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Escribano S, Herrero-Oliver R, Oliver-Roig A, Richart-Martínez M. Psychometric properties of the maternal breastfeeding evaluation scale: a confirmatory factor analysis. BMC Pregnancy Childbirth 2024; 24:486. [PMID: 39026186 PMCID: PMC11264472 DOI: 10.1186/s12884-024-06693-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 07/11/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND It has been suggested that maternal satisfaction should be included as an additional and appropriate outcome indicator in relation to the breastfeeding process. The aim of this study was to analyze the psychometric properties of various existing versions of the Maternal Breastfeeding Evaluation Scale in a Spanish sample. METHODS This was a longitudinal observational study, evaluated at three different time points: in the hospital after delivery, and then at five and 12 months after delivery in a Spanish sample. A total of 690 mother participated in this study. RESULTS Confirmatory factor analysis results indicated an improved fit of the data to the original model (CFI = 0.984; TLI = 0.982; RMSEA = 0.079). All dimensions of the Maternal Breastfeeding Evaluation Scale are positively associated with breastfeeding rates and negatively associated with perceived difficulty in continuing to breastfeed after returning to work at five months postpartum. Moreover, the scale can predict breastfeeding behavior at 12 months postpartum. CONCLUSIONS The results of this study indicate that the structure of the original version of the Maternal Breastfeeding Evaluation Scale mean it is a is valid and reliable tool for assessing maternal perceptions of the breastfeeding experience in Spain. This research enhances our understanding of maternal satisfaction with the breastfeeding experience and its potential implications for supporting breastfeeding practices. It is an opportunity for the academic, healthcare, and policy sectors to develop more effective interventions to improve breastfeeding rates and ensure a positive experience for mothers.
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Affiliation(s)
- Silvia Escribano
- Department of Nursing, Faculty of Health Sciences, University of Alicante, Carretera San Vicente del Raspeig s/n, Alicante, 03690, Spain
| | | | - Antonio Oliver-Roig
- Department of Nursing, Faculty of Health Sciences, University of Alicante, Carretera San Vicente del Raspeig s/n, Alicante, 03690, Spain.
| | - Miguel Richart-Martínez
- Department of Nursing, Faculty of Health Sciences, University of Alicante, Carretera San Vicente del Raspeig s/n, Alicante, 03690, Spain
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Singh GK, Mudge A, Matthews R, Yates P, Phillips JL, Virdun C. Experience of care from the perspectives of inpatients with palliative care needs: a cross-sectional study using a patient reported experience measure (PREM). BMC Palliat Care 2024; 23:177. [PMID: 39026237 PMCID: PMC11256639 DOI: 10.1186/s12904-024-01494-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 06/26/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Improving palliative care for inpatients is urgently needed. Data from patient-reported experience measures (PREM) can assist in identifying areas for focused improvement. This study aimed to describe patient reported experience of care in inpatients with palliative care needs, to inform a baseline understanding of care experience and identify key areas for improvement. METHODS Cross-sectional study design where inpatients with palliative care needs were invited to complete 'consideRATE,' a patient reported experience measure of care, over six months in 2022. Inpatients with palliative care needs receiving care on an oncology, general medicine/renal and general medicine/respiratory ward (n = 3) at an Australian metropolitan hospital were screened for eligibility. Carers could provide proxy responses where inpatients were unable to participate. Descriptive statistics were used to analyse quantitative ratings, whilst free text responses were analysed using integrated thematic analysis. RESULTS One-hundred and twenty participants (108 patients and 12 carers) completed consideRATE. The questions with the highest number of 'very good' responses were attention to symptoms, attention to feelings and attention to what matters most; the questions with the lowest number of 'very good' responses was attention to patients' affairs, what to expect, and the environment of care. Almost half (n = 57, 48%) indicated that attention to patients' affairs 'did not apply' to their inpatient stay. Analysis of 532 free text responses across 8 questions highlighted the importance of feeling supported, feeling informed, feeling heard and navigating the clinical environment. CONCLUSION Enabling inpatients with palliative care needs to provide feedback about their experience of care is one method of ensuring improvements matter to patients. Supporting clinical teams to understand and use these data to make tailored improvements is the next step in this multi-phase research.
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Affiliation(s)
- Gursharan K Singh
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia.
