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Hjollund NHI. Fifteen Years' Use of Patient-Reported Outcome Measures at the Group and Patient Levels: Trend Analysis. J Med Internet Res 2019; 21:e15856. [PMID: 31573943 PMCID: PMC6792031 DOI: 10.2196/15856] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 09/09/2019] [Accepted: 09/20/2019] [Indexed: 02/06/2023] Open
Abstract
Background Since 2004, we have collected patient-reported outcome (PRO) data from several Danish patient populations for use at the group and patient levels. Objective The aim of this paper is to highlight trends during the last 15 years with respect to patient inclusion, the methods for collection of PRO data, the processing of the data, and the actual applications and use of the PRO measurements. Methods All PRO data have been collected using the AmbuFlex/WestChronic PRO system, which was developed by the author in 2004 and has been continuously updated since. The analysis of trends was based on a generic model applicable for any kind of clinical health data, according to which any application of clinical data may be divided into four processes: patient identification, data collection, data aggregation, and the actual data use. Data for analysis were generated by a specific application in the system and transferred for analysis to the R package. Results During the 15-year period, 78,980 patients within 28 different groups of chronic and malignant illnesses have answered 260,433 questionnaires containing a total of 13,538,760 responses. Several marked changes have taken place: (1) the creation of cohorts for clinical epidemiological research purposes has shifted towards cohorts defined by clinical use of PRO data at the patient level; (2) the development of AmbuFlex, where PRO data are used as the entire basis for outpatient follow-up instead of fixed appointments, has undergone exponential growth and the system is currently in use in 47 International Statistical Classification of Diseases and Related Health Problems groups, covering 16,000 patients and 94 departments throughout Denmark; (3) response rates (up to 92%) and low attrition rates have been reached in group level projects, and there are even higher response rates in AmbuFlex where the patients are individually referred; (4) The answering method has shifted, as while in 2005 a total of 66.5% of questionnaires were paper based, this is the case for only 4.3% in 2019; and (5) the approach methods for questionnaires and reminders have changed dramatically from letter, emails, and short message service text messaging to a national, secure electronic mail system through which 93.2% of the communication to patients took place in 2019. The combination of secure email and web-based answering has resulted in a low turnaround time in which half of responses are now received within 5 days. Conclusions The demand for clinical use of PRO measurements has increased, driven by a wish among patients as well as clinicians to use PRO to promote better symptom assessment, more patient-centered care, and more efficient use of resources. Important technological changes have occurred, creating new opportunities, and making PRO collection and use cheaper and more feasible. Several legal changes may constitute a barrier for further development as well as a barrier for better utilization of patients’ questionnaire data. The current legal restrictions on the joint use of health data imposed by the European Union’s General Data Protection Regulation makes no distinction between use and misuse, and steps should be taken to alleviate these restrictions on the joint use of PRO data.
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Affiliation(s)
- Niels Henrik I Hjollund
- AmbuFlex/WestChronic, Occupational Medicine, University Research Clinic, Aarhus University, Herning, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Kivimäki M, Pentti J, Ferrie JE, Batty GD, Nyberg ST, Jokela M, Virtanen M, Alfredsson L, Dragano N, Fransson EI, Goldberg M, Knutsson A, Koskenvuo M, Koskinen A, Kouvonen A, Luukkonen R, Oksanen T, Rugulies R, Siegrist J, Singh-Manoux A, Suominen S, Theorell T, Väänänen A, Vahtera J, Westerholm PJM, Westerlund H, Zins M, Strandberg T, Steptoe A, Deanfield J. Work stress and risk of death in men and women with and without cardiometabolic disease: a multicohort study. Lancet Diabetes Endocrinol 2018; 6:705-713. [PMID: 29884468 PMCID: PMC6105619 DOI: 10.1016/s2213-8587(18)30140-2] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 04/11/2018] [Accepted: 04/23/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Although some cardiovascular disease prevention guidelines suggest a need to manage work stress in patients with established cardiometabolic disease, the evidence base for this recommendation is weak. We sought to clarify the status of stress as a risk factor in cardiometabolic disease by investigating the associations between work stress and mortality in men and women with and without pre-existing cardiometabolic disease. METHODS In this multicohort study, we used data from seven cohort studies in the IPD-Work