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Kablan N, Bakhsh HR, Alammar W, Tatar Y, Ferriero G. Psychometric evaluation of the Arabic version of the Quebec user evaluation of satisfaction with assistive technology (A-QUEST 2.0) in prosthesis users. Eur J Phys Rehabil Med 2022; 58:118-126. [PMID: 34247472 PMCID: PMC9980568 DOI: 10.23736/s1973-9087.21.06880-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The evaluation of patient satisfaction and perceptions plays a vital role in determining the quality of prosthesis users' devices and the competency of healthcare services. AIM To evaluate the psychometric properties of the Arabic Quebec User Evaluation of Satisfaction with Assistive Technology (A-QUEST 2.0) with prosthetics users. DESIGN A methodological study. SETTING Saudi Arabia, Turkey. POPULATION A convenience sample of outpatient prosthesis users (N.=183). METHODS The A-QUEST 2.0 includes two subscales respectively evaluating the user's satisfaction with the device and the services provided. The data for each subscale were investigated using Rasch analysis to evaluate the item fit, reliability indices, item difficulty, local item dependency, and differential item functioning (DIF). RESULTS Both subscales met the Rasch criteria for the functioning of rating scale categories. All items showed an acceptable fit to the Rasch model. The person separation indices for the Device and Services subscales were 2.21 (Cronbach's α=0.90) and 1.72 (Cronbach's α=0.85), respectively. Therefore, the two subscales are sensitive enough to distinguish between at least three different levels of satisfaction. The unidimensionality of each subscale was confirmed, and none of the items displayed differential item functioning across age, gender, location of amputation, country, and duration of use. CONCLUSIONS Overall, the findings indicate the psychometric evaluation of A-QUEST 2.0 is effective with prosthesis users across different clinical contexts and cultures. Thus, the A-QUEST 2.0 allows for a comprehensive understanding of users' perceptions of prosthesis characteristics, particularly among subjects with lower limb amputations caused by traumatic injuries. CLINICAL REHABILITATION IMPACT Our paper provides clinicians dealing with Arabic patients a validated outcome measure for satisfaction with prosthesis. Besides providing information in the development of new products and service delivery. Further studies are necessary to improve the measure's metric quality in different contexts and for different prosthesis devices.
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Affiliation(s)
- Nilüfer Kablan
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Medeniyet University, Istanbul, Turkey
| | - Hadeel R Bakhsh
- Department of Rehabilitation, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia -
| | - Walaa Alammar
- Department of Rehabilitation, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Yaşar Tatar
- Faculty of Sports Sciences, Marmara University, Istanbul, Turkey
| | - Giorgio Ferriero
- Unit of Physical and Rehabilitation Medicine, Scientific Institute of Tradate, IRCCS Maugeri, Tradate, Varese, Italy.,Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
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Lansdaal D, van Nassau F, van der Steen M, Bruijne MD, Smeulers M. Lessons learned on the experienced facilitators and barriers of implementing a tailored VBHC model in a Dutch university hospital from a perspective of physicians and nurses. BMJ Open 2022; 12:e051764. [PMID: 34983762 PMCID: PMC8728449 DOI: 10.1136/bmjopen-2021-051764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 12/07/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE This study aims to obtain insight into experienced facilitators and barriers of implementing a tailored value-based healthcare (VBHC) model in a Dutch university hospital from a perspective of physicians and nurses. METHOD A descriptive qualitative study with 12 physicians, nurses and managers of seven different care pathways who were involved in the implementation of a tailored VBHC methodology was conducted. Thematic content analysis was used to analyse the data guided by all factors of the Consolidated Framework for Implementation Research (CFIR). FINDINGS The method designed for the implementation of a tailored VBHC methodology was appointed as a structured guide for the process. Throughout the implementation process, leadership and team dynamics were considered as important for the implementation to succeed. Also, sharing experiences with other value teams and the cooperation with external Information Technology (IT) teams in the hospital was mentioned as desirable. The involvement of patients, that is part of the VBHC methodology, was considered useful in the decision-making and improvement of the care process because it gave better insights in topics that are important for patients. The time-consuming nature of the implementation process was named as barrier to the VBHC methodology. On top of that, the shaping of the involvement of patients and the ongoing changes in departments were established as difficult. Finally, working with the Electronic Health Records and acquiring the necessary digital skills were considered to be often forgotten and, thus, hindering implementation. CONCLUSION Clinical Healthcare organisations implementing a tailored VBHC methodology will benefit from the use of a structured implementation methodology, a well-led strong team and cooperation with (external) teams and patients. However, shaping patient involvement, alignment with other departments and attention to digitisation were seen as a most important concerns in implementation and require further attention.
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Affiliation(s)
- Dane Lansdaal
- Strategy and Improvement, Amsterdam UMC De Boelelaan Site, Amsterdam, The Netherlands
| | - Femke van Nassau
- Vrije Universiteit Amsterdam, Department of Public and Occupational health, Amsterdam Public Health Institute, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Marije van der Steen
- Strategy and Improvement, Amsterdam UMC De Boelelaan Site, Amsterdam, The Netherlands
| | - Martine de Bruijne
- Department of Public and Occupational Health, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Marian Smeulers
- Division of Outpatient Department, Amsterdam UMC Locatie AMC, Amsterdam, North Holland, The Netherlands
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103
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Engler K, Vicente S, Ma Y, Hijal T, Cox J, Ahmed S, Klein M, Achiche S, Pant Pai N, de Pokomandy A, Lacombe K, Lebouché B. Implementation of an electronic patient-reported measure of barriers to antiretroviral therapy adherence with the Opal patient portal: Protocol for a mixed method type 3 hybrid pilot study at a large Montreal HIV clinic. PLoS One 2021; 16:e0261006. [PMID: 34969046 PMCID: PMC8717992 DOI: 10.1371/journal.pone.0261006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 07/12/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Adherence to antiretroviral therapy (ART) remains problematic. Regular monitoring of its barriers is clinically recommended, however, patient-provider communication around adherence is often inadequate. Our team thus decided to develop a new electronically administered patient-reported outcome measure (PROM) of barriers to ART adherence (the I-Score) to systematically capture this data for physician consideration in routine HIV care. To prepare for a controlled definitive trial to test the I-Score intervention, a pilot study was designed. Its primary objectives are to evaluate patient and physician perceptions of the I-Score intervention and its implementation strategy. METHODS This one-arm, 6-month study will adopt a mixed method type 3 implementation-effectiveness hybrid design and be conducted at the Chronic Viral Illness Service of the McGill University Health Centre (Montreal, Canada). Four HIV physicians and 32 of their HIV patients with known or suspected adherence problems will participate. The intervention will involve having patients complete the I-Score through a smartphone application (Opal), before meeting with their physician. Both patients and physicians will have access to the I-Score results, for consideration during the clinic visits at Times 1, 2 (3 months), and 3 (6 months). The implementation strategy will focus on stakeholder involvement, education, and training; promoting the intervention's adaptability; and hiring an Application Manager to facilitate implementation. Implementation, patient, and service outcomes will be collected (Times 1-2-3). The primary outcome is the intervention's acceptability to patients and physicians. Qualitative data obtained, in part, through physician focus groups (Times 2-3) and patient interviews (Times 2-3) will help evaluate the implementation strategy and inform any methodological adaptations. DISCUSSION This study will help plan a definitive trial to test the efficacy of the I-Score intervention. It will generate needed data on electronic PROM interventions in routine HIV care that will help improve understanding of conditions for their successful implementation. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04702412; https://clinicaltrials.gov/.
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Affiliation(s)
- Kim Engler
- Center for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Serge Vicente
- Department of Mathematics and Statistics, University of Montreal, Montreal, Quebec, Canada
| | - Yuanchao Ma
- Center for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Tarek Hijal
- Department of Radiation Oncology, Cedars Cancer Center, McGill University Health Centre, Montreal, Quebec, Canada
| | - Joseph Cox
- Division of Infectious Disease, Department of Medicine, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Sara Ahmed
- School of Physical & Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Marina Klein
- Center for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Division of Infectious Disease, Department of Medicine, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Sofiane Achiche
- Department of Mechanical Engineering, École Polytechnique de Montréal, Montreal, Quebec, Canada
| | - Nitika Pant Pai
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Alexandra de Pokomandy
- Center for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Division of Infectious Disease, Department of Medicine, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Karine Lacombe
- Sorbonne Université, Inserm IPLESP, Hôpital St Antoine, Assistance Publique -Hôpitaux de Paris, Paris, France
| | - Bertrand Lebouché
- Center for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Division of Infectious Disease, Department of Medicine, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
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104
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Lehmann J, Rothmund M, Riedl D, Rumpold G, Grote V, Fischer MJ, Holzner B. Clinical Outcome Assessment in Cancer Rehabilitation and the Central Role of Patient-Reported Outcomes. Cancers (Basel) 2021; 14:cancers14010084. [PMID: 35008247 PMCID: PMC8750070 DOI: 10.3390/cancers14010084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/15/2021] [Accepted: 12/22/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary After completion of acute cancer treatment, it is important to support patients in recovering physically and psychologically and to help them regain their social life. This is the goal of cancer rehabilitation. If we want to know which rehabilitation interventions are helpful, we must measure their effects. This can be done by asking clinicians, testing patients’ performance, observing their behaviors, or by asking patients directly about their experience. This paper focuses on reports from the patients. We give an overview of available questionnaires and offer advice regarding their use. Furthermore, we discuss how to integrate them into clinical practice and research. The most promising way to collect such data are electronic systems, which offer many advantages. The goal of assessing the patient perspective is to help patients, clinicians, and health insurance providers to decide which rehabilitation interventions suit patients’ needs, and therefore, which ones should be chosen and reimbursed. Abstract The aim of cancer rehabilitation is to help patients regain functioning and social participation. In order to evaluate and optimize rehabilitation, it is important to measure its outcomes in a structured way. In this article, we review the different types of clinical outcome assessments (COAs), including Clinician-Reported Outcomes (ClinROs), Observer-Reported Outcomes (ObsROs), Performance Outcomes (PerfOs), and Patient-Reported Outcomes (PROs). A special focus is placed on PROs, which are commonly defined as any direct report from the patient about their health condition without any interpretation by a third party. We provide a narrative review of available PRO measures (PROMs) for relevant outcomes, discuss the current state of PRO implementation in cancer rehabilitation, and highlight trends that use PROs to benchmark value-based care. Furthermore, we provide examples of PRO usage, highlight the benefits of electronic PRO (ePRO) collection, and offer advice on how to select, implement, and integrate PROs into the cancer rehabilitation setting to maximize efficiency.
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Affiliation(s)
- Jens Lehmann
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Hospital of Psychiatry II, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.R.); (D.R.); (G.R.); (B.H.)
- Correspondence: ; Tel.: +43-50-504-81551
| | - Maria Rothmund
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Hospital of Psychiatry II, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.R.); (D.R.); (G.R.); (B.H.)
| | - David Riedl
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Hospital of Psychiatry II, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.R.); (D.R.); (G.R.); (B.H.)
| | - Gerhard Rumpold
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Hospital of Psychiatry II, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.R.); (D.R.); (G.R.); (B.H.)
| | - Vincent Grote
- Ludwig Boltzmann Institute for Rehabilitation Research, 1140 Vienna, Austria; (V.G.); (M.J.F.)
| | - Michael J. Fischer
- Ludwig Boltzmann Institute for Rehabilitation Research, 1140 Vienna, Austria; (V.G.); (M.J.F.)
- Vamed Rehabilitation Center Kitzbühel, 6370 Tyrol, Austria
| | - Bernhard Holzner
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Hospital of Psychiatry II, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.R.); (D.R.); (G.R.); (B.H.)
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105
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Villegas L, Amaral S. Patient-Reported Outcomes in Children With Chronic Kidney Disease. Semin Nephrol 2021; 41:476-484. [PMID: 34916009 DOI: 10.1016/j.semnephrol.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Patient-reported outcomes (PROs) are quantitative assessments of a patient's perspective on their health and are derived directly from the patient, as opposed to clinician interpretation. PROs can serve as unique tools to improve health care providers' understanding of the patient's daily lived experience and highlight salient domains that are specific to children with chronic kidney disease (CKD). As such, PROs fill an important gap in achieving optimal health and well-being for children with CKD. However, several knowledge gaps remain in the implementation of PROs within both the clinical and research realms. This review provides a broad overview of PRO development, implementation for children with CKD, and highlights future directions and challenges.
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Affiliation(s)
- Leonela Villegas
- Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA.
| | - Sandra Amaral
- Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA; Division of Epidemiology, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA
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106
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Laplante-Lévesque A, Dubno JR, Mosnier I, Ferrary E, McRackan TR. Best Practices in the Development, Translation, and Cultural Adaptation of Patient-Reported Outcome Measures for Adults With Hearing Impairment: Lessons From the Cochlear Implant Quality of Life Instruments. Front Neurosci 2021; 15:718416. [PMID: 34899153 PMCID: PMC8653796 DOI: 10.3389/fnins.2021.718416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 11/02/2021] [Indexed: 12/02/2022] Open
Abstract
This manuscript summarizes available evidence-based best practices in the development, translation, and cultural adaptation of one type of outcome measure for adults with hearing impairment, patient-reported outcome measures (PROMs). It presents the development of the Cochlear Implant Quality of Life (CIQOL) instruments and the ongoing translation and cultural adaptation of the CIQOL-35 Profile from English to French as case studies and discusses useful lessons for selecting, developing, translating, culturally adapting, and using PROMs. Relevant best practice guides are introduced, described and their steps are illustrated with examples. Future trends in hearing-related PROMs, including computerized adaptive testing, patient-reported experience measures (PREMs), economic evaluation and allocation of scarce resources, and PROMs in low-resource settings, are discussed. The manuscript concludes on the lessons that can be learned from implementation science for the successful and sustainable integration of PROMs in clinical practice.