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia.
| | - Alison Mudge
- Greater Brisbane Medical School, The University of Queensland, Herston, QLD, Australia
- Department of Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD, Australia
| | - Robyn Matthews
- Cancer Care Services, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD, Australia
| | - Patsy Yates
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia
| | - Jane L Phillips
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia
| | - Claudia Virdun
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia
- Research Centre for Palliative Care, Death, and Dying, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
- Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney (UTS), Ultimo, NSW, Australia
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Jolidon V, Eicher M, Peytremann-Bridevaux I, Arditi C. Inequalities in patients' experiences with cancer care: the role of economic and health literacy determinants. BMC Health Serv Res 2024; 24:733. [PMID: 38877526 PMCID: PMC11179203 DOI: 10.1186/s12913-024-11174-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 06/05/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Patients with fewer socioeconomic and health literacy resources are disadvantaged in their access and use of healthcare, which may give rise to worse experiences with care and thus inequalities in patient experiences. However, only a limited number of studies have examined how socioeconomic and health literacy factors shape inequalities in patients' experiences with cancer care. OBJECTIVE To examine whether patients' experiences with cancer care differ according to their economic status and health literacy. METHODS Secondary analysis of data on 2789 adult patients diagnosed with cancer from the Swiss Cancer Patient Experiences-2 (SCAPE-2) study, a cross-sectional survey conducted in eight hospitals across Switzerland from September 2021 to February 2022. Regression analysis was applied to examine the independent effect of patients' economic status and health literacy on various outcomes of experiences with cancer care, covering eight different dimensions of patient-centred care, controlling for confounding factors. RESULTS Adjusted regression analysis showed that patients with lower economic status reported significantly worse experiences with cancer care in 12 out of 29 specific care experiences, especially in the dimensions of 'respect for patients' preferences' and 'physical comfort' where all items of experiences were associated with economic status. Additionally, lower health literacy was associated with worse patient experiences in 23 specific care experiences. All items in the dimensions of 'respect for patients' preferences', 'physical comfort' and 'emotional support' were associated with health literacy. DISCUSSION This study revealed significant inequalities in experiences with cancer care shaped by the economic status and health literacy of patients across different dimensions of patient-centred care. It is essential to address the needs of more disadvantaged patients who face obstacles in their access and use of the healthcare system, not only to mitigate inequalities in cancer care but also to avoid inequalities in health outcomes.
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Affiliation(s)
- Vladimir Jolidon
- Unisanté, University Center for Primary Care and Public Health, Department of Epidemiology and Health Systems, University of Lausanne, CH-1011 Lausanne, Switzerland
| | - Manuela Eicher
- Institute of Higher Education and Research in Healthcare (IUFRS), Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Department of Oncology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Isabelle Peytremann-Bridevaux
- Unisanté, University Center for Primary Care and Public Health, Department of Epidemiology and Health Systems, University of Lausanne, CH-1011 Lausanne, Switzerland
| | - Chantal Arditi
- Unisanté, University Center for Primary Care and Public Health, Department of Epidemiology and Health Systems, University of Lausanne, CH-1011 Lausanne, Switzerland.
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Šafran V, Lin S, Nateqi J, Martin AG, Smrke U, Ariöz U, Plohl N, Rojc M, Bēma D, Chávez M, Horvat M, Mlakar I. Multilingual Framework for Risk Assessment and Symptom Tracking (MRAST). SENSORS (BASEL, SWITZERLAND) 2024; 24:1101. [PMID: 38400259 PMCID: PMC10892413 DOI: 10.3390/s24041101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/02/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024]
Abstract
The importance and value of real-world data in healthcare cannot be overstated because it offers a valuable source of insights into patient experiences. Traditional patient-reported experience and outcomes measures (PREMs/PROMs) often fall short in addressing the complexities of these experiences due to subjectivity and their inability to precisely target the questions asked. In contrast, diary recordings offer a promising solution. They can provide a comprehensive picture of psychological well-being, encompassing both psychological and physiological symptoms. This study explores how using advanced digital technologies, i.e., automatic speech recognition and natural language processing, can efficiently capture patient insights in oncology settings. We introduce the MRAST framework, a simplified way to collect, structure, and understand patient data using questionnaires and diary recordings. The framework was validated in a prospective study with 81 colorectal and 85 breast cancer survivors, of whom 37 were male and 129 were female. Overall, the patients evaluated the solution as well made; they found it easy to use and integrate into their daily routine. The majority (75.3%) of the cancer survivors participating in the study were willing to engage in health monitoring activities using digital wearable devices daily for an extended period. Throughout the study, there was a noticeable increase in the number of participants who perceived the system as having excellent usability. Despite some negative feedback, 44.44% of patients still rated the app's usability as above satisfactory (i.e., 7.9 on 1-10 scale) and the experience with diary recording as above satisfactory (i.e., 7.0 on 1-10 scale). Overall, these findings also underscore the significance of user testing and continuous improvement in enhancing the usability and user acceptance of solutions like the MRAST framework. Overall, the automated extraction of information from diaries represents a pivotal step toward a more patient-centered approach, where healthcare decisions are based on real-world experiences and tailored to individual needs. The potential usefulness of such data is enormous, as it enables better measurement of everyday experiences and opens new avenues for patient-centered care.
