e-intake tool in clinical otology and audiology practice. Int J Audiol 2019; 59:282-300. [DOI: 10.1080/14992027.2019.1691746] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Lisette M. van Leeuwen
- Otolaryngology-Head and Neck Surgery, Ear and Hearing, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marieke Pronk
- Otolaryngology-Head and Neck Surgery, Ear and Hearing, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Paul Merkus
- Otolaryngology-Head and Neck Surgery, Ear and Hearing, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - S. Theo Goverts
- Otolaryngology-Head and Neck Surgery, Ear and Hearing, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Johannes R. Anema
- Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sophia E. Kramer
- Otolaryngology-Head and Neck Surgery, Ear and Hearing, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Walton DM, Elliott JM, Salim S, Al-Nasri I. A reconceptualization of the pain numeric rating scale: Anchors and clinically important differences. J Hand Ther 2019; 31:179-183. [PMID: 29433765 DOI: 10.1016/j.jht.2017.12.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 12/13/2017] [Accepted: 12/16/2017] [Indexed: 02/03/2023]
Affiliation(s)
- David M Walton
- Faculty of Health Sciences, Western University, London, Ontario, Canada.
| | - James M Elliott
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Shahan Salim
- Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Iyad Al-Nasri
- Faculty of Health Sciences, Western University, London, Ontario, Canada
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Lamb CC, Wolfberg A, Lyytinen K. UK vs US physician decision-making in the treatment of haemophilia. Haemophilia 2019; 25:616-625. [PMID: 31056808 PMCID: PMC6850192 DOI: 10.1111/hae.13766] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 03/29/2019] [Accepted: 04/04/2019] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Patient-physician shared decision-making (SDM) has become increasingly seen as having a positive effect on management of chronic diseases. However, little is known of the factors that encourage SDM or how effective it may be at improving health outcomes or how cost-effective it is. AIM To investigate the uses and applications of patient physician-SDM in the management of haemophilia and the influence of healthcare systems in the United States and the United Kingdom. METHODS This was a qualitative study based on interviews with treatment experts in the United States and United Kingdom. A grounded theory approach was used to analyse the data from the transcribed interviews and themes that emerged as related to the decision influencers. Twelve physicians from each country were interviewed by the author. RESULTS Treatment guidelines were viewed as having only limited applicability because of the lack of universal best options in haemophilia. The US physicians in the sample appeared to be more influenced by patient preferences than physicians in the UK, who instead tended to follow policies and standards of care more closely. Physicians in both countries commented that many of their patents had become highly knowledgeable of their bleeding disorder. US physicians were sometimes limited by insurance company policies but also reported that they were often successful in appealing insurance decisions. CONCLUSION The research suggests that there are different influences on decision-making between healthcare systems; patients and overarching healthcare systems play a major role in how physicians treat haemophilia.
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Affiliation(s)
- Christopher C. Lamb
- Weatherhead School of ManagementCase Western Reserve UniversityClevelandOhio
| | - Adrian Wolfberg
- Weatherhead School of ManagementCase Western Reserve UniversityClevelandOhio
| | - Kalle Lyytinen
- Weatherhead School of ManagementCase Western Reserve UniversityClevelandOhio
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Lapin BR, Honomichl RD, Thompson NR, Rose S, Sugano D, Udeh B, Katzan IL. Association Between Patient Experience With Patient-Reported Outcome Measurements and Overall Satisfaction With Care in Neurology. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:555-563. [PMID: 31104734 DOI: 10.1016/j.jval.2019.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 02/14/2019] [Accepted: 02/21/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND There has been increasing focus on both patient-reported outcome measurement (PROM) collection and patient satisfaction ratings; nevertheless, little is known about their relationship. OBJECTIVES To determine the association between patient experience with PROM collection and visit satisfaction and to identify characteristics of better ratings for each. METHODS This cross-sectional observational study included all patients seen in 15 neurological clinics who completed PROMs as well as 6 questions on the patient experience with PROMs at least once from October 1, 2015 to December 31, 2016. Visit satisfaction was evaluated using a composite measure of physician communication, overall physician rating, and the likelihood of recommending that physician as indicated on the Clinician and Group Consumer Assessment of Healthcare Providers and Systems survey. Predictors of PROM experience and satisfaction were identified using proportional odds and logistic regression models, respectively. RESULTS There were 6454 patients (average age 58 ± 15 years, 59% women) who completed PROMs and responded to the Clinician and Group Consumer Assessment of Healthcare Providers and Systems survey. There were significant positive associations between each PROM experience question and visit satisfaction (r = 0.11-0.19; P<.010), although factors predicting visit satisfaction differed from those predicting PROM experience. A differential effect of PROMs on visit satisfaction was identified for patients who were nonwhite, had lower income, and had more comorbidities. CONCLUSIONS Although there was a significant association between better PROM experience and higher visit satisfaction, relationships with clinical characteristics differed, providing insights into how PROMs may be associated with patients' visit satisfaction. Further research is necessary to confirm whether PROMs can be used to improve visit satisfaction, particularly in patients who historically have reported lower quality of care.