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Affiliation(s)
- Ariane Laplante-Lévesque
- Department of Clinical Evidence Cochlear Implants, Oticon Medical A/S, Smørum, Denmark.,Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Judy R Dubno
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, United States
| | - Isabelle Mosnier
- Hearing Institute, Institut Pasteur/Université de Paris/Inserm, Paris, France.,Unité Fonctionnelle Implants Auditifs, ORL, GH Pitié-Salpêtrière, AP-HP Sorbonne Université, Paris, France
| | - Evelyne Ferrary
- Hearing Institute, Institut Pasteur/Université de Paris/Inserm, Paris, France.,Unité Fonctionnelle Implants Auditifs, ORL, GH Pitié-Salpêtrière, AP-HP Sorbonne Université, Paris, France
| | - Theodore R McRackan
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, United States
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A Rapid Realist Review of Quality Care Process Metrics Implementation in Nursing and Midwifery Practice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211932. [PMID: 34831694 PMCID: PMC8621300 DOI: 10.3390/ijerph182211932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/03/2021] [Accepted: 11/09/2021] [Indexed: 12/02/2022]
Abstract
Quality measurement initiatives promote quality improvement in healthcare but can be challenging to implement effectively. This paper presents a Rapid Realist Review (RRR) of published literature on Quality Care-Process Metrics (QCP-M) implementation in nursing and midwifery practice. An RRR informed by RAMESES II standards was conducted as an efficient means to synthesize evidence using an expert panel. The review involved research question development, quality appraisal, data extraction, and evidence synthesis. Six program theories summarised below identify the key characteristics that promote positive outcomes in QCP-M implementation. Program Theory 1: Focuses on the evidence base and accessibility of the QCP-M and their ease of use by nurses and midwives working in busy and complex care environments. Program Theory 2: Examines the influence of external factors on QCP-M implementation. Program Theory 3: Relates to existing cultures and systems within clinical sites. Program Theory 4: Relates to nurses’ and midwives’ knowledge and beliefs. Program Theory 5: Builds on the staff theme of Programme Theory four, extending the culture of organizational learning, and highlights the meaningful engagement of nurses and midwives in the implementation process as a key characteristic of success. Program Theory 6: Relates to patient needs. The results provide nursing and midwifery policymakers and professionals with evidence-based program theory that can be translated into action-orientated strategies to help guide successful QCP-M implementation.
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108
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Martin-Delgado J, Guilabert M, Mira-Solves J. Patient-Reported Experience and Outcome Measures in People Living with Diabetes: A Scoping Review of Instruments. THE PATIENT 2021; 14:759-773. [PMID: 34043215 PMCID: PMC8563512 DOI: 10.1007/s40271-021-00526-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/16/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Diabetes mellitus is a global public health concern, with over 463 million people living with this chronic disease. Pathology complexity, management difficulty, and limited participation in care has resulted in healthcare systems seeking new strategies to engage people living with diabetes. Patient-reported experience measures (PREMs) and patient-reported outcome measures (PROMs) were developed to address the gap between the healthcare system expectation and patient preference. OBJECTIVE This study aimed to review the existing literature on PREMs and PROMs specific to type 1 and 2 diabetes, and report the dimensions report the dimensions they have measured. METHODS A scoping review was conducted from January 1985 to March 2020 of six databases, MEDLINE, EMBASE, PsycINFO, CINHAL, Scopus, and BiblioPro, to identify PREM and PROM instruments specific for type 1 and 2 diabetes. RESULTS Overall, 34 instruments were identified, 32 PROMs and two PREMs. The most common instrument included outcomes related to quality of life at 44% (n = 15), followed by satisfaction (whether with treatment, device, and healthy habits) at 26% (n = 9). Furthermore, instruments regarding personal well-being accounted for 15% (n = 5). For instruments that measure experiences of persons with diabetes, there were two scales of symptoms, and one related to the attitude patients have toward the disease. CONCLUSIONS Diabetes-specific validated instruments mainly focus on quality of life, education, and treatment, and sometimes overlap each other, in their subscales and assessment dimensions. Constructs such as cultural and religious beliefs, leisure, and work life may need more attention. There appears to be a gap in instruments to measure experiences of individuals who "live with diabetes" and seek to lead a "normal life."
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Affiliation(s)
- Jimmy Martin-Delgado
- Atenea Research Group, Foundation for the Promotion of Health and Biomedical Research, Health District Alicante-Sant Joan, Carretera Nacional 332, Av. de Benidorm, Sant Joan d´Alacant, 03550, Alicante, Spain.
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter, UK.
- Department of Public Health, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador.
| | - Mercedes Guilabert
- Department of Health Psychology, Miguel Hernández University, Elche, Spain
| | - José Mira-Solves
- Atenea Research Group, Foundation for the Promotion of Health and Biomedical Research, Health District Alicante-Sant Joan, Carretera Nacional 332, Av. de Benidorm, Sant Joan d´Alacant, 03550, Alicante, Spain
- Department of Health Psychology, Miguel Hernández University, Elche, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Alicante, Spain
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109
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Nitsch KP, Stipp K, Gracz K, Ehrlich-Jones L, Graham ID, Heinemann AW. Integrating Spinal Cord Injury - Quality of Life instruments into rehabilitation: Implementation science to guide adoption of patient-reported outcome measures. J Spinal Cord Med 2021; 44:940-948. [PMID: 31971479 PMCID: PMC8725717 DOI: 10.1080/10790268.2020.1712893] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Context/objective: This study describes a development strategy for integrating the Spinal Cord Injury - Quality of Life (SCI-QOL) item banks into inpatient spinal cord injury (SCI) rehabilitation and recommendations for protocol implementation.Design: We adopted an implementation science approach to develop a strategy for adapting and contextualizing SCI-QOL use during SCI rehabilitation. We conducted focus groups and stakeholder meetings with clinical assessment champions to (1) identify barriers and supports to SCI-QOL adoption; (2) reduce barriers and emphasize supports; (3) evaluate and select relevant SCI-QOL domains and item banks; (4) develop administration and reporting guidelines; and (5) identify hospital roles to alert with SCI-QOL results.Setting: A regional inpatient rehabilitation hospital. This study focuses on clinicians providing inpatient rehabilitation to patients with SCI.Participants: Fifty-nine clinicians, including physicians, speech language pathologists, occupational and physical therapists, nurses, and social workers providing care to SCI inpatients.Interventions: N/A.Outcome measures: N/A.Results: Clinicians identified the SCI-QOL domains that were most relevant to inpatient care; when SCI-QOL should be administered; what hospital roles were best suited for administering SCI-QOL; how results should be displayed in the electronic medical record; and which clinical roles needed notification of SCI-QOL results.Conclusions: Clinicians acknowledge the value of patient-reported outcome measures in inpatient SCI rehabilitation, but noted barriers to adoption. Engaging clinicians in the decision-making process for developing an implementation and administration protocol can inform strategies to overcome barriers and emphasize supports.
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Affiliation(s)
- Kristian P. Nitsch
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kelsey Stipp
- Department of Psychology, Illinois Institute of Technology, Chicago, Illinois, USA
| | | | - Linda Ehrlich-Jones
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois, USA
| | - Ian D. Graham
- School Epidemiology & Public Health, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Allen W. Heinemann
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine
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Sinnige A, Spruijt S, Saes M, Van der Wees PJ, Hoogeboom TJ, Teijink JAW. Using a Learning Health System to Improve Physical Therapy Care for Patients With Intermittent Claudication: Lessons Learned From the ClaudicatioNet Quality System. Phys Ther 2021; 102:6408933. [PMID: 34723323 PMCID: PMC8802141 DOI: 10.1093/ptj/pzab249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 06/28/2021] [Accepted: 08/30/2021] [Indexed: 11/14/2022]
Abstract
UNLABELLED Routinely collected outcomes data can be used to improve physical therapy care through benchmarking, personalization, continued education, and treatment optimization. This article describes how a nationwide infrastructure to routinely collect data from daily practice was created and how these data were used through a support system (called the ClaudicatioNet Quality system) to improve physical therapy care for patients with intermittent claudication in the Netherlands. ClaudicatioNet is a nationwide network of 2100 specialized physical therapists, providing high-quality supervised exercise therapy in combination with lifestyle counseling. The ClaudicatioNet Quality system uses a large national registry in which specific relevant health outcomes have been routinely collected since 2015. These data have then been used in turn to assess quality of care and provide transparency to therapists and other stakeholders. The Quality system is intended to serve as a learning health system, to support continuous learning at the therapist, practice, and network level. In this approach, individual patients and physical therapists are provided with opportunities to personalize, benchmark, and evaluate (and possibly alter) a treatment plan using routinely collected data from historical patients. The Quality system is described based on the essential elements of a learning health system. The challenges and lessons learned in developing the Quality system also are described. IMPACT The use of routinely collected health outcomes can, if implemented correctly, facilitate continuous learning among physical therapists and contribute to person-centered care. This example of a learning health system might serve as a blueprint for physical therapists on how to optimally implement and distill meaning from routinely collected clinical data.
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Affiliation(s)
- Anneroos Sinnige
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, the Netherlands,ClaudicatioNet, Eindhoven, the Netherlands
| | | | | | - Philip J Van der Wees
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands
| | - Thomas J Hoogeboom
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands
| | - Joep A W Teijink
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, the Netherlands,ClaudicatioNet, Eindhoven, the Netherlands,CAPHRI Research School, Maastricht University Medical Centre+, Maastricht, the Netherlands
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111
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Al Sayah F, Lahtinen M, Bonsel GJ, Ohinmaa A, Johnson JA. A multi-level approach for the use of routinely collected patient-reported outcome measures (PROMs) data in healthcare systems. J Patient Rep Outcomes 2021; 5:98. [PMID: 34637031 PMCID: PMC8511251 DOI: 10.1186/s41687-021-00375-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 12/24/2022] Open
Affiliation(s)
- Fatima Al Sayah
- Alberta PROMs and EQ-5D Research and Support Unit (APERSU), School of Public Health, University of Alberta, 2-040 Li Ka Shing Centre for Health Research Innovation, Edmonton, Alberta, T6G 2E1, Canada.
| | | | | | - Arto Ohinmaa
- Alberta PROMs and EQ-5D Research and Support Unit (APERSU), School of Public Health, University of Alberta, 2-040 Li Ka Shing Centre for Health Research Innovation, Edmonton, Alberta, T6G 2E1, Canada
| | - Jeffrey A Johnson
- Alberta PROMs and EQ-5D Research and Support Unit (APERSU), School of Public Health, University of Alberta, 2-040 Li Ka Shing Centre for Health Research Innovation, Edmonton, Alberta, T6G 2E1, Canada
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112
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Kelly PJ, Beck AK, Deane FP, Larance B, Baker AL, Hides L, Manning V, Shakeshaft A, Neale J, Kelly JF, Oldmeadow C, Searles A, Palazzi K, Lawson K, Treloar C, Gray RM, Argent A, McGlaughlin R. Feasibility of a Mobile Health App for Routine Outcome Monitoring and Feedback in SMART Recovery Mutual Support Groups: Stage 1 Mixed Methods Pilot Study. J Med Internet Res 2021; 23:e25217. [PMID: 34612829 PMCID: PMC8529481 DOI: 10.2196/25217] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 03/25/2021] [Accepted: 04/25/2021] [Indexed: 01/19/2023] Open
Abstract
Background Mutual support groups are an important source of long-term help for people impacted by addictive behaviors. Routine outcome monitoring (ROM) and feedback are yet to be implemented in these settings. SMART Recovery mutual support groups focus on self-empowerment and use evidence-based techniques (eg, motivational and behavioral strategies). Trained facilitators lead all SMART Recovery groups, providing an opportunity to implement ROM. Objective The aim of this stage 1 pilot study is to explore the feasibility, acceptability, and preliminary outcomes of a novel, purpose-built mobile health ROM and feedback app (SMART Track) in mutual support groups coordinated by SMART Recovery Australia (SRAU) over 8 weeks. Methods SMART Track was developed during phase 1 of this study using participatory design methods and an iterative development process. During phase 2, 72 SRAU group participants were recruited to a nonrandomized, prospective, single-arm trial of the SMART Track app. Four modes of data collection were used: ROM data directly entered by participants into the app; app data analytics captured by Amplitude Analytics (number of visits, number of unique users, visit duration, time of visit, and user retention); baseline, 2-, and 8-week follow-up assessments conducted through telephone; and qualitative telephone interviews with a convenience sample of study participants (20/72, 28%) and facilitators (n=8). Results Of the 72 study participants, 68 (94%) created a SMART Track account, 64 (88%) used SMART Track at least once, and 42 (58%) used the app for more than 5 weeks. During week 1, 83% (60/72) of participants entered ROM data for one or more outcomes, decreasing to 31% (22/72) by the end of 8 weeks. The two main screens designed to provide personal feedback data (Urges screen and Overall Progress screen) were the most frequently visited sections of the app. Qualitative feedback from participants and facilitators supported the acceptability of SMART Track and the need for improved integration into the SRAU groups. Participants reported significant reductions between the baseline and 8- week scores on the Severity of Dependence Scale (mean difference 1.93, SD 3.02; 95% CI 1.12-2.73) and the Kessler Psychological Distress Scale-10 (mean difference 3.96, SD 8.31; 95% CI 1.75-6.17), but no change on the Substance Use Recovery Evaluator (mean difference 0.11, SD 7.97; 95% CI –2.02 to 2.24) was reported. Conclusions Findings support the feasibility, acceptability, and utility of SMART Track. Given that sustained engagement with mobile health apps is notoriously difficult to achieve, our findings are promising. SMART Track offers a potential solution for ROM and personal feedback, particularly for people with substance use disorders who attend mutual support groups. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12619000686101; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377336 International Registered Report Identifier (IRRID) RR2-10.2196/15113
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Affiliation(s)
- Peter J Kelly
- School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Alison K Beck
- School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
| | - Frank P Deane
- School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Briony Larance
- School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Amanda L Baker
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Leanne Hides
- Centre for Youth Substance Abuse Research, Lives Lived Well Group, School of Psychology, University of Queensland, Brisbane St Lucia, Australia
| | - Victoria Manning
- Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Box Hill, Australia
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Joanne Neale
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - John F Kelly
- Harvard Medical School, Harvard University, Boston, MA, United States
| | - Christopher Oldmeadow
- Clinical Research Design, IT and Statistical Support Unit, Hunter Medical Research Institute, New Lambton, Australia
| | - Andrew Searles
- Hunter Medical Research Institute Health Research Economics, Hunter Medical Research Institute, New Lambton, Australia
| | - Kerrin Palazzi
- Clinical Research Design, IT and Statistical Support Unit, Hunter Medical Research Institute, New Lambton, Australia
| | - Kenny Lawson
- Hunter Medical Research Institute Health Research Economics, Hunter Medical Research Institute, New Lambton, Australia
| | - Carla Treloar
- Centre for Social Research in Health, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, Australia
| | - Rebecca M Gray
- Centre for Social Research in Health, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, Australia
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113
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Jayakumar P, Duckworth E, Bozic KJ. Value-based Healthcare: Three Ways Healthcare Systems Can Get More Usage Out of Their Patient Engagement Tools. Clin Orthop Relat Res 2021; 479:2136-2138. [PMID: 34546188 PMCID: PMC8445570 DOI: 10.1097/corr.0000000000001934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Prakash Jayakumar
- Director of Value Based Health Care and Outcome Measurement, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Elizabeth Duckworth
- Resident, Orthopaedic Surgery, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Kevin J. Bozic
- Professor of Orthopaedic Surgery and Chair of the Department of Surgery, Dell Medical School, University of Texas at Austin, Austin, TX, USA
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114
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Long C, Beres LK, Wu AW, Giladi AM. Patient-level barriers and facilitators to completion of patient-reported outcomes measures. Qual Life Res 2021; 31:1711-1718. [PMID: 34533759 DOI: 10.1007/s11136-021-02999-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To identify patient-level barriers and facilitators to completion of patient-reported outcomes measures (PROMs) in a hand and upper extremity clinic in Baltimore, Maryland. METHODS We conducted 12 h of direct observation of PROM completion (October-November, 2020). Ethnographic observation memos were qualitatively analyzed for barriers and facilitators using rapid thematic analysis. Informed by observation findings, we conducted 17 semi-structured interviews with mixed-literacy patients, caregivers, and clinic staff to understand the patient experience when completing PROMs (November 2020-March 2021). We identified initial themes through inductive and deductive framework analysis and validated findings through subsequent interviews with member-checking. RESULTS We identified nine patient-level factors that influence PROM completion: platform design, print literacy, health literacy, technology literacy, language proficiency, physical functioning, vision, cognitive functioning, and time. CONCLUSIONS There are multiple distinct patient-level factors that affect PROM completion. Failure to consider these factors in PROM design and implementation may lower completion rates or prevent accurate completion, undermining PROM validity. Because certain factors affect minority populations at disproportionate rates, this may also contribute to existing health disparities.