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Affiliation(s)
- Valentino Šafran
- Faculty of Electrical Engineering and Computer Science, University of Maribor, 2000 Maribor, Slovenia; (V.Š.); (U.S.); (U.A.); (M.R.)
| | - Simon Lin
- Science Department, Symptoma GmbH, 1030 Vienna, Austria (A.G.M.)
- Department of Internal Medicine, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Jama Nateqi
- Science Department, Symptoma GmbH, 1030 Vienna, Austria (A.G.M.)
- Department of Internal Medicine, Paracelsus Medical University, 5020 Salzburg, Austria
| | | | - Urška Smrke
- Faculty of Electrical Engineering and Computer Science, University of Maribor, 2000 Maribor, Slovenia; (V.Š.); (U.S.); (U.A.); (M.R.)
| | - Umut Ariöz
- Faculty of Electrical Engineering and Computer Science, University of Maribor, 2000 Maribor, Slovenia; (V.Š.); (U.S.); (U.A.); (M.R.)
| | - Nejc Plohl
- Department of Psychology, Faculty of Arts, University of Maribor, 2000 Maribor, Slovenia;
| | - Matej Rojc
- Faculty of Electrical Engineering and Computer Science, University of Maribor, 2000 Maribor, Slovenia; (V.Š.); (U.S.); (U.A.); (M.R.)
| | - Dina Bēma
- Institute of Clinical and Preventive Medicine, University of Latvia, LV-1586 Riga, Latvia;
| | - Marcela Chávez
- Department of Information System Management, Centre Hospitalier Universitaire de Liège, 4000 Liège, Belgium;
| | - Matej Horvat
- Department of Oncology, University Medical Centre Maribor, 2000 Maribor, Slovenia;
| | - Izidor Mlakar
- Faculty of Electrical Engineering and Computer Science, University of Maribor, 2000 Maribor, Slovenia; (V.Š.); (U.S.); (U.A.); (M.R.)
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Kalenderian E, Tungare S, Mehta U, Hamid S, Mungia R, Yansane AI, Holmes D, Funkhouser K, Ibarra-Noriega AM, Urata J, Rindal DB, Spallek H, White J, Walji MF. Patient and dentist perspectives on collecting patient reported outcomes after painful dental procedures in the National Dental PBRN. BMC Oral Health 2024; 24:201. [PMID: 38326805 PMCID: PMC10848340 DOI: 10.1186/s12903-024-03931-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/24/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Dental Patient Reported Outcomes (PROs) relate to a dental patient's subjective experience of their oral health. How practitioners and patients value PROs influences their successful use in practice. METHODS Semi-structured interviews were conducted with 22 practitioners and 32 patients who provided feedback on using a mobile health (mHealth) platform to collect the pain experience after dental procedures. A themes analysis was conducted to identify implementation barriers and facilitators. RESULTS Five themes were uncovered: (1) Sense of Better Care. (2) Tailored Follow-up based on the dental procedure and patient's pain experience. (3) Effective Messaging and Alerts. (4) Usable Digital Platform. (5) Routine mHealth Integration. CONCLUSION Frequent automated and preferably tailored follow-up messages using an mHealth platform provided a positive care experience for patients, while providers felt it saved them time and effort. Patients thought that the mHealth questionnaires were well-developed and of appropriate length. The mHealth platform itself was perceived as user-friendly by users, and most would like to continue using it. PRACTICAL IMPLICATIONS Patients are prepared to use mobile phones to report their pain experience after dental procedures. Practitioners will be able to close the post-operative communication gap with their patients, with little interruption of their workflow.