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Affiliation(s)
- Brittany R Lapin
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
| | - Ryan D Honomichl
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Nicolas R Thompson
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Susannah Rose
- Office of Patient Experience, Cleveland Clinic, Cleveland, OH, USA
| | - David Sugano
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Belinda Udeh
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Irene L Katzan
- Cerebrovascular Center, Cleveland Clinic, Cleveland, OH, USA
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Konkle BA, Skinner M, Iorio A. Hemophilia trials in the twenty-first century: Defining patient important outcomes. Res Pract Thromb Haemost 2019; 3:184-192. [PMID: 31011702 PMCID: PMC6462740 DOI: 10.1002/rth2.12195] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 02/01/2019] [Indexed: 01/19/2023] Open
Abstract
Treatment for hemophilia has advanced dramatically over the past 5 decades. Success of prophylactic therapy in preventing bleeding and decreasing associated complications has established a new standard of care. However, with the advent of gene therapy and treatments that effectively mimic sustained coagulation factor replacement, outcome measures that worked well for assessing factor replacement therapies in past clinical trials need to be reassessed. In addition, while therapies have advanced, so has the science of outcome assessment, including recognition of the importance of patient important and patient reported outcomes. This manuscript reviews strengths and limitations of outcome measures used in hemophilia from both a provider and patient perspective.
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Affiliation(s)
- Barbara A. Konkle
- Bloodworks NorthwestSeattleWashington
- Department of MedicineUniversity of WashingtonSeattleWashington
| | - Mark Skinner
- Institute for Policy Advancement, Ltd.WashingtonDistrict of Columbia
- Department of Health Resource Methods, Evidence, and ImpactMcMaster UniversityHamiltonCanada
| | - Alfonso Iorio
- Department of Health Resource Methods, Evidence, and ImpactMcMaster UniversityHamiltonCanada
- Department of MedicineMcMaster UniversityHamiltonCanada
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Papadakos JK, Charow RC, Papadakos CJ, Moody LJ, Giuliani ME. Evaluating cancer patient-reported outcome measures: Readability and implications for clinical use. Cancer 2019; 125:1350-1356. [PMID: 30620401 DOI: 10.1002/cncr.31928] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 10/29/2018] [Accepted: 11/20/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND The benefits of patient-reported outcome measures (PROMs) are well known; however, their readability has come into question because multiple PROMs have been found to be incomprehensible to patients. This is a critical safety and equity consideration because PROMs are increasingly being integrated into routine clinical practice. A key strategy for promoting patient comprehension is the use of plain language. The aim of this study was to determine whether PROMs routinely used in the cancer setting meet plain-language best practices. METHODS To report the plain-language level of each PROM, readability (Fry Readability Graph, Simple Measure of Gobbledygook, Flesch Reading Ease, and FORCAST) and understandability assessments (Patient Education Materials Assessment Tool [PEMAT] for Printable Materials) were performed. PROMs at grade level 6 or lower and with PEMAT scores greater than 80% were considered to meet plain-language best practices. PROMs were divided into 4 domains (physical, emotional, social, and quality of life) and 17 dimensions (eg, pain was a dimension of the physical domain). A subanalysis was conducted to determine whether specific domains and dimensions were more likely to adhere to plain-language best practices. RESULTS More than half of the 45 PROMs evaluated (n = 33 [73%]) had a grade level higher than 6. Understandability scores ranged from 29% to 100%. The majority of the PROMs that did not meet plain-language best practices were within the physical and emotional domains and focused on the patient's symptom experience. CONCLUSIONS This evaluation shows that more than half of the most commonly used cancer PROMs do not meet plain-language best practices. Practice implications include the necessity for plain-language assessment during the PROM validation process, the consideration of plain language in PROM selection, and plain-language review and editing of low-scoring PROMs.