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Affiliation(s)
- Chao Long
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD, USA.,Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Laura K Beres
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Albert W Wu
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Aviram M Giladi
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD, USA.
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115
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Generalova O, Roy M, Hall E, Shah SA, Cunanan K, Fardeen T, Velazquez B, Chu G, Bruzzone B, Cabot A, Fisher GA, Srinivas S, Fan AC, Haraldsdottir S, Wakelee HA, Neal JW, Padda SK, Johnson T, Heestand GM, Hsieh RW, Ramchandran K. Implementation of a cloud-based electronic patient-reported outcome (ePRO) platform in patients with advanced cancer. J Patient Rep Outcomes 2021; 5:91. [PMID: 34524558 PMCID: PMC8443731 DOI: 10.1186/s41687-021-00358-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 08/26/2021] [Indexed: 11/18/2022] Open
Abstract
Background Patient reported outcomes (PROs) have been associated with improved symptom management and quality of life in patients with cancer. However, the implementation of PROs in an academic clinical practice has not been thoroughly described. Here we report on the execution, feasibility and healthcare utilization outcomes of an electronic PRO (ePRO) application for cancer patients at an academic medical center. Methods We conducted a randomized trial comparing an experimental ePRO arm to standard of care in patients with advanced cancer in the thoracic, gastrointestinal, and genitourinary oncology groups at Stanford Cancer Center from March 2018 to November 2019. We describe the pre-implementation, implementation, and post-implementation phases of the ePRO arm, technological barriers, electronic health record (EHR) integration, clinician burden, and patient data privacy and security. Feasibility was pre-specified to be at least 70% completion of all questionnaires. Acceptability was based on patient and clinician feedback. Ambulatory healthcare utilization was assessed by reviewing numbers of phone messages, electronic portal messages, and referrals for supportive care. Results Of 617 ePRO questionnaires sent to 72 patients, 445 (72%) were completed. Most clinicians (87.5%) and patients (93%) felt neutral or positive about the ePRO tool’s ease of use. Exposure to ePRO did not cause a measurable change in ambulatory healthcare utilization, with a median of less than two phone messages and supportive care referrals, and 5–6 portal messages. Conclusions Web-based ePRO tools for patients with advanced cancer are feasible and acceptable without increasing clinical burden. Key lessons include the importance of pilot testing, engagement of stakeholders at all levels, and the need for customization by disease group. Future directions for this work include completion of EHR integration, expansion to other centers, and development of integrated workflows for routine clinical practice. Supplementary Information The online version contains supplementary material available at 10.1186/s41687-021-00358-2.
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Affiliation(s)
| | - Mohana Roy
- Stanford Cancer Institute, Stanford, USA. .,Division of Medical Oncology, Stanford University School of Medicine, Stanford, USA.
| | - Evan Hall
- Department of Medical Oncology, University of Washington School of Medicine, Seattle, WA, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Sumit A Shah
- Stanford Cancer Institute, Stanford, USA.,Division of Medical Oncology, Stanford University School of Medicine, Stanford, USA
| | - Kristen Cunanan
- Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, USA
| | | | | | - Gilbert Chu
- Stanford Cancer Institute, Stanford, USA.,Division of Medical Oncology, Stanford University School of Medicine, Stanford, USA
| | | | | | - George A Fisher
- Stanford Cancer Institute, Stanford, USA.,Division of Medical Oncology, Stanford University School of Medicine, Stanford, USA
| | - Sandy Srinivas
- Stanford Cancer Institute, Stanford, USA.,Division of Medical Oncology, Stanford University School of Medicine, Stanford, USA
| | - Alice C Fan
- Stanford Cancer Institute, Stanford, USA.,Division of Medical Oncology, Stanford University School of Medicine, Stanford, USA
| | - Sigurdis Haraldsdottir
- Stanford Cancer Institute, Stanford, USA.,Division of Medical Oncology, Stanford University School of Medicine, Stanford, USA
| | - Heather A Wakelee
- Stanford Cancer Institute, Stanford, USA.,Division of Medical Oncology, Stanford University School of Medicine, Stanford, USA
| | - Joel W Neal
- Stanford Cancer Institute, Stanford, USA.,Division of Medical Oncology, Stanford University School of Medicine, Stanford, USA
| | - Sukhmani K Padda
- Stanford Cancer Institute, Stanford, USA.,Division of Medical Oncology, Stanford University School of Medicine, Stanford, USA
| | - Tyler Johnson
- Stanford Cancer Institute, Stanford, USA.,Division of Medical Oncology, Stanford University School of Medicine, Stanford, USA
| | - Gregory M Heestand
- Stanford Cancer Institute, Stanford, USA.,Division of Medical Oncology, Stanford University School of Medicine, Stanford, USA
| | - Robert W Hsieh
- Stanford Cancer Institute, Stanford, USA.,Division of Medical Oncology, Stanford University School of Medicine, Stanford, USA
| | - Kavitha Ramchandran
- Stanford Cancer Institute, Stanford, USA.,Division of Medical Oncology, Stanford University School of Medicine, Stanford, USA
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116
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Cheung YT, Chan A, Charalambous A, Darling HS, Eng L, Grech L, van den Hurk CJG, Kirk D, Mitchell SA, Poprawski D, Rammant E, Ramsey I, Fitch MI, Chan RJ. The use of patient-reported outcomes in routine cancer care: preliminary insights from a multinational scoping survey of oncology practitioners. Support Care Cancer 2021; 30:1427-1439. [PMID: 34524527 PMCID: PMC8440726 DOI: 10.1007/s00520-021-06545-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/04/2021] [Indexed: 11/18/2022]
Abstract
Background There exists scant evidence on the optimal approaches to integrating patient-reported outcomes (PROs) in clinical practice. This study gathered oncology practitioners’ experiences with implementing PROs in cancer care. Methods Between December 2019 and June 2020, we surveyed practitioners who reported spending > 5% of their time providing clinical care to cancer patients. Respondents completed an online survey describing their experiences with and barriers to using PROs in clinical settings. Results In total, 362 practitioners (physicians 38.7%, nurses 46.7%, allied health professionals 14.6%) completed the survey, representing 41 countries (Asia–Pacific 42.5%, North America 30.1%, Europe 24.0%, others 3.3%). One quarter (25.4%) identified themselves as “high frequency users” who conducted PRO assessments on > 80% of their patients. Practitioners commonly used PROs to facilitate communication (60.2%) and monitor treatment responses (52.6%). The most commonly reported implementation barriers were a lack of technological support (70.4%) and absence of a robust workflow to integrate PROs in clinical care (61.5%). Compared to practitioners from high-income countries, more practitioners in low-middle income countries reported not having access to a local PRO expert (P < .0001) and difficulty in identifying the appropriate PRO domains (P = .006). Compared with nurses and allied health professionals, physicians were more likely to perceive disruptions in clinical care during PRO collection (P = .001) as an implementation barrier. Conclusions Only a quarter of the surveyed practitioners reported capturing PROs in routine clinical practice. The implementation barriers to PRO use varied across respondents in different professions and levels of socioeconomic resources. Our findings can be applied to guide planning and implementation of PRO collection in cancer care. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-021-06545-7.
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Affiliation(s)
- Yin Ting Cheung
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Alexandre Chan
- School of Pharmacy & Pharmaceutical Sciences, Department of Clinical Pharmacy Practice, University of California, Irvine, LA, USA
| | - Andreas Charalambous
- Department of Nursing, Cyprus University of Technology, Limassol, Cyprus.,Department of Nursing, University of Turku, Turku, Finland
| | - H S Darling
- Department of Medical Oncology, Command Hospital Air Force, Bangalore, India
| | - Lawson Eng
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto, Canada
| | - Lisa Grech
- School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Medicine Monash Health, Monash University, Melbourne, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.,Health Sciences, Swinburne University, Melbourne, Australia.,Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | - Deborah Kirk
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia
| | - Sandra A Mitchell
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Dagmara Poprawski
- Department of Oncology, King Faisal Specialist Hospital & Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Elke Rammant
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Imogen Ramsey
- Rosemary Bryant AO Research Centre, Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - Margaret I Fitch
- Bloomberg Faculty of Nursing, University of Toronto, 207 Chisholm Ave, Toronto, ON, Canada.
| | - Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, 5042, Australia.
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117
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Greenhalgh J. Understanding the complexities of collecting and using PRO data in a primary care context. BMJ Qual Saf 2021; 31:175-178. [PMID: 34510019 DOI: 10.1136/bmjqs-2021-013315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Joanne Greenhalgh
- School of Sociology and Social Policy, University of Leeds, Leeds, UK .,President Elect, International Society for Quality of Life Research (ISOQOL)
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118
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Sibert NT, Breidenbach C, Wesselmann S, Schult S, Benz SR, Post S, Seufferlein T, Schloss P, Kowalski C. Which EORTC QLQ-C30 and -CR29 scores are relevant for clinicians for therapy planning and decisions? COLOPROCTOLOGY 2021. [DOI: 10.1007/s00053-021-00560-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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119
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Krone-Hjertstrøm H, Norbye B, Abelsen B, Obstfelder A. Organizing work in local service implementation: an ethnographic study of nurses' contributions and competencies in implementing a municipal acute ward. BMC Health Serv Res 2021; 21:840. [PMID: 34412624 PMCID: PMC8375113 DOI: 10.1186/s12913-021-06869-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 08/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The increased prevalence of chronic diseases and an ageing population challenge healthcare delivery, particularly hospital-based care. To address this issue, health policy aims to decentralize healthcare by transferring responsibility and introducing new services in primary healthcare. In-depth knowledge of associated implementation processes is crucial for health care managers, policymakers, and the health care personnel involved. In this article, we apply an ethnographic approach in a study of nurses' contributions to the implementation of a new inpatient service in an outpatient primary care emergency clinic and explore the competencies involved. The approach allowed us to explore the unexpressed yet significant effort, knowledge and competence of nurses that shaped the new service. METHODS The study combines observations (250 h) and several in situ interviews with healthcare personnel and individual in-depth interviews with nurses (n = 8) at the emergency clinic. In our analysis, we draw on a sociological perspective on healthcare work and organization that considers nursing a practice within the boundaries of clinical patient work, organizational structures, and managerial and professional requirements. RESULTS We describe the following three aspects of nurses' contributions to the implementation of the new service: (1) anticipating worst-case scenarios and taking responsibility for preventing them, (2) contributing coherence in patient care by ensuring that new and established procedures are interconnected, and (3) engaging in "invisible work". The nurses draw on their own experiences from their work as emergency nurses and knowledge of the local and regional contexts. They utilize their knowledge, competence, and organizing skills to influence the implementation process and ensure high-quality healthcare delivery in the extended service. CONCLUSIONS Our study illustrates that nurses' contributions are vital to coordinating and adjusting extended services. Organizing work, in addition to clinical work, is a crucial aspect of nursing work. It 'glues' the complex and varied components of the individual patient's services into coherent and holistic care trajectories. It is this organizing competence that nurses utilize when coordinating and adjusting extended services. We believe that nurses' organizing work is generally invaluable in implementing new services, although it has not been well emphasized in practice and research.
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Affiliation(s)
- Helle Krone-Hjertstrøm
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway. .,Telemark Research Institute, Bø, Norway.
| | - Bente Norbye
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Birgit Abelsen
- The Department of Community Medicine, The National Centre of Rural Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Aud Obstfelder
- Department of Health Sciences in Gjøvik, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Gjøvik, Norway
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120
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Comorbid Anxiety and Depression, Though Underdiagnosed, Are Not Associated with High Rates of Low-Value Care in Patients with Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 2021; 18:442-451. [PMID: 33306930 DOI: 10.1513/annalsats.201912-877oc] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rationale: Patients with chronic obstructive pulmonary disease (COPD) and anxiety or depression experience more symptoms and exacerbations than patients without these comorbidities. Failure to provide beneficial COPD therapies to appropriate patients (underuse) and provision of potentially harmful therapies to patients without an appropriate indication (overuse) could contribute to respiratory symptoms and exacerbations. Anxiety and depression are known to affect the provision of health services for other comorbid conditions; therefore, underuse or overuse of therapies may explain the increased risk of severe symptoms among these patients.Objectives: To determine whether diagnosed anxiety and depression, as well as significant anxiety and depression symptoms, are associated with underuse and overuse of appropriate COPD therapies.Methods: We analyzed data from a multicenter prospective cohort study of 2,376 participants (smokers and control subjects) enrolled between 2010 and 2015. We identified two subgroups of participants, one at risk for inhaled corticosteroid (ICS) overuse and one at risk for long-acting bronchodilator (LABD) underuse based on the 2011 Global Initiative for Chronic Obstructive Lung Disease statement. Our primary outcomes were self-reported overuse and underuse. Our primary exposures of interest were self-reported anxiety and depression and significant anxiety and depression symptoms. We adopted a propensity-score method with inverse probability of treatment weighting adjusting for differences in prevalence of confounders and performed inverse probability of treatment weighting logistic regression to evaluate all associations between the exposures and outcomes.Results: Among the 1,783 study participants with COPD confirmed by spirometry, 667 (37.4%) did not have an indication for ICS use, whereas 985 (55.2%) had an indication for LABD use. Twenty-five percent (n = 167) of patients reported ICS use, and 72% (n = 709) denied LABD use in each subgroup, respectively. Neither self-reported anxiety and depression nor significant anxiety and depression symptoms were associated with overuse or underuse. At least 50% of patients in both subgroups with significant symptoms of anxiety or depression did not report a preexisting mental health diagnosis.Conclusions: Underuse of LABDs and overuse of ICSs are common but are not associated with comorbid anxiety or depression diagnosis or symptoms. Approximately one-third of individuals with COPD experience anxiety or depression, and most are undiagnosed. There are significant opportunities to improve disease-specific and patient-centered treatment for individuals with COPD.