consortium, initiated between 1985 and 2002 in Finland, France, Sweden, and the UK, to examine the association between work stress and mortality. Work stress was denoted as job strain or effort-reward imbalance at work. We extracted individual-level data on prevalent cardiometabolic diseases (coronary heart disease, stroke, or diabetes [without differentiation by diabetes type]) at baseline. Work stressors, socioeconomic status, and conventional and lifestyle risk factors (systolic and diastolic blood pressure, total cholesterol, smoking status, BMI, physical activity, and alcohol consumption) were also assessed at baseline. Mortality data, including date and cause of death, were obtained from national death registries. We used Cox proportional hazards regression to study the associations of work stressors with mortality in men and women with and without cardiometabolic disease. RESULTS We identified 102 633 individuals with 1 423 753 person-years at risk (mean follow-up 13·9 years [SD 3·9]), of whom 3441 had prevalent cardiometabolic disease at baseline and 3841 died during follow-up. In men with cardiometabolic disease, age-standardised mortality rates were substantially higher in people with job strain (149·8 per 10 000 person-years) than in those without (97·7 per 10 000 person-years; mortality difference 52·1 per 10 000 person-years; multivariable-adjusted hazard ratio [HR] 1·68, 95% CI 1·19-2·35). This mortality difference for job strain was almost as great as that for current smoking versus former smoking (78·1 per 10 000 person-years) and greater than those due to hypertension, high total cholesterol concentration, obesity, physical inactivity, and high alcohol consumption relative to the corresponding lower risk groups (mortality difference 5·9-44·0 per 10 000 person-years). Excess mortality associated with job strain was also noted in men with cardiometabolic disease who had achieved treatment targets, including groups with a healthy lifestyle (HR 2·01, 95% CI 1·18-3·43) and those with normal blood pressure and no dyslipidaemia (6·17, 1·74-21·9). In all women and in men without cardiometabolic disease, relative risk estimates for the work stress-mortality association were not significant, apart from effort-reward imbalance in men without cardiometabolic disease (mortality difference 6·6 per 10 000 person-years; multivariable-adjusted HR 1·22, 1·06-1·41). INTERPRETATION In men with cardiometabolic disease, the contribution of job strain to risk of death was clinically significant and independent of conventional risk factors and their treatment, and measured lifestyle factors. Standard care targeting conventional risk factors is therefore unlikely to mitigate the mortality risk associated with job strain in this population. FUNDING NordForsk, UK Medical Research Council, and Academy of Finland.
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Affiliation(s)
- Mika Kivimäki
- Clinicum, Faculty of Medicine, and Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland; Department of Epidemiology and Public Health, University College London, London, UK.
| | - Jaana Pentti
- Clinicum, Faculty of Medicine, and Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland; Department of Public Health, University of Turku, Turku, Finland
| | - Jane E Ferrie
- Department of Epidemiology and Public Health, University College London, London, UK; School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - G David Batty
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Solja T Nyberg
- Clinicum, Faculty of Medicine, and Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Markus Jokela
- Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland
| | - Marianna Virtanen
- Institute of Public Health and Caring Sciences, University of Uppsala, Uppsala, Sweden
| | - Lars Alfredsson
- Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Nico Dragano
- Institute for Medical Sociology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Eleonor I Fransson
- Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden; School of Health and Welfare, Jönköping University, Jönköping, Sweden; Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Marcel Goldberg
- Inserm UMS 011, Population-Based Epidemiological Cohorts Unit, Villejuif, France; Versailles St-Quentin University, UMS 011, Villejuif, France
| | - Anders Knutsson
- Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden
| | - Markku Koskenvuo
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Aki Koskinen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Anne Kouvonen
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland; Division of Health Psychology, SWPS University of Social Sciences and Humanities in Wroclaw, Wroclaw, Poland; Administrative Data Research Centre Northern Ireland, Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Ritva Luukkonen
- Clinicum, Faculty of Medicine, and Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Tuula Oksanen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Reiner Rugulies
- National Research Centre for the Working Environment, Copenhagen, Denmark; Department of Public Health and Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Johannes Siegrist