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Affiliation(s)
- Janet K Papadakos
- Cancer Health Literacy Research Centre, Cancer Education Program, Princess Margaret Cancer Centre, University Health Network, Cancer Education Program, Toronto, Ontario, Canada.,Patient Education, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Rebecca C Charow
- Cancer Health Literacy Research Centre, Cancer Education Program, Princess Margaret Cancer Centre, University Health Network, Cancer Education Program, Toronto, Ontario, Canada
| | - Christine J Papadakos
- Cancer Health Literacy Research Centre, Cancer Education Program, Princess Margaret Cancer Centre, University Health Network, Cancer Education Program, Toronto, Ontario, Canada.,Patient Education, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Lesley J Moody
- Person Centred Care, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Meredith E Giuliani
- Cancer Health Literacy Research Centre, Cancer Education Program, Princess Margaret Cancer Centre, University Health Network, Cancer Education Program, Toronto, Ontario, Canada.,Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
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Travlos V, Downs J, Wilson A, Hince D, Patman S. Mental wellbeing in non-ambulant youth with neuromuscular disorders: What makes the difference? Neuromuscul Disord 2019; 29:48-58. [DOI: 10.1016/j.nmd.2018.08.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 07/29/2018] [Accepted: 08/29/2018] [Indexed: 01/14/2023]
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Abburu S. GIS Based Health Information Management through LETL, Multi Criteria Query, Analysis, Visualization. INTERNATIONAL JOURNAL OF E-HEALTH AND MEDICAL COMMUNICATIONS 2019. [DOI: 10.4018/ijehmc.2019010103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
For effective decision making in public health information management(HIM) system, health information availability, accessibility, prompt exchange, GIS linkage, spatiotemporal analysis of diseases is crucial. Lack of cost-effective technical support and information gaps are the main obstacles in HIM. This article defines a generic conceptual process framework for effective HIM that provides cost-effective, portable, easy to use solution. The solution incorporates GIS, Mobile technology, information management concepts, ICD-10 codes, WHO and mHealth standards. The current research is implemented as an android application that facilitates: 1) Patient disease data collection, geospatial mapping of disease data and accumulate a centralized server 2) LETL that supports bulk disease data upload 3) Addresses syntactic and semantic heterogeneity in health data 4) A strong multi-criteria query engine, visualization and spatiotemporal analysis of diseases are designed with a global perspective to be used across the globe.
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van Leeuwen LM, Pronk M, Merkus P, Goverts ST, Anema JR, Kramer SE. Barriers to and enablers of the implementation of an ICF-based intake tool in clinical otology and audiology practice-A qualitative pre-implementation study. PLoS One 2018; 13:e0208797. [PMID: 30533057 PMCID: PMC6289452 DOI: 10.1371/journal.pone.0208797] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 11/26/2018] [Indexed: 12/03/2022] Open
Abstract
The authors are developing an intake tool based on the Brief International Classification of Functioning Disability and Health Core Set for Hearing Loss, by operationalizing its categories into a Patient Reported Outcome Measure. This study was aimed at identifying enablers and barriers to using this tool as perceived by hearing health professionals (HHPs) and patients. Focus groups and interviews were held with HHPs (ENT surgeons, N = 14; audiologists, N = 8) and patients (N = 18). Interview questions were based on the Capability-Opportunity-Motivation-Behavior (COM-B) model. Using the COM-B model and the Theoretical Domains Framework (TDF), transcript fragments were divided into meaning units, which were then categorized into capability-, opportunity- and motivation-related barriers and enablers. These were further specified into TDF domains. HHP barriers included: lack of time to use the tool (O); and fear of being made responsible for addressing any emerging problems, which may be outside the expertise of the HHP (M). Enablers included integration of the tool in the electronic patient record (O); opportunity for the patient to be better prepared for the intake visit (M); and provision of a complete picture of the patient’s functioning via the tool (M). Patient’ barriers included fear of losing personal contact with the HHP (M); and fear that use of the tool might negatively affect conversations with the HHP (M). Enablers included knowledge on the aim and relevance of the tool (C); expected better self-preparation (M); and a more focused intake (M). These findings suggest that an intervention is needed to enhance HHPs’ knowledge, skills and motivation regarding the relevance and the clinical usefulness of the tool. Providing clear and specific information on the purpose of the tool can also enhance patient motivation. For both HHPs and patients, opportunities relating to the (digital) administration and the design of the tool provide additional targets for successful implementation.