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121
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Herrmann S, Power B, Rashidi A, Cypher M, Mastaglia F, Grace A, McKinnon E, Sarrot P, Michau C, Skinner M, Desai R, Duracinsky M. Supporting Patient-Clinician Interaction in Chronic HIV Care: Design and Development of a Patient-Reported Outcomes Software Application. J Med Internet Res 2021; 23:e27861. [PMID: 34328442 PMCID: PMC8367117 DOI: 10.2196/27861] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/19/2021] [Accepted: 06/14/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The consideration of health-related quality of life (HRQL) is a hallmark of best practice in HIV care. Information technology offers an opportunity to more closely engage patients with chronic HIV infection in their long-term management and support a focus on HRQL. However, the implementation of patient-reported outcome (PRO) measures, such as HRQL in routine care, is challenged by the need to synthesize data generated by questionnaires, the complexity of collecting data between patient visits, and the integration of results into clinical decision-making processes. OBJECTIVE Our aim is to design and pilot-test a multimedia software platform to overcome these challenges and provide a vehicle to increase focus on HRQL issues in HIV management. METHODS A multidisciplinary team in France and Australia conducted the study with 120 patients and 16 doctors contributing to the design and development of the software. We used agile development principles, user-centered design, and qualitative research methods to develop and pilot the software platform. We developed a prototype application to determine the acceptability of the software and piloted the final version with 41 Australian and 19 French residents using 2 validated electronic questionnaires, the Depression, Anxiety and Stress Scale-21 Items, and the Patient Reported Outcomes Quality of Life-HIV. RESULTS Testing of the prototype demonstrated that patients wanted an application that was intuitive and without excessive instruction, so it felt effortless to use, as well as secure and discreet. Clinicians wanted the PRO data synthesized, presented clearly and succinctly, and clinically actionable. Safety concerns for patients and clinicians included confidentiality, and the potential for breakdown in communication if insufficient user training was not provided. The final product, piloted with patients from both countries, showed that most respondents found the application easy to use and comprehend. The usability testing survey administered found that older Australians had reduced scores for understanding the visual interface (P=.004) and finding the buttons organized (P=.02). Three-fourths of the respondents were concerned with confidentiality (P=.007), and this result was more prevalent in participants with higher anxiety and stress scores (P=.01), as measured by the Depression, Anxiety and Stress Scale-21 Items. These statistical associations were not observed in 15 French patients who completed the same questionnaire. CONCLUSIONS Digital applications in health care should be safe and fit for purpose. Our software was acceptable to patients and shows potential to overcome some barriers to the implementation of PROs in routine care. The design of the clinicians' interface presents a solution to the problem of voluminous data, both synthesizing and providing a snapshot of longitudinal data. The next stage is to conduct a randomized controlled trial to determine whether patients experience increased satisfaction with care and whether doctors perceive that they deliver better clinical care without compromising efficiency.
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Affiliation(s)
- Susan Herrmann
- Medical School, University of Western Australia, Crawley, Australia
| | - Brad Power
- College of Arts, Business, Law & Social Sciences, Murdoch University, Murdoch, WA, Australia
| | - Amineh Rashidi
- School of Nursing & Midwifery, Edith Cowan University, Joondalup, WA, Australia
| | - Mark Cypher
- College of Arts, Business, Law & Social Sciences, Murdoch University, Murdoch, WA, Australia
| | - Frank Mastaglia
- College of Arts, Business, Law & Social Sciences, Murdoch University, Murdoch, WA, Australia
| | - Amy Grace
- School of Psychology and Exercise Science, Murdoch University, Murdoch, WA, Australia
| | | | - Pierre Sarrot
- Patient-Centered Outcomes Research, Health Economics Clinical Trial Unit, Hospital Hotel-Dieu, AP-HP, University de Paris, Paris, France
| | | | | | - Renae Desai
- Perron Institute for Neurological & Translational Science, Queen Elizabeth II Medical Centre, Nedlands, WA, Australia
| | - Martin Duracinsky
- Patient-Centered Outcomes Research, Health Economics Clinical Trial Unit, Hospital Hotel-Dieu, AP-HP, University de Paris, Paris, France.,Department of Internal Medicine & Immunology, Hospital Bicetre, AP-HP, Kremlin-Bicetre, France
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Amini M, Oemrawsingh A, Verweij LM, Lingsma HF, Hazelzet JA, Eijkenaar F, van Leeuwen N. Facilitators and barriers for implementing patient-reported outcome measures in clinical care: An academic center's initial experience. Health Policy 2021; 125:1247-1255. [PMID: 34311981 DOI: 10.1016/j.healthpol.2021.07.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 06/18/2021] [Accepted: 07/04/2021] [Indexed: 11/19/2022]
Abstract
Objectives The aim of this study was to explore the perspectives of healthcare providers and researchers in a large academic hospital on facilitators and barriers for implementing patient-reported outcome measures (PROMs) in clinical care. Methods A customized web-based questionnaire was developed and disseminated to healthcare providers and researchers across multiple medical departments involved in a value-based health care initiative in the hospital. Questionnaire statements were rated using a 5-point Likert scale ranging from "strongly agree" to "strongly disagree". In addition, 8 open-ended questions were included allowing respondents to mention additional facilitators and barriers for implementing PROMs. Descriptive statistics were used to summarize the results. Results In total, 61 participants from both surgical and non-surgical departments completed the survey. Most respondents (51%) were medical specialists and the median employment duration was 14 years. Frequently reported facilitators were the presence of a PROM coordinator in the (outpatient) clinic (85%), the integration of PROMs in the electronic health record (81%), and the intrinsic motivation of members involved in the implementation (N=9 open responses). Commonly reported barriers were language barriers (76%), IT issues (N=17 open responses), and time constraints (N=14 open responses). Conclusions For the successful implementation of PROMs in clinical practice, it is imperative that healthcare organizations consider supporting motivated healthcare professionals, involving PROMs coordinators, and investing in an adequate IT infrastructure, and removal of language barriers.
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Affiliation(s)
- Marzyeh Amini
- Center for Medical Decision Making, Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Arvind Oemrawsingh
- Center for Medical Decision Making, Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Hester F Lingsma
- Center for Medical Decision Making, Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jan A Hazelzet
- Center for Medical Decision Making, Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Frank Eijkenaar
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Nikki van Leeuwen
- Center for Medical Decision Making, Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
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Chen A, Väyrynen K, Leskelä RL, Heinonen S, Lillrank P, Tekay A, Torkki P. A qualitative study on professionals' attitudes and views towards the introduction of patient reported measures into public maternity care pathway. BMC Health Serv Res 2021; 21:645. [PMID: 34217284 PMCID: PMC8254939 DOI: 10.1186/s12913-021-06658-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 06/16/2021] [Indexed: 11/10/2022] Open
Abstract
Background The importance and potential benefits of introducing patient reported measures (PRMs) into health care service have been widely acknowledged, yet the experience regarding their implementation into practice is limited. There is a considerable paucity of research in adopting PRMs in maternity care routine. This study, which utilizes the PRMs included in Pregnancy and Childbirth (PCB) outcome set developed by International Consortium for Health Outcomes Measurement (ICHOM) as sample measures, aims to elicit Finnish professionals’ views on PRMs and to explore the applicability of PRMs in Finnish public maternity care. Methods This qualitative study, applying semi-structured interviews, described the local professionals’ views towards the application of PRMs in Finnish public maternity care. Professionals were asked to assess the PRMs defined in ICHOM PCB set and provide their expectations and concerns on the implementation of PRMs in Finnish public maternity service. Results Twenty professionals participated in the interviews. Participants agreed on the importance and relevance of the PRMs questions included in ICHOM PCB set for delivering and developing maternity care in Finland. However, they criticized the number and length of questions as well as the recommended time points of data collection. In addition, for a successful implementation, various steps like developing suitable questions, redesigning service pathway and protocols, and motivating women to respond to PRMs questions were considered to be important. Also, some potential obstacles, difficulties and risks associated with the implementation were underlined. Conclusion This study indicates that the implementation of PRMs into Finnish public maternity service is possible, highly relevant and important. However, the adoption of PRMs into routine practice may be challenging and will require a series of efforts. This study shows viewpoints from Finnish professionals who have not participated in developing the ICHOM PCB standard set and provides important insights on the development and implementation of PRMs. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06658-z.
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Affiliation(s)
- An Chen
- Department of Industrial Engineering and Management, Institute of Healthcare Engineering, Management and Architecture (HEMA), Aalto University, Maarintie 8, P.O. Box 15500, FI-00076 AALTO, 02150, Espoo, Finland. .,Nordic Healthcare Group Oy, Vattuniemenranta 2, 00210, Helsinki, Finland.
| | - Kirsi Väyrynen
- Department of Obstetrics and Gynaecology, Central Finland Central Hospital, Keskussairaalantie 19, 40620, Jyväskylä, Finland
| | | | - Seppo Heinonen
- Department of Obstetrics and Gynaecology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 2, 00290, Helsinki, Finland
| | - Paul Lillrank
- Department of Industrial Engineering and Management, Institute of Healthcare Engineering, Management and Architecture (HEMA), Aalto University, Maarintie 8, P.O. Box 15500, FI-00076 AALTO, 02150, Espoo, Finland
| | - Aydin Tekay
- Department of Obstetrics and Gynaecology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 2, 00290, Helsinki, Finland
| | - Paulus Torkki
- Department of Industrial Engineering and Management, Institute of Healthcare Engineering, Management and Architecture (HEMA), Aalto University, Maarintie 8, P.O. Box 15500, FI-00076 AALTO, 02150, Espoo, Finland.,Nordic Healthcare Group Oy, Vattuniemenranta 2, 00210, Helsinki, Finland.,Department of Public Health, Faculty of Medicine, Helsinki University, Biomedicum 1, 00290, Helsinki, Finland
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van Muilekom MM, Luijten MAJ, van Oers HA, Conijn T, Maurice‐Stam H, van Goudoever JB, Grootenhuis MA, Haverman L, M. A. B, J. M. VDB, A. H. M. B, C. C. B, C. J. F, J. W. G, C. M. VDH, B. J, A. K, H. K, B. J. P. K, L. A. M, M. A. MH, M. P, M. A. J. VR, N. W. P. R, H. J. S, A. Y. N. S, F. S, M. M. T, A. S. P. T, F. A. W. Paediatric patients report lower health-related quality of life in daily clinical practice compared to new normative PedsQL TM data. Acta Paediatr 2021; 110:2267-2279. [PMID: 33838052 PMCID: PMC8360011 DOI: 10.1111/apa.15872] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 02/25/2021] [Accepted: 04/08/2021] [Indexed: 01/04/2023]
Abstract
Aim To compare Health‐Related Quality of Life (HRQOL) of paediatric patients with newly collected HRQOL data of the general Dutch population, explore responses to individual items and investigate variables associated with HRQOL. Methods Children (8–12y) and adolescents (13–17y) from the general population (N = 966) and from a paediatric population (N = 1209) completed the Pediatric Quality of Life Inventory (PedsQLTM) online via the KLIK Patient‐Reported Outcome Measures portal. PedsQLTM scale scores were compared between groups with independent t tests, by age group and gender. Responses to PedsQLTM items were explored using descriptive analyses. Linear regression analyses were performed to determine which variables were associated with HRQOL. Results Paediatric patients reported worse HRQOL than the general population on all PedsQLTM scales (p ≤ .001, d = 0.20–1.03), except social functioning, and a high proportion reported problems on PedsQLTM items, for example, ‘I have trouble sleeping’. Younger age, female gender and school absence were negatively associated with HRQOL (β = −0.37–0.10, p ≤ .008). Conclusion Paediatric patients reported lower HRQOL than the general population, and school absence, female gender and younger age were associated with lower HRQOL. The results underline the importance to structurally monitor paediatric patients’ HRQOL in clinical practice to detect problems and offer the right help on time.
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Affiliation(s)
- Maud M. van Muilekom
- Department of Child and Adolescent Psychiatry and Psychosocial Care Amsterdam Reproduction and Development Amsterdam Public Health Emma Children's HospitalAmsterdam UMCUniversity of Amsterdam Amsterdam The Netherlands
| | - Michiel A. J. Luijten
- Department of Child and Adolescent Psychiatry and Psychosocial Care Amsterdam Reproduction and Development Amsterdam Public Health Emma Children's HospitalAmsterdam UMCUniversity of Amsterdam Amsterdam The Netherlands
- Department of Epidemiology and Data Science Amsterdam Public Health Amsterdam UMCVrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Hedy A. van Oers
- Department of Child and Adolescent Psychiatry and Psychosocial Care Amsterdam Reproduction and Development Amsterdam Public Health Emma Children's HospitalAmsterdam UMCUniversity of Amsterdam Amsterdam The Netherlands
| | - Thirsa Conijn
- Department of Child and Adolescent Psychiatry and Psychosocial Care Amsterdam Reproduction and Development Amsterdam Public Health Emma Children's HospitalAmsterdam UMCUniversity of Amsterdam Amsterdam The Netherlands
| | | | - Johannes B. van Goudoever
- Department of Pediatrics Emma Children's HospitalAmsterdam UMCUniversity of AmsterdamVrije Universiteit Amsterdam The Netherlands
| | | | - Lotte Haverman
- Department of Child and Adolescent Psychiatry and Psychosocial Care Amsterdam Reproduction and Development Amsterdam Public Health Emma Children's HospitalAmsterdam UMCUniversity of Amsterdam Amsterdam The Netherlands
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Greenberg KK, Schwartz AE, Kramer JM. Adoption of patient-reported outcome measures with youth with intellectual/developmental disabilities: Contextual influences and practice patterns. Child Care Health Dev 2021; 47:501-508. [PMID: 33646573 DOI: 10.1111/cch.12862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/28/2020] [Accepted: 02/21/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The purpose of this study was to identify potential barriers to patient reported outcome measure (PROM) adoption with youth and young adults with intellectual and/or developmental disabilities (IDD) and to understand current PROM adoption patterns of paediatric practitioners working with this population. METHODS We used a web-based survey to collect data from paediatric practitioners who work with youth with IDD about factors influencing the adoption of PROMs and the frequency of PROM use across age groups (elementary, middle school and high school/transition age) and practice settings (school and rehabilitation). RESULTS A total of 113 paediatric practitioners (occupational therapist = 48, physical therapist = 32, physician = 16, other = 17) responded to the survey with an average of 15 years of experience working with youth ages 8-21 with IDD. Accessibility and appropriateness, psychometric evidence, and time were most frequently ranked among the top three factors that influence practitioners' adoption of PROMs. Practitioners reported 'never or rarely' using PROMs 39%-65% of the time across age groups. CONCLUSIONS Our results suggest that paediatric practitioners may be infrequently using PROMs with youth with IDD because of perceived inaccessibility and time requirements of PROMs and practice-environment barriers, including access to evidence and caseload demands. Because PROMs can facilitate client-centred care, addressing these potential barriers to adoption may improve paediatric rehabilitation.