- Institute for Medical Sociology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Archana Singh-Manoux
- Department of Epidemiology and Public Health, University College London, London, UK; Inserm UMR 1018, Centre for Research in Epidemiology and Population Health, Villejuif, France
| | - Sakari Suominen
- Department of Public Health, University of Turku, Turku, Finland; Folkhälsan Research Center, Helsinki, Finland; School of Health and Education, University of Skövde, Skövde, Sweden; School of Social Policy, Sociology and Social Research, University of Kent, Canterbury, UK
| | - Töres Theorell
- Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Ari Väänänen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Jussi Vahtera
- Department of Public Health, University of Turku, Turku, Finland; Turku University Hospital, Turku, Finland
| | | | - Hugo Westerlund
- Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Marie Zins
- Inserm UMS 011, Population-Based Epidemiological Cohorts Unit, Villejuif, France; Versailles St-Quentin University, UMS 011, Villejuif, France
| | - Timo Strandberg
- Clinicum, Faculty of Medicine, and Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland; Department of Internal Medicine, Helsinki University Hospital, Helsinki, Finland; Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Andrew Steptoe
- Department of Epidemiology and Public Health, University College London, London, UK
| | - John Deanfield
- National Centre for Cardiovascular Prevention and Outcomes, University College London, London, UK
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Biering K, Lund T, Andersen JH, Hjollund NH. Effect of Psychosocial Work Environment on Sickness Absence Among Patients Treated for Ischemic Heart Disease. JOURNAL OF OCCUPATIONAL REHABILITATION 2015; 25:776-82. [PMID: 26077204 DOI: 10.1007/s10926-015-9587-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
INTRODUCTION During the last decades mortality has declined in patients with coronary heart disease due to improvements in treatments and changes in life style, resulting in more people living with chronic heart disease. This implies that focus on rehabilitation and re-integration to the work-force becomes increasingly important. Previous studies among healthy workers suggest that the psychosocial working environment is associated with sickness absence. Whether the psychosocial working environment plays a role for patients with existing cardiovascular disease on return to work and sickness absence is less studied. METHODS A cohort of patients under 67 years and treated with percutaneous coronary intervention (PCI) was established in 2006. Three months after the procedure the patients (n = 625) answered a questionnaire about their psychosocial working environment. Patients were followed in registers for the following year. We examined the association between psychosocial working environment and sickness absence at 3 months, 1 year and new sick-listings during the first year with logistic regression. RESULTS A total of 528 patients had returned to work 3 months after the PCI, while 97 was still sick-listed. After 1 year one was dead, 465 were working and 85 were receiving health related benefits, while 74 had left the workforce permanently. A number of 106 patients were sick-listed during the whole first year or had left the workforce permanently. After the initial return to work, 90 experienced a new sickness absence during the first year while the remaining 429 did not. High work pace, low commitment to the workplace, low recognition (rewards) and low job control were associated with sickness absence at 3 months, but not after 1 year. Low job control as well as job strain (combination of high demands and low control) was associated with new sick-listings. CONCLUSION The psychosocial working environment was associated with sickness absence 3 months after the PCI, but not 1 year after.
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Affiliation(s)
- Karin Biering
- Department of Occupational Medicine, Danish Ramazzini Centre, University Research Clinic, Regional Hospital West Jutland, 7400, Herning, Denmark.
| | - Thomas Lund
- Department of Occupational Medicine, Danish Ramazzini Centre, University Research Clinic, Regional Hospital West Jutland, 7400, Herning, Denmark
- National Centre for Occupational Rehabilitation, Rauland, Norway
- Research and Development, Public Health and Quality Improvement, Central Denmark Region, MarselisborgCentret, Århus, Denmark
| | - Johan Hviid Andersen
- Department of Occupational Medicine, Danish Ramazzini Centre, University Research Clinic, Regional Hospital West Jutland, 7400, Herning, Denmark
| | - Niels Henrik Hjollund
- Department of Occupational Medicine, Danish Ramazzini Centre, University Research Clinic, Regional Hospital West Jutland, 7400, Herning, Denmark
- WestChronic, Regional Hospital West Jutland, Herning, Denmark
- Department of Clinical Epidemiology, Aarhus University Hospital, Århus, Denmark
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