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Affiliation(s)
- Lisette M van Leeuwen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology-Head and Neck Surgery, Ear & Hearing, Amsterdam Public Health, De Boelelaan, Amsterdam, Netherlands
| | - Marieke Pronk
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology-Head and Neck Surgery, Ear & Hearing, Amsterdam Public Health, De Boelelaan, Amsterdam, Netherlands
| | - Paul Merkus
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology-Head and Neck Surgery, Ear & Hearing, Amsterdam Public Health, De Boelelaan, Amsterdam, Netherlands
| | - S Theo Goverts
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology-Head and Neck Surgery, Ear & Hearing, Amsterdam Public Health, De Boelelaan, Amsterdam, Netherlands
| | - Johannes R Anema
- Amsterdam UMC, Vrije Universiteit Amsterdam, Public and Occupational Health, Amsterdam Public Health, De Boelelaan, Amsterdam, Netherlands
| | - Sophia E Kramer
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology-Head and Neck Surgery, Ear & Hearing, Amsterdam Public Health, De Boelelaan, Amsterdam, Netherlands
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Ladewig NM, Tedesco TK, Gimenez T, Braga MM, Raggio DP. Patient-reported outcomes associated with different restorative techniques in pediatric dentistry: A systematic review and MTC meta-analysis. PLoS One 2018; 13:e0208437. [PMID: 30521577 PMCID: PMC6283634 DOI: 10.1371/journal.pone.0208437] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 11/17/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Despite the increasing number of studies evaluating patient reported outcome measures (PROs), there is no clearness regarding which restorative treatment offers major benefits based on the pediatric patient perspective. AIM To compare different restorative techniques in pediatric dentistry regarding patient-reported outcomes. DESIGN Literature searching was carried out on prospective studies indexed in PubMed, Scopus and OpenGrey. A Mixed Treatment Comparisons (MTC) meta-analysis was undertaken considering the results from reviewed studies. Anxiety, pain and quality of life were extracted as mean with standard deviation, percentage of pain, and mean difference of scores with standard deviation, respectively. For direct comparisons, data were combined using a random-effect model. Heterogeneity was assessed with the I2 statistic. For indirect comparisons, fixed and random effects were chosen through comparison of competing models based on the Deviance Information Criteria (DIC). The expected efficacy ranking based on the posterior probabilities of all treatment rankings was also calculated. RESULTS An initial search resulted in 4,322 articles, of which 17 were finally selected. Due to unavailability of data, only pain, anxiety and oral health related quality of life (OHRQoL) were statistically analyzed. The difference in means (95% CI) of anxiety between treatments using only hand instruments with or without chemomechanical agents were -5.35 (-6.42 to -4.20) and -5.79 (-7.77 to -3.79) respectively when compared to conventional treatment using rotary instruments and/or local anesthesia. Regarding pain, there was a trend for treatments without rotary instruments and local anesthesia to be less frequently reported as painful. No statistical difference was found intragroup nor among treatments for OHRQoL. CONCLUSIONS Anxiety and pain are directly related with more invasive restorative treatments. On the other hand, quality of life is not improved regardless of the restorative technique used. Further well-designed prospective studies regarding PROs in children are still necessary.