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Affiliation(s)
- Kimberly K Greenberg
- Department of Occupational Therapy, Boston University, Boston, Massachusetts, USA
| | - Ariel E Schwartz
- Department of Occupational Therapy, Boston University, Boston, Massachusetts, USA
| | - Jessica M Kramer
- Department of Occupational Therapy, University of Florida, Gainesville, Florida, USA
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van Rooijen M, van Dijk-de Vries A, Lenzen S, Dalemans R, Moser A, Beurskens A. How to foster successful implementation of a patient reported experience measurement in the disability sector: an example of developing strategies in co-creation. RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:45. [PMID: 34167588 PMCID: PMC8229276 DOI: 10.1186/s40900-021-00287-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 05/20/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The integrated uptake of patient-reported experience measures, using outcomes for the micro, meso and macro level, calls for a successful implementation process which depends on how stakeholders are involved in this process. Currently, the impact of stakeholders on strategies to improve the integrated use is rarely reported, and information about how stakeholders can be engaged, including care-users who are communication vulnerable, is limited. This study illustrates the impact of all stakeholders on developing tailored implementation strategies and provides insights into supportive conditions to involve care-users who are communication vulnerable. METHODS With the use of participatory action research, implementation strategies were co-created by care-users who are communication vulnerable (n = 8), professionals (n = 12), management (n = 6) and researchers (n = 5) over 9 months. Data collection consisted of audiotapes, reports, and researchers' notes. Conventional content analysis was performed. RESULTS The impact of care-users concerned the strategies' look and feel, understandability and relevance. Professionals influenced impact on how to use strategies and terminology. The impact of management was on showing the gap between policy and practice, and learning from previous improvement failures. Researchers showed impact on analysis, direction of strategy changes and translating academic and development experience into practice. The engagement of care-users who are communication vulnerable was supported, taking into account organisational issues and the presentation of information. CONCLUSIONS The impact of all engaged stakeholders was identified over the different levels strategies focused on. Care-users who are communication vulnerable were valuable engaged in co-creation implementation strategies by equipping them to their needs and routines, which requires adaptation in communication, delimited meetings and a safe group environment. TRIAL REGISTRATION Reviewed by the Medical Ethics Committee of Zuyderland-Zuyd (METCZ20190006). NL7594 registred at https://www.trialregister.nl/ .
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Affiliation(s)
- Marjolein van Rooijen
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, P. Debyeplein 1, 6229, HA, Maastricht, The Netherlands.
| | - Anneke van Dijk-de Vries
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, P. Debyeplein 1, 6229, HA, Maastricht, The Netherlands
| | - Stephanie Lenzen
- Research Centre for Autonomy and Participation of Persons with a Chronic Illness, Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Ruth Dalemans
- Research Centre for Autonomy and Participation of Persons with a Chronic Illness, Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Albine Moser
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, P. Debyeplein 1, 6229, HA, Maastricht, The Netherlands
- Research Centre for Autonomy and Participation of Persons with a Chronic Illness, Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Anna Beurskens
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, P. Debyeplein 1, 6229, HA, Maastricht, The Netherlands
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Wolff AC, Dresselhuis A, Hejazi S, Dixon D, Gibson D, Howard AF, Liva S, Astle B, Reimer-Kirkham S, Noonan VK, Edwards L. Healthcare provider characteristics that influence the implementation of individual-level patient-centered outcome measure (PROM) and patient-reported experience measure (PREM) data across practice settings: a protocol for a mixed methods systematic review with a narrative synthesis. Syst Rev 2021; 10:169. [PMID: 34108024 PMCID: PMC8188663 DOI: 10.1186/s13643-021-01725-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Substantial literature has highlighted the importance of patient-reported outcome and experience measures (PROMs and PREMs, respectively) to collect clinically relevant information to better understand and address what matters to patients. The purpose of this systematic review is to synthesize the evidence about how healthcare providers implement individual-level PROMs and PREMs data into daily practice. METHODS This mixed methods systematic review protocol describes the design of our synthesis of the peer-reviewed research evidence (i.e., qualitative, quantitative, and mixed methods), systematic reviews, organizational implementation projects, expert opinion, and grey literature. Keyword synonyms for "PROMs," PREMs," and "implementation" will be used to search eight databases (i.e., MEDLINE, CINAHL, PsycINFO, Web of Science, Embase, SPORTDiscus, Evidence-based Medicine Reviews, and ProQuest (Dissertation and Theses)) with limiters of English from 2009 onwards. Study selection criteria include implementation at the point-of-care by healthcare providers in any practice setting. Eligible studies will be critically appraised using validated tools (e.g., Joanna Briggs Institute). Guided by the review questions, data extraction and synthesis will occur simultaneously to identify biographical information and methodological characteristics as well as classify study findings related to implementation processes and strategies. As part of the narrative synthesis approach, two frameworks will be utilized: (a) Consolidated Framework for Implementation Research (CFIR) to identify influential factors of PROMs and PREMs implementation and (b) Expert Recommendations for Implementing Change (ERIC) to illicit strategies. Data management will be undertaken using NVivo 12TM. DISCUSSION Data from PROMs and PREMs are critical to adopt a person-centered approach to healthcare. Findings from this review will guide subsequent phases of a larger project that includes interviews and a consensus-building forum with end users to create guidelines for implementing PROMs and PREMs at the point of care. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020182904 .
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Affiliation(s)
- Angela C. Wolff
- School of Nursing, Trinity Western University, 22500 University Drive, Langley, British Columbia V2Y 1Y1 Canada
| | - Andrea Dresselhuis
- School of Nursing, Trinity Western University, 22500 University Drive, Langley, British Columbia V2Y 1Y1 Canada
| | - Samar Hejazi
- Department of Evaluation and Research Services, Fraser Health Authority, Suite 400, 13450 – 102nd Avenue, Surrey, BC V3T 0H1 Canada
| | - Duncan Dixon
- N.M. Alloway Library, Trinity Western University, 22500 University Drive, Langley, BC V2Y 1Y1 Canada
| | - Deborah Gibson
- School of Nursing, Trinity Western University, 22500 University Drive, Langley, British Columbia V2Y 1Y1 Canada
| | - A. Fuchsia Howard
- Faculty of Applied Sciences, School of Nursing, The University of British Columbia, Vancouver Campus, T201 - 2211 Wesbrook Mall, Vancouver, British Columbia V6T 2B5 Canada
| | - Sarah Liva
- School of Nursing, Trinity Western University, 22500 University Drive, Langley, British Columbia V2Y 1Y1 Canada
| | - Barbara Astle
- School of Nursing, Trinity Western University, 22500 University Drive, Langley, British Columbia V2Y 1Y1 Canada
| | - Sheryl Reimer-Kirkham
- School of Nursing, Trinity Western University, 22500 University Drive, Langley, British Columbia V2Y 1Y1 Canada
| | - Vanessa K. Noonan
- Research and Best Practice Implementation, Praxis Spinal Cord Institute, 818 West 10th Avenue, Vancouver, BC V5Z 1M9 Canada
| | - Lisa Edwards
- Faculty of Health Studies, University of Bradford, Richmond Road, Bradford, West Yorkshire BD7 1DP UK
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Wang Y, Snoep JD, Hemmelder MH, van der Bogt KEA, Bos WJW, van der Boog PJM, Dekker FW, de Vries APJ, Meuleman Y. Outcomes after kidney transplantation, let's focus on the patients' perspectives. Clin Kidney J 2021; 14:1504-1513. [PMID: 34084453 PMCID: PMC8162867 DOI: 10.1093/ckj/sfab008] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Indexed: 02/03/2023] Open
Abstract
Graft function and patient survival are traditionally the most used parameters to assess the objective benefits of kidney transplantation. Monitoring graft function, along with therapeutic drug concentrations and transplant complications, comprises the essence of outpatient management in kidney transplant recipients (KTRs). However, the patient's perspective is not always included in this process. Patients' perspectives on their health after kidney transplantation, albeit subjective, are increasingly acknowledged as valuable healthcare outcomes and should be considered in order to provide patient-centred healthcare. Such outcomes are known as patient-reported outcomes (PROs; e.g. health-related quality of life and symptom burden) and are captured using PRO measures (PROMs). So far, PROMs have not been routinely used in clinical care for KTRs. In this review we will introduce PROMs and their potential application and value in the field of kidney transplantation, describe commonly used PROMs in KTRs and discuss structural PROMs implementation into kidney transplantation care.
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Affiliation(s)
- Yiman Wang
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jaapjan D Snoep
- Department of Internal Medicine, Tergooi, Hilversum, The Netherlands
| | - Marc H Hemmelder
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Koen E A van der Bogt
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
- Transplant Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Willem Jan W Bos
- Department of Internal Medicine, St Antonius Hospital, Nieuwegein, The Netherlands
- Department of Internal Medicine, Division of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Paul J M van der Boog
- Transplant Center, Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, Division of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Aiko P J de Vries
- Transplant Center, Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, Division of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Yvette Meuleman
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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Mou D, Horn DM, Heng M, Castillo-Angeles M, Ladin K, Frendl D, Kaur M, Del Carmen M, Sequist TD, Sisodia RC. Primary care physician's (PCP) perceived value of patient-reported outcomes (PROs) in clinical practice: a mixed methods study. BMJ Qual Saf 2021; 31:221-229. [PMID: 34016689 DOI: 10.1136/bmjqs-2020-012206] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 03/20/2021] [Accepted: 05/01/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND Patient-reported outcomes (PROs) can promote patient engagement, shared-decision making and improve the overall experience of care. However, PRO integration in the primary care clinical setting is limited. Exploring the perspectives of primary care physicians (PCPs) on PROs is key to understanding how they are being used in the clinical setting. We sought to elucidate this clinical perspective at one of the largest US health systems that has integrated a wide range of PROs into routine primary care. METHODS Mixed methods study with both anonymous online surveys and in-person qualitative semistructured interviews conducted with PCPs to understand their clinical perspectives on the applications of the existing PROs. PCPs from the 19 affiliated clinics were prompted to complete the survey. Interviewed PCPs were selected via a combination of random and purposive selection from the PCP directory. RESULTS Of 172 PCPs, 117 (68%) completed the online survey and 28 completed semistructured interviews. Most PCPs (77%) reviewed PRO responses with their patients. PCPs endorsed that PROs improve clinic efficiency and clinical management. However, PCPs have heterogeneous perspectives on the relevance of PROs in clinical practice, likely due to variations in clinic practice. For specific PRO instruments, PCPs reported anxiety and depression screening PROs to be most helpful. PCPs felt that PROs assisted with completing screening questions that are required by regulatory bodies. Barriers to using PROs include poor user-interface for both clinicians and patients and inadequate training. CONCLUSIONS Most PCPs regularly use PRO data though there are mixed opinions about their clinical relevance. An adaptable, user-friendly PRO system has the potential to have meaningful clinical applications in primary care.
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Affiliation(s)
- Danny Mou
- Physician Organization, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daniel M Horn
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marilyn Heng
- Massachusetts General Hospital Department of Orthopaedic Surgery, Boston, Massachusetts, USA
| | - Manuel Castillo-Angeles
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Keren Ladin
- Occupational Therapy and Community Health, Tufts University, Medford, Massachusetts, USA
| | - Daniel Frendl
- Urology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Manraj Kaur
- Patient Reported Outcomes, Value, and Experience (PROVE) Center, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Marcela Del Carmen
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Rachel C Sisodia
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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Using an Activity Tracker in Healthcare: Experiences of Healthcare Professionals and Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105147. [PMID: 34066296 PMCID: PMC8152035 DOI: 10.3390/ijerph18105147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/07/2021] [Accepted: 05/09/2021] [Indexed: 02/07/2023]
Abstract
Despite the increased use of activity trackers, little is known about how they can be used in healthcare settings. This study aimed to support healthcare professionals and patients with embedding an activity tracker in the daily clinical practice of a specialized mental healthcare center and gaining knowledge about the implementation process. An action research design was used to let healthcare professionals and patients learn about how and when they can use an activity tracker. Data collection was performed in the specialized center with audio recordings of conversations during therapy, reflection sessions with the therapists, and semi-structured interviews with the patients. Analyses were performed by directed content analyses. Twenty-eight conversations during therapy, four reflection sessions, and eleven interviews were recorded. Both healthcare professionals and patients were positive about the use of activity trackers and experienced it as an added value. Therapists formulated exclusion criteria for patients, a flowchart on when to use the activity tracker, defined goals, and guidance on how to discuss (the data of) the activity tracker. The action research approach was helpful to allow therapists to learn and reflect with each other and embed the activity trackers into their clinical practice at a specialized mental healthcare center.
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Breidenbach C, Kowalski C, Wesselmann S, Sibert NT. Could existing infrastructure for using patient-reported outcomes as quality measures also be used for individual care in patients with colorectal cancer? BMC Health Serv Res 2021; 21:448. [PMID: 33975586 PMCID: PMC8111716 DOI: 10.1186/s12913-021-06457-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 04/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background There has been increasing interest in integrating patient-reported outcomes (PROs) into routine oncological practice. To date, however, PROs have rarely been implemented in Germany. Currently, PROs are being used as performance measures in colorectal cancer centers in Germany. This content analysis identified factors that may inhibit or facilitate the additional use of PROMs for individual patient management. Methods The analysis follows an exploratory approach. Out of 103 centers that participated in a multicentric PRO quality management and benchmarking program in Germany, twelve oncological health-care providers from eight certified colorectal cancer centers were interviewed using a semi-structured interview guide. The interviewees were clinicians (physicians, nurses, psycho-oncologist and physician assistant) who care for colorectal cancer patients. This analysis evaluated whether and how PROs that are primarily collected for quality management/benchmarking reasons could also be used for the management of individual patients. The data was analyzed using a content-analysis approach. Results The interviewees were not using PRO in their routine clinical work, but they recognized its added value and pointed out potential example uses. Identified inhibiting factors for the use of PROs in clinical routine work were effortful access to PRO reports, lacking coordinating structures, time delays and time points of measurements as well as redundancy with other instruments. Facilitating factors for the use of PROs in clinical routine work that were identified included access via electronic patient records, implementation of coordinating structures for PRO processes in the center, clear PRO reports that are easy to interpret, and measurements at relevant time points. Discussion Clinicians had quite a positive attitude toward PROs and recognized their added value. Inhibiting and facilitating factors of an organizational and technical nature were identified. Conclusions These findings indicate how PROs used for quality management purposes may also be used for the management of individual patients. Therefore, existing structures and processes in the certified colorectal cancer centers, as well as lessons learned from the literature on the implementation of PROs monitoring individual patients need to be taken into account. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06457-6.
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Affiliation(s)
- Clara Breidenbach
- German Cancer Society, Kuno-Fischer-Straße 8, 14057, Berlin, Germany.
| | | | - Simone Wesselmann
- German Cancer Society, Kuno-Fischer-Straße 8, 14057, Berlin, Germany
| | - Nora Tabea Sibert
- German Cancer Society, Kuno-Fischer-Straße 8, 14057, Berlin, Germany
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Sibert NT, Kowalski C, Pfaff H, Wesselmann S, Breidenbach C. Clinicians' knowledge and attitudes towards patient reported outcomes in colorectal cancer care - insights from qualitative interviews. BMC Health Serv Res 2021; 21:366. [PMID: 33879141 PMCID: PMC8056693 DOI: 10.1186/s12913-021-06361-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 04/05/2021] [Indexed: 01/21/2023] Open
Abstract
Introduction Patient-reported outcomes (PROs) can be used in cancer care to monitor patients’ disease-related symptoms and functional status. However, successful implementation of such instruments is only possible if clinical staff are convinced of the clinical benefits. It is therefore crucial to investigate the attitudes of clinical staff to PROs in routine cancer care. Methods Semi-structured, guideline-based interviews were held with 12 clinicians working in certified colorectal cancer centers in Germany who are taking part in an observational study on PROs (five surgeons, two oncologists, one psycho-oncologist, two oncological care nurses, one stoma therapist, and one physician assistant) in order to investigate firstly, how clinicians describe PRO instruments (“wording”); and secondly, the clinicians’ general attitude toward PROs. A qualitative content analysis according to Kuckartz was performed. Results The wording used to describe PROs was not consistent. Statements on attitudes toward PROs were very heterogeneous and were therefore categorized into “(rather) positive” and “(rather) negative.” The principal advantages of PROs mentioned by participants included broader, structured knowledge about patients and treatment, as well as relevance for patients. Subcategories for (rather) negative attitudes included statements expressing doubts about the questionnaires and “no need for PROs.” Discussion The clinicians participating mainly expressed fairly positive attitudes toward PROs. However, they had little knowledge about PROs in general and the interviews therefore mainly reflect their expectations and assumptions about them. These initial impressions may be regarded as providing a basis for future implementation strategies and for training of clinicians on how to use PROs in routine cancer care. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06361-z.
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Affiliation(s)
- Nora Tabea Sibert
- German Cancer Society, Kuno-Fischer-Straße 8, 14057, Berlin, Germany.
| | | | - Holger Pfaff
- University of Cologne, Faculty of Human Sciences, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Eupener Str. 129, 50933, Köln, Germany
| | - Simone Wesselmann
- German Cancer Society, Kuno-Fischer-Straße 8, 14057, Berlin, Germany
| | - Clara Breidenbach
- German Cancer Society, Kuno-Fischer-Straße 8, 14057, Berlin, Germany
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Hanmer J, Ray KN, McCracken P, Ferrante L, Wardlaw S, Fleischman L, Wolfson D. Uptake of an Integrated Electronic Questionnaire System in Community Pediatric Clinics. Appl Clin Inform 2021; 12:310-319. [PMID: 33853141 DOI: 10.1055/s-0041-1727198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE The study aimed to evaluate an integrated electronic questionnaire system implementation in outpatient community pediatric practices on workflow, completion rates, and recorded scores. METHODS We evaluated the implementation and outcomes of an integrated electronic questionnaire system at 45 community pediatric practices that used standardized questionnaires to screen for autism, depression, and substance use and to measure asthma control. Electronic health record (EHR) data for all well child visits were extracted for the 3 months before and after implementation. We used statistical process control charts to evaluate questionnaire completion rates and Chi-square tests to evaluate screening completion and positive screening rates. The collection and entry of questionnaire information was observed and timed. RESULTS EHR data included 107,120 encounters across 45 practices that showed significant and sustained improvement in completion rates for all questionnaires. The rate of recorded concerning questionnaires decreased for asthma control (19.3 vs. 12.8%, p < 0.001), stayed the same for autism (96.6 vs. 96.2%, p = 0.38), decreased for depression (9.5 vs. 6.7%, p ≤ 0.001), and increased for any substance use (9.8 vs. 12.8%, p < 0.001). Twelve practices were observed, and patient time and staff time managing questionnaires were decreased after implementation. DISCUSSION Electronic questionnaire administration saved staff time and patient time. We report overall improvement in questionnaire completion rates, with notable variation in improvement in completion across practices and in change in concerning recorded result rates across measures. CONCLUSION Conversion of four standard paper questionnaires to an integrated electronic system reduces patient and staff time while increasing completion rates when well integrated into routine care.
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Affiliation(s)
- Janel Hanmer
- Department of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Kristin N Ray
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Polly McCracken
- Department of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Lorraine Ferrante
- UPMC Children's Community Pediatrics, Pittsburgh, Pennsylvania, United States
| | - Sharon Wardlaw
- UPMC Children's Community Pediatrics, Pittsburgh, Pennsylvania, United States
| | - Lauren Fleischman
- UPMC Children's Community Pediatrics, Pittsburgh, Pennsylvania, United States
| | - David Wolfson
- UPMC Children's Community Pediatrics, Pittsburgh, Pennsylvania, United States
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Tyack Z, Simons M, McPhail SM, Harvey G, Zappala T, Ware RS, Kimble RM. Improving the patient-centred care of children with life-altering skin conditions using feedback from electronic patient-reported outcome measures: protocol for a hybrid effectiveness-implementation study (PEDS-ePROM). BMJ Open 2021; 11:e041861. [PMID: 33837095 PMCID: PMC8043009 DOI: 10.1136/bmjopen-2020-041861] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Using patient-reported outcome measures (PROMs) with children have been described as 'giving a voice to the child'. Few studies have examined the routine use of these measures as potentially therapeutic interventions. This study aims to investigate: (1) the effectiveness of feedback using graphical displays of information from electronic PROMs (ePROMs) that target health-related quality of life, to improve health outcomes, referrals and treatment satisfaction and (2) the implementation of ePROMs and graphical displays by assessing acceptability, sustainability, cost, fidelity and context of the intervention and study processes. METHODS AND ANALYSIS A hybrid II effectiveness-implementation study will be conducted from February 2020 with children with life-altering skin conditions attending two outpatient clinics at a specialist paediatric children's hospital. A pragmatic randomised controlled trial and mixed methods process evaluation will be completed. Randomisation will occur at the child participant level. Children or parent proxies completing baseline ePROMs will be randomised to: (1) completion of ePROMs plus graphical displays of ePROM results to treating clinicians in consultations, versus (2) completion of ePROMs without graphical display of ePROM results. The primary outcome of the effectiveness trial will be overall health-related quality of life of children. Secondary outcomes will include other health-related quality of life outcomes (eg, child psychosocial and physical health, parent psychosocial health), referrals and treatment satisfaction. Trial data will be primarily analysed using linear mixed-effects models; and implementation data using inductive thematic analysis of interviews, meeting minutes, observational field notes and study communication mapped to the Consolidated Framework for Implementation Research. ETHICS AND DISSEMINATION Ethical approval was obtained from Children's Health Queensland Human Research Ethics Committee (HREC/2019/QCHQ/56290), The University of Queensland (2019002233) and Queensland University of Technology (1900000847). Dissemination will occur through stakeholder groups, scientific meetings and peer-reviewed publications. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN12620000174987).
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Affiliation(s)
- Zephanie Tyack
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia
- Pegg Leditschke Children's Burns Centre, Children's Health Queensland, South Brisbane, Queensland, Australia
- Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Megan Simons
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia
- Department of Occupational Therapy, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Clinical Informatics Directorate, Metro South Health, Brisbane, Queensland, Australia
| | - Gillian Harvey
- Adelaide Nursing School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Tania Zappala
- General Paediatrics and Dermatology Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University - GC Campus, Southport, Queensland, Australia
| | - Roy M Kimble
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia
- Pegg Leditschke Children's Burns Centre, Children's Health Queensland, South Brisbane, Queensland, Australia
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135
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van der Veer SN, Couchoud C, Morton RL. The role of kidney registries in expediting large-scale collection of patient-reported outcome measures for people with chronic kidney disease. Clin Kidney J 2021; 14:1495-1503. [PMID: 34276974 PMCID: PMC8280932 DOI: 10.1093/ckj/sfab061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Indexed: 11/21/2022] Open
Abstract
In this issue of Clinical Kidney Journal, Van der Willik et al. report findings from a pilot study where they introduced collection of patient-reported outcome measures (PROMs) into routine kidney care in Dutch dialysis centres. It is comparable to a registry-led PROMs initiative in Sweden, published in Clinical Kidney Journal in 2020. Both studies reported low average PROMs response rates with substantial between-centre variation, and both identified suboptimal patient and staff engagement as a key barrier to implementing PROMs in routine care for people with chronic kidney disease (CKD). This suggests that national kidney registries could be well placed to facilitate large-scale collection of PROMs data, but that they may require additional guidance on how to do this successfully. In this editorial, we discuss the current state-of-play of PROMs collection by kidney registries and provide an overview of what is (un)known about the feasibility and effectiveness of PROMs in CKD and other conditions. We anticipate that the fast-growing evidence base on whether, and how, PROMs can be of value in CKD settings will expedite registry-based PROMs collection, which will ultimately lead to more valuable and person-centred services and to enhanced health and well-being of people with CKD.
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Affiliation(s)
- Sabine N van der Veer
- Faculty of Biology, Medicine and Health, Division of Informatics, Imaging and Data Sciences, Centre for Health Informatics, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Cecile Couchoud
- REIN Registry, Agence de la Biomédecine, Saint Denis La Plaine, France
| | - Rachael L Morton
- Faculty of Medicine and Health, NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, Australia
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McMorrow R, Hunter B, Hendrieckx C, Kwasnicka D, Cussen L, Ho FCS, Speight J, Emery J, Manski-Nankervis JA. Effect of routinely assessing and addressing depression and diabetes distress using patient-reported outcome measures in improving outcomes among adults with type 2 diabetes: a systematic review protocol. BMJ Open 2021; 11:e044888. [PMID: 33722873 PMCID: PMC7970291 DOI: 10.1136/bmjopen-2020-044888] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Type 2 diabetes is a global health priority. People with diabetes are more likely to experience mental health problems relative to people without diabetes. Diabetes guidelines recommend assessment of depression and diabetes distress during diabetes care. This systematic review will examine the effect of routinely assessing and addressing depression and diabetes distress using patient-reported outcome measures in improving outcomes among adults with type 2 diabetes. METHODS AND ANALYSIS MEDLINE, Embase, CINAHL Complete, PsycInfo, The Cochrane Library and Cochrane Central Register of Controlled Trials will be searched using a prespecified strategy using a prespecified Population, Intervention, Comparator, Outcomes, Setting and study design strategy. The date range of the search of all databases will be from inception to 3 August 2020. Randomised controlled trials, interrupted time-series studies, prospective and retrospective cohort studies, case-control studies and analytical cross-sectional studies published in peer-reviewed journals in the English language will be included. Two review authors will independently screen abstracts and full texts with disagreements resolved by a third reviewer, if required, using Covidence software. Two reviewers will undertake risk of bias assessment using checklists appropriate to study design. Data will be extracted using prespecified template. A narrative synthesis will be conducted, with a meta-analysis, if appropriate. ETHICS AND DISSEMINATION Ethics approval is not required for this review of published studies. Presentation of results will follow the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidance. Findings will be disseminated via peer-reviewed publication and conference presentations. PROSPERO REGISTRATION NUMBER CRD42020200246.
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Affiliation(s)
- Rita McMorrow
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Barbara Hunter
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Christel Hendrieckx
- Diabetes Victoria, The Australian Centre for Behavioural Research in Diabetes, Melbourne, Victoria, Australia
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Dominika Kwasnicka
- NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Warsaw, Mazovia, Poland
| | - Leanne Cussen
- Department of Endocrinology, Beaumont Hospital, Dublin, Ireland
| | - Felicia Ching Siew Ho
- Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jane Speight
- Diabetes Victoria, The Australian Centre for Behavioural Research in Diabetes, Melbourne, Victoria, Australia
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Jon Emery
- Department of General Practice and Centre for Cancer Research, The University of Melbourne, Melbourne, Victoria, Australia
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Apon I, Rogers-Vizena CR, Koudstaal MJ, Allori AC, Peterson P, Versnel SL, Ramirez JP. Barriers and Facilitators to the International Implementation of Standardized Outcome Measures in Clinical Cleft Practice. Cleft Palate Craniofac J 2021; 59:5-13. [PMID: 33663243 PMCID: PMC8670748 DOI: 10.1177/1055665621997668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objective: To identify barriers and facilitators to international implementation of a prospective system for standardized outcomes measurement in cleft care. Design: Cleft teams that have implemented the International Consortium for Health Outcomes Measurement Standard Set for cleft care were invited to participate in this 2-part qualitative study: (1) an exploratory survey among clinicians, health information technology professionals, and project coordinators, and (2) semistructured interviews of project leads. Thematic content analysis was performed, with organization of themes according to the dimensions of the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) framework: reach, effectiveness, adoption, implementation, and maintenance. Results: Four cleft teams in Europe and North America participated in this study. Thirteen participants completed exploratory questionnaires and 5 interviewees participated in follow-up interviews. Survey responses and thematic content analysis revealed common facilitators and barriers to implementation at all sites. Teams reach patients either via email or during the clinic visit to capture patient-reported outcomes. Adopting routine data collection is enhanced by aligning priorities at the organizational and cleft team level. Streamlining workflows and developing an efficient data collection platform are necessary early on, followed by pilot testing or stepwise implementation. Regular meetings and financial resources are crucial for implementing, sustaining, analyzing collected data, and providing feedback to health care professionals and patients. Fostering patient-centered care was articulated as a positive outcome, whereas time presented challenges across all RE-AIM dimensions. Conclusions: Identified themes can inform ongoing implementation efforts. Intentionally investing time to lay a sound foundation early on will benefit every phase of implementation and help overcome barriers such as lack of support or motivation.
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Affiliation(s)
- Inge Apon
- Department of Oral and Maxillofacial Surgery, 6993Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Maarten J Koudstaal
- Department of Oral and Maxillofacial Surgery, 6993Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Alexander C Allori
- Division of Plastic, Maxillofacial, and Oral Surgery, 22957Duke University Hospital, Durham, NC, USA
| | - Petra Peterson
- Department of Plastic and Craniofacial Surgery, 59562Karolinska University Hospital, Stockholm, Sweden
| | - Sarah L Versnel
- Department of Plastic and Reconstructive Surgery, 6993Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jessily P Ramirez
- International Consortium for Health Outcomes Measurement (ICHOM), Boston, MA, USA
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Sutherland JM, Rajapakshe S, Crump T, Chartrand A, Liu G, Karimuddin A. Comparing patient-reported outcomes across countries: An assessment of methodological challenges. J Health Serv Res Policy 2021; 26:163-171. [PMID: 33554667 PMCID: PMC8267072 DOI: 10.1177/1355819621990696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objectives There is little published literature on the comparison of patient-reported outcomes between countries. This study aimed to assess pre- and postoperative health among samples of patients undergoing elective groin hernia repair procedures in the National Health Service (NHS), England, and groin hernia patients in Vancouver, Canada. Methods We used datasets from two different sources. For the English NHS we used published anonymized patient-level data files which include the EQ-5D(3L) patient-reported outcome measure and a number of demographic and clinical characteristics. For Vancouver, we used data from a sample of Vancouver patients who completed the same instrument during a similar time frame. English patients were matched with Vancouver participant’s characteristics using propensity score methods. A linear regression model was used to measure differences in postoperative visual analogue scale values between countries, adjusting for patient characteristics. Results Our study revealed a range of methodological issues concerning the comparability of patient-reported outcomes following hernia repair surgery in the two health systems. These related to differences in approaches to collecting patient-reported outcome measures and the nature of explanatory variables (self-report vs. administrative data), among other challenges. As a consequence, there were differences between the matched samples and the NHS data, indicating a healthy participant bias. Unadjusted results found that Vancouver patients (N = 280) reported more problems in domains of mobility, self care, usual activities and anxiety/depression than the matched cohort of NHS patients (N = 840). Interpreting differences is challenging given different sampling designs. Conclusions There are significant hurdles facing comparisons of surgical patients’ outcomes between countries, including adjusting for patient differences, health system factors and approaches to survey administration. While between-country comparisons of surgical outcomes using patient-reported outcomes shows significant promise, much work on standardizing sampling design, variables and analytic methods is needed.