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Affiliation(s)
- Nathalia Miranda Ladewig
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Tamara Kerber Tedesco
- Department of Pediatric Dentistry, Faculty of Dentistry, University of Ibirapuera, São Paulo, São Paulo, Brazil
| | - Thaís Gimenez
- Department of Pediatric Dentistry, Faculty of Dentistry, University of Ibirapuera, São Paulo, São Paulo, Brazil
| | - Mariana Minatel Braga
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Daniela Prócida Raggio
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, University of São Paulo, São Paulo, São Paulo, Brazil
- * E-mail:
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Tey KR, Mohan P, Liu X, Desai AP. Closing the Quality Chasm in Cirrhosis. Clin Liver Dis (Hoboken) 2018; 12:45-49. [PMID: 30988910 PMCID: PMC6385903 DOI: 10.1002/cld.725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/10/2018] [Accepted: 04/21/2018] [Indexed: 02/04/2023] Open
Affiliation(s)
| | | | - Xibei Liu
- Department of MedicineUniversity of ArizonaTucsonAZ
| | - Archita P. Desai
- Division of Gastroenterology, Thomas D. Boyer Liver Research Institute, Department of MedicineUniversity of ArizonaTucsonAZ
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Physician–patient shared decision making in the treatment of primary immunodeficiency: an interview-based survey of immunologists. LYMPHOSIGN JOURNAL 2018. [DOI: 10.14785/lymphosign-2018-0010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: Patient–physician shared decision making (SDM) can result in better care as well as reduced treatment costs. A better understanding of the factors predicting when physicians implement SDM during the treatment of primary immunodeficiency (PID) could provide insight for making recommendations to improve outcomes and reduce healthcare costs in PID and other long-term chronic conditions. Method: This study made use of grounded theory and was based on the interview responses of 15 immunologists in the United States. It focused on their decision making in the diagnosis and treatment of PID, how they interact with patients, and the circumstances under which they encourage SDM with patients. Results: All invited immunologists took part in the interviews and were included in the study. All but one had 10 or more years of experience in treating PID. The study found that SDM is bounded/limited by “nudging” bias, power balance considerations, and consideration of patient health literacy alignment. Immunologists also reported that they were mainly responsible for coordinating care and for allowing sufficient time for consultations. Conclusion: SDM occurs between the physician and patient throughout the treatment of PID. The study also shows the ways physicians influence SDM by guiding patients through the process. Statement of novelty: Little is known about the factors that influence SDM in the long-term management of chronic diseases. The present study investigated the extent to which immunologists experienced in the treatment of patients with PID include SDM in clinical practice. Findings such of these may be of use when formulating treatment guidelines and improving the effectiveness of long-term management of PID.
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Grooming a CAT: customizing CAT administration rules to increase response efficiency in specific research and clinical settings. Qual Life Res 2018; 27:2403-2413. [DOI: 10.1007/s11136-018-1870-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2018] [Indexed: 12/13/2022]
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Armas A, Meyer SB, Corbett KK, Pearce AR. Face-to-face communication between patients and family physicians in Canada: A scoping review. PATIENT EDUCATION AND COUNSELING 2018; 101:789-803. [PMID: 29173960 DOI: 10.1016/j.pec.2017.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 11/07/2017] [Accepted: 11/16/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Patient-provider communication is critical in primary care. Canada's unique health system, population distribution, and cultural context suggest there is value in addressing the topic in the Canadian context. We conducted a scoping review to synthesize recent Canadian literature to inform practice in primary care settings and identify research agendas for patient-provider communication in Canada. METHODS Using Arksey and O'Malley's framework we searched four literature databases: Medline, Web of Science, CINAHL and EMBASE. We extracted 21,932 articles published between 2010 and 2017. A total of 108 articles met the inclusion criteria. The articles were analyzed qualitatively using thematic analysis to identify major themes. RESULTS Four major themes were identified: information sharing, relationships, health system challenges, and development and use of communication tools. CONCLUSION Our review identified a need for Canadian research regarding: communication in primary care with Aboriginal, immigrant, and rural populations; the impact of medical tourism on primary care; and how to improve communication to facilitate continuity of care. PRACTICE IMPLICATIONS Challenges providers face in primary care in Canada include: communicating with linguistically and culturally diverse populations; addressing issues that emerge with the rise of medical tourism; a need for decision aids to improve communication with patients.