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Affiliation(s)
- Jason M Sutherland
- Professor, Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Shanika Rajapakshe
- Research Assistant, School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Trafford Crump
- Assistant Professor, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Andrée Chartrand
- Research Assistant, Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Canada
| | - Guiping Liu
- Statistician, School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Ahmer Karimuddin
- Clinical Associate Professor, Section of Colorectal Surgery, Department of Surgery, University of British Columbia, Vancouver, Canada
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Depla AL, Crombag NM, Franx A, Bekker MN. Implementation of a standard outcome set in perinatal care: a qualitative analysis of barriers and facilitators from all stakeholder perspectives. BMC Health Serv Res 2021; 21:113. [PMID: 33530989 PMCID: PMC7852077 DOI: 10.1186/s12913-021-06121-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 01/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To improve their quality, healthcare systems are increasingly focused on value delivered to patients. For perinatal care, the International Consortium for Health Outcomes Measurement (ICHOM) proposed a patient-centred outcome set with both clinical and patient-reported measures for pregnancy and childbirth (PCB set). This study aimed to identify factors that affect the implementation of the PCB set at the pre-implementation stage, using the consolidated framework for implementation research (CFIR). METHODS In this qualitative study, we conducted semi-structured interviews amongst a purposive sample of key stakeholders within an obstetric care network (OCN): 1) patients, 2) perinatal care professionals involved in the full cycle of perinatal care, and 3) policy makers, including hospital managers, administrative staff and health care insurers. While the CFIR guided data capture and structuring, thematic analysis revealed overarching themes that best reflected the barriers and facilitators from different stakeholder perspectives. Within these overarching themes, the CFIR constructs were maintained. RESULTS Interviews were conducted with 6 patients, 16 professionals and 5 policy makers. Thematic analysis supported by the CFIR framework identified four main themes: the instrument and its implementation process, use in individual patient care, use in quality improvement, and the context of the OCN. Important barriers included professional workload, data reliability, and interprofessional and interorganizational collaboration. Potential facilitators were the PCB set's direct value in individual care, interprofessional feedback and education, and aligning with existing systems. Prominent variations between stakeholder groups included the expected patient burden, the level of use, transparency of outcomes and the degree of integrated care. CONCLUSIONS This study clarified critical factors that affect successful implementation of the PCB set in perinatal care. Practice recommendations, suggested at multiple levels, can enable structural patient-centred care improvement and may unite stakeholders towards integrated birth care.
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Affiliation(s)
- Anne L Depla
- Department of Obstetrics and Gynaecology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, KE.04.123.1, Lundlaan 6, 3584, EA, Utrecht, The Netherlands
| | - Neeltje M Crombag
- Department of Development and Regeneration, KU Leuven University, Leuven, Belgium
| | - Arie Franx
- Department of Obstetrics and Gynaecology, Erasmus Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Mireille N Bekker
- Department of Obstetrics and Gynaecology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, KE.04.123.1, Lundlaan 6, 3584, EA, Utrecht, The Netherlands.
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Haines ER, Lux L, Smitherman AB, Kessler ML, Schonberg J, Dopp A, Stover AM, Powell BJ, Birken SA. An actionable needs assessment for adolescents and young adults with cancer: the AYA Needs Assessment & Service Bridge (NA-SB). Support Care Cancer 2021; 29:4693-4704. [PMID: 33511477 DOI: 10.1007/s00520-021-06024-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/21/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE In the USA, many of the nearly 90,000 adolescents and young adults (AYAs) diagnosed with cancer each year do not receive services to address the full scope of needs they experience during and after cancer treatment. To facilitate a systematic and patient-centered approach to delivering services to address the unmet needs of AYAs with cancer, we developed the AYA Needs Assessment & Service Bridge (NA-SB). METHODS To develop NA-SB, we leveraged user-centered design, an iterative process for intervention development based on prospective user (i.e., provider and AYA) engagement. Specifically, we conducted usability testing and concept mapping to refine an existing tool-the Cancer Needs Questionnaire-Young People-to promote its usability and usefulness in routine cancer practice. RESULTS Our user-centered design process yielded a need assessment which assesses AYAs' physical, psychosocial, and practical needs. Importantly, needs in the assessment are grouped by services expected to address them, creating an intuitive and actionable link between needs and services. CONCLUSION NA-SB has the potential to improve care coordination at the individual level by allowing cancer care programs to tailor service delivery and resource provision to the individual needs of AYAs they serve.
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Affiliation(s)
- Emily R Haines
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, 525 Vine Street, Winston-Salem, NC, 27101, USA.
| | - Lauren Lux
- UNC Adolescent and Young Adult Cancer Program, Lineberger Comprehensive Cancer Center, 101 Manning Dr, Chapel Hill, NC, 27514, USA
| | - Andrew B Smitherman
- Pediatric Hematology-Oncology, Lineberger Comprehensive Cancer Center, 101 Manning Dr, Chapel Hill, NC, 27514, USA
| | - Melody L Kessler
- Department of Chemistry, University of North Carolina at Chapel Hill, 125 South Road, Chapel Hill, NC, 27599-3290, USA
| | - Jacob Schonberg
- Center for Excellence in Community Mental Health, Department of Psychiatry, University of North Carolina School of Medicine, 3010 Falstaff Rd, Raleigh, NC, 27610, USA
| | - Alex Dopp
- RAND Corporation, 1776 Main St, Santa Monica, CA, 90401, USA
| | - Angela M Stover
- Department of Health Policy & Management, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27516, USA
| | - Byron J Powell
- Brown School & School of Medicine, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA
| | - Sarah A Birken
- Department of Implementation Science, Wake Forest School of Medicine, 525@Vine Room 5219, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
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Prichard RA, Zhao FL, Mcdonagh J, Goodall S, Davidson PM, Newton PJ, Farr-Wharton B, Hayward CS. Discrepancies between proxy estimates and patient reported, health related, quality of life: minding the gap between patient and clinician perceptions in heart failure. Qual Life Res 2021; 30:1049-1059. [PMID: 33387292 DOI: 10.1007/s11136-020-02722-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Health related quality of life (HRQoL) is rarely routinely measured in the clinical setting. In the absence of patient reported data, clinicians rely on proxy and informal estimates to support clinical decisions. This study compares clinician estimates (proxy) with patient reported HRQoL in patients with advanced heart failure and examines factors influencing discrepancies. METHODS Seventy-five patients with heart failure, (22 females, 53 males) completed the EQ-5D-5L questionnaire. Thirty-nine clinicians (11 medical, 23 nursing, 5 allied health) completed the proxy version (V1) producing 194 dyads. Correlation was assessed using Spearman's rank tests, systematic bias was examined with Bland-Altman analyses. Inter-rater agreement at the domain level, was investigated using linear weighted Kappa statistics while factors influencing the IRG were explored using independent student t-tests, analysis of variance and regression. RESULTS There was a moderate positive correlation between clinician HRQoL estimates and patient reported utility (r = 0.38; p < .0005). Mean clinician estimates were higher than patient reported utility (0.60 vs 0.54; p = 0.008), with significant underestimation of reported problems apparent in three of the five EQ-5D-5L domains. Patient sex (female), depressed mood and frailty were all associated with an increased inter-rater gap. CONCLUSION Clinicians in this sample overestimated HRQoL. Factors affecting the inter-rater gap, including sex and depression, support formal HRQoL screening to enhance clinical conversations and decision making. The discrepancy also supports regulatory restriction on the use of expert opinion in the development of QALYs in health economic analysis.
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Affiliation(s)
- Roslyn A Prichard
- Faculty of Health, University of Technology, Ultimo, NSW, Australia.
| | - Fei-Li Zhao
- School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, Australia
| | - Julee Mcdonagh
- Faculty of Health, University of Technology, Ultimo, NSW, Australia
| | - Stephen Goodall
- Centre for Health Economic Research and Evaluation, University of Technology Sydney, Ultimo, Australia
| | | | - Phillip J Newton
- School of Nursing and Midwifery, Western Sydney University, Parramatta, NSW, Australia
| | - Ben Farr-Wharton
- School of Business and Law, Edith Cowan University, Joondalup, WA, Australia
| | - Christopher S Hayward
- Faculty of Health, University of Technology, Ultimo, NSW, Australia
- Faculty of Medicine, University of New South Wales, Randwick, NSW, Australia
- St Vincent's Hospital Heart and Lung Clinic, St Vincent's Hospital Sydney, Darlinghurst, Australia
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142
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Moula Z, Powell J, Karkou V. An Investigation of the Effectiveness of Arts Therapies Interventions on Measures of Quality of Life and Wellbeing: A Pilot Randomized Controlled Study in Primary Schools. Front Psychol 2020; 11:586134. [PMID: 33384642 PMCID: PMC7769838 DOI: 10.3389/fpsyg.2020.586134] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/24/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Over the last decades there has been a change in the way schooling is perceived recognizing that children's learning is closely linked to children's health. Children spend most of their time at school, which is often the place where problems are identified and interventions are offered, not only for treatment but also prevention. Embedding arts therapies into the educational system may help address children's emerging needs and have a positive impact on their wellbeing. METHODS A pilot cross-over randomized controlled design was employed to investigate the effectiveness of an arts therapies intervention on a series of child- and teacher-reported outcome measures, specifically, health related quality of life (assessed using a HRQOL scale; EQ-5D-Y), wellbeing and life functioning (assessed using the child outcome rating scale; CORS), emotional and behavioral difficulties (assessed using the strengths and difficulties questionnaire; SDQ), as well as duration of sleep (assessed using Fitbits). Sample size calculations for future large-scale studies were also performed, and the sustained impact of the intervention was evaluated at 3, 6, and 12 months follow-up. The pluralistic theoretical and therapeutic framework of this intervention was informed by a systematic review on school-based arts therapies interventions and is presented in detail in the study protocol. Participants were 62 children with mild emotional and behavioral difficulties. RESULTS Improvements in HRQOL and CORS were greater in those engaged in the arts therapies intervention than the control groups and were maintained at the follow-up stages. Significant improvements were only found for duration of sleep (P = 0.002) and SDQ (P = 0.008). Minimal clinically important differences (MCIDs) as defined in the published protocol were found for CORS, SDQ and duration of sleep, but not HRQOL. DISCUSSION Findings indicate that the arts therapies interventions were having a clinically significant effect on life functioning, duration of sleep, emotional and behavioral difficulties. Findings also indicate a small effect size for health related quality of life, suggesting the intervention was having a small positive effect on this outcome measure. The study indicates that all outcome measures assessed here would be suitable for inclusion in a larger randomized controlled study utilizing these arts therapies interventions, and that a sample size of 225 participants would be required if these outcome measures were used.
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Affiliation(s)
- Zoe Moula
- Research Centre for Arts and Wellbeing, Edge Hill University, Lancashire, United Kingdom
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143
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Implementing PROMs in routine clinical care: a qualitative exploration of GP perspectives. BJGP Open 2020; 5:bjgpopen20X101135. [PMID: 33199306 PMCID: PMC7960526 DOI: 10.3399/bjgpopen20x101135] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 07/01/2020] [Indexed: 02/06/2023] Open
Abstract
Background The recently announced long-term plan for the NHS is based on a model of person-centred care, which relies on the sustained engagement of patients, shared decision making, and capability for self-management. For a primary care service under increasing pressure from an ageing and chronically ill population, Patient Reported Outcome Measures (PROMs) appear capable of supporting many of the requirements for person-centred care, yet little is known of the circumstances of their current implementation or how their use might be optimised. Aim To begin the conversation about how successfully PROMs have been integrated into primary care and how their use might be supported. Design & setting A qualitative investigation of the perspectives of GPs exploring the use of PROMs as part of routine clinical care in England. Method Semi-structured telephone interviews were conducted with GPs from across England. The data were analysed using the Consolidated Framework for Implementation Research (CFIR). Results A total of 25 interviews were conducted and GPs described the potential benefit of PROMs in a range of circumstances, but also voiced concerns about their reliability and their potential to constrain consultations. Their flexibility meant they had the potential to be incorporated into existing care processes but only with the requisite logistical support. Conclusion Areas that need to be addressed include the creation of a compelling body of evidence of the benefit of PROMs, appropriate training for staff and patients, and a coherent implementation strategy from policymakers and funding bodies.
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144
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Haex R, Thoma-Lürken T, Zwakhalen S, Beurskens A. The needs of key-stakeholders for evaluating client's experienced quality of home care: a qualitative approach. J Patient Rep Outcomes 2020; 4:96. [PMID: 33169288 PMCID: PMC7652985 DOI: 10.1186/s41687-020-00260-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To optimize home care, it is essential to determine how care recipients experience quality of care. Traditionally, quality of care is measured with normative quality indicators such as safety, efficiency, or prevalence rates such as falls. The growing interest for qualitative patient-reported experience measures in home care requires insight into the needs of care receivers, providers, and organizations as key-stakeholders. Each stakeholder has their own needs that are important to communicate and use to conduct thorough comparisons before implementing new experience measures. This study aims to understand the needs of clients, formal/informal caregivers, and managers/policy officers in measuring client's experienced quality of care in home care. METHODS Four focus group interviews and 25 semi-structured interviews with key-stakeholders were conducted and analyzed by means of content analysis. The value-proposition canvas was used as a thematic framework to explore the purpose of experience quality of care measures and related pains and gains. RESULTS There were two main purposes for measuring experienced quality of care: first improving the primary care process of individual clients and second for learning and improving in home care team. Using experienced quality of care measures for external accountability and transparency on an organizational or national level were considered less relevant. Among others, participants described not having time and no clear procedure for conducting an evaluation as a pain of the current methods used to evaluate perceived quality of home care. As gains they put forward the ability to informally evaluate experiences during care delivery and to openly discuss complaints with a familiar caregiver. CONCLUSIONS This study advocates that home care organizations should be aware of the goal of quality of care measures. They should consider selecting experienced quality of care measures mainly for improving primary care processes of individual clients. The results also underline the relevance of adopting next to quantitative evaluations, more narrative evaluation methods which support communicating openly on care experiences, leading to concrete point-of-improvement. The findings of this study can serve as a guide for both the development or selection of adequate methods, from the perspectives of key-stakeholders, in assessing experienced quality in home care.