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Affiliation(s)
- Alana Armas
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.
| | - Samantha B Meyer
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Kitty K Corbett
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Alex R Pearce
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
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Mueck KM, Cherla DV, Taylor A, Ko TC, Liang MK, Kao LS. Randomized Controlled Trials Evaluating Patient-Reported Outcomes after Cholecystectomy: A Systematic Review. J Am Coll Surg 2017; 226:183-193.e5. [PMID: 29154921 DOI: 10.1016/j.jamcollsurg.2017.10.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 10/20/2017] [Accepted: 10/25/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Krislynn M Mueck
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX; Center for Surgical Trials and Evidence-based Practice (C-STEP), Departments of Surgery and Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX.
| | - Deepa V Cherla
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX; Center for Surgical Trials and Evidence-based Practice (C-STEP), Departments of Surgery and Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
| | - Amy Taylor
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
| | - Tien C Ko
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
| | - Mike K Liang
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX; Center for Surgical Trials and Evidence-based Practice (C-STEP), Departments of Surgery and Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
| | - Lillian S Kao
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX; Center for Surgical Trials and Evidence-based Practice (C-STEP), Departments of Surgery and Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
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Bartlett SJ, Ahmed S. Montreal Accord on Patient-Reported Outcomes (PROs) use series - Paper 1: introduction. J Clin Epidemiol 2017; 89:114-118. [PMID: 28433672 PMCID: PMC5677513 DOI: 10.1016/j.jclinepi.2017.04.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 03/16/2017] [Accepted: 04/10/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Patient-centered health care, where we design and deliver care to address the needs and preferences of patients, represents an important paradigm shift. Patient-reported outcomes (PROs) are critical to capture the patient voice, understand how illness and treatments affect people, and establish how well services and treatments address what matters most to patients. OBJECTIVE Originally developed for use in research, PROs are now used to monitor individuals and populations, manage care, evaluate services and providers, and inform policy. However, moving PROs beyond research settings incurs considerable methodological, organizational, technological, and ethical considerations. National collaborative networks of researchers, clinicians, patients, and other stakeholders can address these challenges by coordinating development, creating standards for use, sharing costs and delivery platforms, and improving widespread uptake of core sets of measures to better inform health care decisions and improve outcomes. DISCUSSION We introduce eight papers from researchers, clinicians, patients, and decision makers who participated in deliberations around creating a national network to accelerate the application and harmonized use of PROs in Canada. They offer a snap shot of the strategies that pioneers and innovative thinkers are using to integrate the patient voice into comprehensive care, research, and health policy planning of chronic diseases.
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Affiliation(s)
- Susan J Bartlett
- Department of Medicine, McGill University/McGill University Health Center (RVH), 687 Pine Ave W R4.29, Montreal, Québec, Canada H3A 1A1; Division of Rheumatology, Johns Hopkins School of Medicine, 5200 Eastern Avenue #4100, Baltimore, MD 21224, USA.
| | - Sara Ahmed
- Department of Medicine, McGill University/McGill University Health Center (RVH), 687 Pine Ave W R4.29, Montreal, Québec, Canada H3A 1A1; School of Physical and Occupational Therapy, McGill University, 3654 Prom Sir-William-Osler, Montreal, Québec, Canada H3G 1Y5; Centre de recherche interdisciplinaire en réadaptation (CRIR), 2275 Laurier Ave. E, Montreal, Quebec, Canada H2H 2N8
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Bartlett SJ, Witter J, Cella D, Ahmed S. Montreal Accord on Patient-Reported Outcomes (PROs) use series - Paper 6: creating national initiatives to support development and use-the PROMIS example. J Clin Epidemiol 2017; 89:148-153. [PMID: 28433674 DOI: 10.1016/j.jclinepi.2017.04.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 03/16/2017] [Accepted: 04/09/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Patient-reported outcome (PRO) data are beneficial to a range of stakeholders including patients, clinicians, researchers, national funding and regulatory agencies, health system administrators, and policymakers. OBJECTIVE Because stakeholders represent diverse groups and needs, it is challenging to reach consensus on how to advance PRO development and harmonize data across settings to enable use for multiple secondary purposes. Collaborative national networks can facilitate the sharing of expertise, resources, and necessary infrastructure; create development, use, and reporting standards; optimize formats to efficiently store and transfer data; and disseminate tools and information for widespread uptake. DISCUSSION In the United States, the National Institutes of Health's Patient-Reported Outcomes Measurement Information System offers an example of how collaborators can work across distances to form essential partnerships, create a common vision, and leverage technology to accelerate the development and testing of universal PROs that are broadly applicable across health conditions and settings.