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Affiliation(s)
- Roy Haex
- CAPHRI Care and Public Health Research Institute, Department of Health Services Research, Living Lab on Ageing and Long-Term Care, Maastricht University, Maastricht, the Netherlands
| | - Theresa Thoma-Lürken
- CAPHRI Care and Public Health Research Institute, Department of Health Services Research, Living Lab on Ageing and Long-Term Care, Maastricht University, Maastricht, the Netherlands
| | - Sandra Zwakhalen
- CAPHRI Care and Public Health Research Institute, Department of Health Services Research, Living Lab on Ageing and Long-Term Care, Maastricht University, Maastricht, the Netherlands
- Faculty of Health, Zuyd University of Applied Sciences, Heerlen, the Netherlands
| | - Anna Beurskens
- CAPHRI Care and Public Health Research Institute, Department of Family Medicine, Maastricht University, Maastricht, the Netherlands
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Girgis A, Durcinoska I, Arnold A, Descallar J, Kaadan N, Koh ES, Miller A, Ng W, Carolan M, Della-Fiorentina SA, Avery S, Delaney GP. Web-Based Patient-Reported Outcome Measures for Personalized Treatment and Care (PROMPT-Care): Multicenter Pragmatic Nonrandomized Trial. J Med Internet Res 2020; 22:e19685. [PMID: 33118954 PMCID: PMC7661255 DOI: 10.2196/19685] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 08/04/2020] [Accepted: 08/18/2020] [Indexed: 12/16/2022] Open
Abstract
Background Despite the acceptability and efficacy of e–patient-reported outcome (ePRO) systems, implementation in routine clinical care remains challenging. Objective This pragmatic trial implemented the PROMPT-Care (Patient Reported Outcome Measures for Personalized Treatment and Care) web-based system into existing clinical workflows and evaluated its effectiveness among a diverse population of patients with cancer. Methods Adult patients with solid tumors receiving active treatment or follow-up care in four cancer centers were enrolled. The PROMPT-Care intervention supported patient management through (1) monthly off-site electronic PRO physical symptom and psychosocial well-being assessments, (2) automated electronic clinical alerts notifying the care team of unresolved clinical issues following two consecutive assessments, and (3) tailored online patient self-management resources. Propensity score matching was used to match controls with intervention patients in a 4:1 ratio for patient age, sex, and treatment status. The primary outcome was a reduction in emergency department presentations. Secondary outcomes were time spent on chemotherapy and the number of allied health service referrals. Results From April 2016 to October 2018, 328 patients from four public hospitals received the intervention. Matched controls (n=1312) comprised the general population of patients with cancer, seen at the participating hospitals during the study period. Emergency department visits were significantly reduced by 33% (P=.02) among patients receiving the intervention compared with patients in the matched controls. No significant associations were found in allied health referrals or time to end of chemotherapy. At baseline, the most common patient reported outcomes (above-threshold) were fatigue (39%), tiredness (38.4%), worry (32.9%), general wellbeing (32.9%), and sleep (24.1%), aligning with the most frequently accessed self-management domain pages of physical well-being (36%) and emotional well-being (23%). The majority of clinical feedback reports were reviewed by nursing staff (729/893, 82%), largely in response to the automated clinical alerts (n=877). Conclusions Algorithm-supported web-based systems utilizing patient reported outcomes in clinical practice reduced emergency department presentations among a diverse population of patients with cancer. This study also highlighted the importance of (1) automated triggers for reviewing above-threshold results in patient reports, rather than passive manual review of patient records; (2) the instrumental role nurses play in managing alerts; and (3) providing patients with resources to support guided self-management, where appropriate. Together, these factors will inform the integration of web-based PRO systems into future models of routine cancer care. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12616000615482; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370633 International Registered Report Identifier (IRRID) RR2-10.1186/s12885-018-4729-3
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Affiliation(s)
- Afaf Girgis
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, Australia
| | - Ivana Durcinoska
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, Australia
| | - Anthony Arnold
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Illawarra Cancer Care Centre, Wollongong Hospital, Wollongong, Australia
| | - Joseph Descallar
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, Australia
| | - Nasreen Kaadan
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia
| | - Eng-Siew Koh
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia
| | - Andrew Miller
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Illawarra Cancer Care Centre, Wollongong Hospital, Wollongong, Australia.,Centre for Oncology Informatics, University of Wollongong, Wollongong, Australia
| | - Weng Ng
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia.,School of Medicine, Western Sydney University, Sydney, Australia
| | - Martin Carolan
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Illawarra Cancer Care Centre, Wollongong Hospital, Wollongong, Australia
| | - Stephen A Della-Fiorentina
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,School of Medicine, Western Sydney University, Sydney, Australia.,Macarthur Cancer Therapy Centre, Campbelltown Hospital, Sydney, Australia
| | - Sandra Avery
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia
| | - Geoff P Delaney
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Sydney, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia
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146
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The utility of the implementation science framework "Integrated Promoting Action on Research Implementation in Health Services" (i-PARIHS) and the facilitator role for introducing patient-reported outcome measures (PROMs) in a medical oncology outpatient department. Qual Life Res 2020; 30:3063-3071. [PMID: 33089474 PMCID: PMC8528793 DOI: 10.1007/s11136-020-02669-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE We evaluated the utility of the implementation science framework "Integrated Promoting Action on Research Implementation in Health Services" (i-PARIHS) for introducing patient-reported outcome measures (PROMs) into a medical oncology outpatient department. The i-PARIHS framework identifies four core constructs for implementation, including Facilitation, Innovation, Context and Recipients. METHODS A pilot study used the i-PARIHS framework to identify PROM implementation barriers and enablers to inform facilitation support strategies, such as training clinicians and staff, workflow support, technical support and audit and feedback. Pre- and post-implementation surveys were completed by 83 and 72 staff, respectively, (nurses, doctors and allied health), to assess perceived knowledge, enablers, barriers and utility of PROMs; and acceptability of the PROM intervention was also assessed post-implementation. RESULTS Important barriers included time constraints and previous experiences with technology. Enablers included good leadership support and a culture of learning. Facilitation strategies were used to overcome barriers identified in the i-PARIHS core domains. Compared to before the intervention, staff surveys showed improvement in perceived usefulness, perceived understanding and interpretation skills for PROMs. Staff perceptions about lack of time to use PROMs during visits remained a major perceived barrier post-implementation. CONCLUSION The i-PARIHS framework was useful for guiding the implementation of PROMs in routine oncology care. The four core i-PARIHS constructs (Facilitation, Innovation, Context and Recipients) identified factors that directly impacted implementation, with Facilitation having a particularly important role to overcome these barriers. Oncology clinics and health systems considering implementing PROMs should consider having a dedicated Facilitator available during PROM implementation.
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Aminnudin AN, Doss JG, Ismail SM, Chai MB, Abidin MZ, Basri CSJM, Kipli NP, Wei LC. Can post-treatment oral cancer patients' concerns reflect their cancer characteristics, HRQoL, psychological distress level and satisfaction with consultation? Ecancermedicalscience 2020; 14:1118. [PMID: 33209109 PMCID: PMC7652548 DOI: 10.3332/ecancer.2020.1118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Indexed: 12/30/2022] Open
Abstract
Background Oral cancer and its treatment impact patients' post-treatment outcomes, challenging clinicians to manage them optimally. Addressing patients' concerns is central to holistic patient-centred care. Objectives This study aimed to determine post-treatment oral cancer patients' concerns and its relationship with patients' clinical characteristics, health-related quality of life (HRQoL), psychological distress and patient satisfaction with the follow-up consultation. Methods A total of 85 oral cancer patients were recruited from a three-armed pragmatic RCT study on the patient concerns inventory for head and neck cancer (PCI-H&N), which was conducted at six hospital-based oral maxillofacial specialist clinics throughout Malaysia. Malaysians aged 18 years and above and on follow-ups from 1 month to 5 years or more were eligible. Patients completed the PCI-H&N, functional assessment of cancer therapy -H&N v4.0 and Distress Thermometer at pre-consultation and satisfaction questionnaire at post-consultation. The data were analysed descriptively; multiple linear regression and multivariate logistic regression analyses were used to determine possible predictors of patients' HRQoL and psychological distress. Results 'Recurrence or fear of cancer coming back' (31.8%) was most frequently selected. 43.5% of patients selected ≥4 concerns. A significantly high number of concerns were associated with patients of '1-month to 1-year post-treatment' (n = 84%; p = 0.001). A significant association existed between 'time after treatment completed' and patients' concerns of 'chewing/eating', 'mouth opening', 'swelling', 'weight', 'ability to perform', 'cancer treatment' and 'supplement/diet-related'. 'Chewing/eating' was predicted for low HRQoL (p < 0.0001) followed by 'appearance' and 'ability to perform recreation activities' (personal functions domain). Patients with high psychological distress levels were 14 times more likely to select 'ability to perform recreation activities' and seven times more likely to select 'feeling depressed'. No significant association was identified between patients' concerns and patients' satisfaction with the consultation. Conclusion Routine follow-up consultations should incorporate the PCI-H&N prompt list to enhance patient-centred care approach as the type and number of patients' concerns are shown to reflect their HRQoL and psychological distress.TRIAL REGISTRATION: NMRR-18-3624-45010 (IIR).
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Affiliation(s)
- Ainon Natrah Aminnudin
- Community Oral Health and Clinical Prevention, Faculty of Dentistry, University of Malaya, 50603 Kuala Lumpur, Malaysia.,Oral Health Program, Ministry of Health Malaysia (MOH), 62590 Putrajaya, Malaysia
| | - Jennifer Geraldine Doss
- Community Oral Health and Clinical Prevention, Faculty of Dentistry, University of Malaya, 50603 Kuala Lumpur, Malaysia.,Oral Cancer Research and Coordinating Centre (OCRCC), University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Siti Mazlipah Ismail
- Department of Oro-Maxillofacial Surgical & Medical Sciences, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Ma Bee Chai
- Oral Maxillo-Facial Surgery, Sultanah Aminah Hospital, 80100 Johore Bahru, Malaysia
| | - Marzuki Zainal Abidin
- Oral Maxillo-Facial Surgery, Queen Elizabeth Hospital, 88200 Kota Kinabalu, Malaysia
| | | | | | - Lee Chee Wei
- Oral Maxillo-Facial Surgery, Kuala Lumpur General Hospital, 50586 Kuala Lumpur, Malaysia
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Foster A, O'Cathain A, Harris J. How do third sector organisations or charities providing health and well-being services in England implement patient-reported outcome measures (PROMs)? A qualitative interview study. BMJ Open 2020; 10:e039116. [PMID: 33033028 PMCID: PMC7542936 DOI: 10.1136/bmjopen-2020-039116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To identify the facilitators and barriers to implementing patient-reported outcome measures (PROMs) in third sector organisations (TSOs) delivering health and well-being services. DESIGN A qualitative interview study. Participants were recruited using purposive, opportunistic and snowballing methods. Framework analysis was used. SETTING TSOs including charities, community groups and not-for-profit organisations in England, UK. PARTICIPANTS Thirty interviewees including service users, TSO front-line workers and managers, commissioners of TSOs and other stakeholders such as academic researchers. RESULTS TSOs primarily used PROMs because of pressures arising from the external funding context. However, organisations often struggled to implement PROMs, rarely getting the process right first time. Facilitators for implementation included having an implementation lead committed to making it work, investing resources in data management systems and support staff and taking a collaborative approach to designing the PROMs process. The latter helped to ensure an appropriate PROMs process for the specific TSO including choosing a suitable measure and planning how data would be collected, processed and used. There was a dilemma about whether TSOs should use standardised well-being measures (eg, the Warwick-Edinburgh Mental Well-being Scale) or design their own PROM. Not all TSOs sustained the collection and reporting of PROMs over time because this required a change in organisational culture to view PROMs as beneficial for the TSO and PROMs becoming part of front-line workers' job specifications. CONCLUSIONS TSOs are trying to use PROMs because they feel they have no choice but often struggle with implementation. Having an implementation lead, designing an appropriate process, investing resources, training staff and taking mitigating action to address potential barriers can facilitate implementation. Some of the findings are consistent with the experiences of more clinical services so appear relevant to the implementation of PROMs irrespective of the specific context.
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Affiliation(s)
- Alexis Foster
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Alicia O'Cathain
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Janet Harris
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Speerin R, Needs C, Chua J, Woodhouse LJ, Nordin M, McGlasson R, Briggs AM. Implementing models of care for musculoskeletal conditions in health systems to support value-based care. Best Pract Res Clin Rheumatol 2020; 34:101548. [PMID: 32723576 PMCID: PMC7382572 DOI: 10.1016/j.berh.2020.101548] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Models of Care (MoCs), and their local Models of Service Delivery, for people with musculoskeletal conditions are becoming an acceptable way of supporting effective implementation of value-based care. MoCs can support the quadruple aim of value-based care through providing people with musculoskeletal disease improved access to health services, better health outcomes and satisfactory experience of their healthcare; ensure the health professionals involved are experiencing satisfaction in delivering such care and health system resources are better utilised. Implementation of MoCs is relevant at the levels of clinical practice (micro), service delivery organisations (meso) and health system (macro) levels. The development, implementation and evaluation of MoCs has evolved over the last decade to more purposively engage people with lived experience of their condition, to operationalise the Chronic Care Model and to employ innovative solutions. This paper explores how MoCs have evolved and are supporting the delivery of value-based care in health systems.
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Affiliation(s)
- Robyn Speerin
- The Sydney University, Level 7, Department of Rheumatology, Royal North Shore Hospital, Reserve Road, ST LEONARDS, NSW, 2065, Australia.
| | - Christopher Needs
- Department of Rheumatology, Level 4, QEII Building, Royal Prince Alfred Hospital, 59 Missenden Road, Camperdown, NSW, 2050, Australia.
| | - Jason Chua
- Centre for Musculoskeletal Outcomes Research, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
| | - Linda J Woodhouse
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.
| | - Margareta Nordin
- Departments of Orthopedic Surgery and Environmental Medicine, Occupational and Industrial Orthopedic Center (OIOC), New York University, New York, NY, USA.
| | - Rhona McGlasson
- Bone & Joint Canada, P.O. Box 1036, Toronto, ON, M5K 1P2, Canada.
| | - Andrew M Briggs
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.
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Implementing Patient-Reported Outcome Measures in Routine Cleft-Craniofacial Practice. J Craniofac Surg 2020; 32:366-367. [PMID: 32956315 DOI: 10.1097/scs.0000000000007015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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