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Affiliation(s)
- Susan J Bartlett
- Department of Medicine, McGill University/McGill University Health Center, 687 Pine Avenue W R4.29, Montreal, QC, Canada H3A 1A1; Division of Rheumatology, Johns Hopkins School of Medicine, 5200 Eastern Avenue #4100, Baltimore, MD 21224, USA.
| | - James Witter
- Division of Skin and Rheumatic Diseases, NIAMS, One Democracy Plaza, 6701 Democracy Boulevard, Suite 800, Bethesda, MD 20892-4872, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 633 N. Street Clair Suite 1900, Chicago, IL 60611, USA
| | - Sara Ahmed
- Department of Medicine, McGill University/McGill University Health Center, 687 Pine Avenue W R4.29, Montreal, QC, Canada H3A 1A1; School of Physical and Occupational Therapy, McGill University, 3654 Prom Sir-William-Osler, Montreal, QC, Canada H3G 1Y5; Centre de recherche interdisciplinaire en réadaptation (CRIR), 2275 Laurier Ave E, Montreal, Quebec, Canada H2H 2N8
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Bingham CO, Noonan VK, Auger C, Feldman DE, Ahmed S, Bartlett SJ. Montreal Accord on Patient-Reported Outcomes (PROs) use series - Paper 4: patient-reported outcomes can inform clinical decision making in chronic care. J Clin Epidemiol 2017; 89:136-141. [PMID: 28433678 DOI: 10.1016/j.jclinepi.2017.04.014] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 03/16/2017] [Accepted: 04/09/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Providing patient-centered health care requires that patient needs, preferences, and valued outcomes are more fully integrated into all decisions. Patient-reported outcome (PRO) measures provide unique information from the patient perspective on overall health, symptoms, burden, and treatment response. OBJECTIVE We sought to describe applications of PROs in clinical settings and considerations for implementation from the perspectives of PRO researchers, clinicians, administrators, policy makers, and patients attending a multidisciplinary meeting. DISCUSSION Clinical applications of PROs include individual level use for medical decision making and aggregate use for comparative effectiveness research, program evaluation, quality improvement, and performance assessments. Considerations of feasibility on workflow impact and patient burden, display of results, and administration frequency are important. PROs with strong psychometric properties, actionable thresholds, and interpretable results should be selected. We provide current exemplars of PRO use in various clinical applications, initial lessons learned, and highlight conceptual, logistical, and consequential considerations of PRO data collection. A research agenda is proposed to address critical knowledge gaps. In conclusion, PROs can be used in clinical settings to support patient-centered care. This requires an assessment of feasibility in the intended setting of use, measurement considerations, and process measures to optimize integration and use.
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Affiliation(s)
- Clifton O Bingham
- Johns Hopkins Division of Rheumatology, 5200 Eastern Avenue, Mason F. Lord Bldg, Suite 4100, Baltimore, MD 21224, USA.
| | - Vanessa K Noonan
- Rick Hansen Institute, Blusson Spinal Cord Centre, 818 West 10th Avenue, Vancouver, British Columbia, Canada V5Z 1M9
| | - Claudine Auger
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, CRLB, 2275 Laurier East, Montréal, Québec, Canada H2H 2N8
| | - Debbie E Feldman
- Direction de la Santé Publique, Montréal, 1301 Sherbrooke East, Montreal, Québec, Canada H2L 1M3
| | - Sara Ahmed
- Department of Medicine, McGill University/McGill University Health Center (RVH), 687 Pine Avenue West, Ross Pavilion R4.29, Montreal, Québec, Canada H3A 1A1; School of Physical and Occupational Therapy, McGill University, 3654 Prom Sir-William-Osler, Montreal, Québec, Canada H3G 1Y5; Centre de recherche interdisciplinaire en réadaptation (CRIR), 2275 Laurier Ave E, Montreal, Quebec, Canada H2H 2N8
| | - Susan J Bartlett
- Johns Hopkins Division of Rheumatology, 5200 Eastern Avenue, Mason F. Lord Bldg, Suite 4100, Baltimore, MD 21224, USA; Department of Medicine, McGill University/McGill University Health Center (RVH), 687 Pine Avenue West, Ross Pavilion R4.29, Montreal, Québec, Canada H3A 1A1
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