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Affiliation(s)
- Elsbeth Kalenderian
- Marquette University, School of Dentistry, Milwaukee, WI, USA
- University of California San Francisco, School of Dentistry, 600 Parnassus Avenue, San Francisco, CA, USA
- University of Pretoria, School of Dentistry, Pretoria, South Africa
| | - Sayali Tungare
- UTHealth School of Dentistry, 7500 Cambridge St. room 4160, Houston, TX, TX 77054, USA
| | - Urvi Mehta
- UTHealth School of Dentistry, 7500 Cambridge St. room 4160, Houston, TX, TX 77054, USA
| | - Sharmeen Hamid
- UTHealth School of Dentistry, 7500 Cambridge St. room 4160, Houston, TX, TX 77054, USA
| | - Rahma Mungia
- UTHealth School of Dentistry, San Antonio, TX, USA
| | - Alfa-Ibrahim Yansane
- University of California San Francisco, School of Dentistry, 600 Parnassus Avenue, San Francisco, CA, USA
| | | | - Kim Funkhouser
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Avenue, Portland, OR, 97227-1098, USA
| | - Ana M Ibarra-Noriega
- UTHealth School of Dentistry, 7500 Cambridge St. room 4160, Houston, TX, TX 77054, USA
| | - Janelle Urata
- University of California San Francisco, School of Dentistry, 600 Parnassus Avenue, San Francisco, CA, USA
| | | | - Heiko Spallek
- University of Sydney, School of Dentistry, Sydney, Australia
| | - Joel White
- University of California San Francisco, School of Dentistry, 600 Parnassus Avenue, San Francisco, CA, USA
| | - Muhammad F Walji
- UTHealth School of Dentistry, 7500 Cambridge St. room 4160, Houston, TX, TX 77054, USA.
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Meng J, Zheng C, Wang H, Välimäki M, Wang M. Non-pharmacological interventions for improving sleep in people living with HIV: a systematic narrative review. Front Neurol 2023; 14:1017896. [PMID: 38125837 PMCID: PMC10732507 DOI: 10.3389/fneur.2023.1017896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/27/2023] [Indexed: 12/23/2023] Open
Abstract
Background Sleep disturbances are common in people living with Human Immunodeficiency Virus (HIV) and may lead to poor adherence to antiretroviral therapy and worsen HIV symptom severity. Due to the side effects of pharmacotherapy for sleep disturbances, there is more room for non-pharmacological interventions, but knowledge of how these non-pharmacological interventions have been used to improve sleep in people living with HIV (PLWH) is still missing. Objective To investigate the content of non-pharmacological interventions, sleep measurements, and the impact of these interventions on improving sleep in PLWH. Methods Following PRISMA guidelines, we conducted a systematic search on PubMed, EMBASE, Cochrane Central Registry of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, Web of Science, China National Knowledge Infrastructure, Wanfang Data, and China Biology Medicine disc. Non-pharmacological interventions for improving sleep in PLWH were included, and study quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklists. We performed a narrative approach to synthesize the data to better understand the details and complexity of the interventions. Results Fifteen experimental studies in three categories for improving sleep in PLWH were included finally, including psychological interventions (components of cognitive-behavioral therapy for insomnia or mindfulness-based cognitive therapy, n = 6), physical interventions (auricular plaster therapy, acupuncture, and exercise, n = 8), and elemental interventions (speed of processing training with transcranial direct current stimulation, n = 1). Wrist actigraphy, sleep diary, and self-reported scales were used to measure sleep. Psychological interventions and physical interventions were found to have short-term effects on HIV-related sleep disturbances. Conclusions Psychological and physical interventions of non-pharmacological interventions can potentially improve sleep in PLWH, and the combination of patient-reported outcomes and actigraphy devices can help measure sleep comprehensively. Future non-pharmacological interventions need to follow protocols with evidence-based dosing, contents, and measures to ensure their sustainable and significant effects.
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Affiliation(s)
- Jingjing Meng
- School of Nursing, Anhui Medical University, Hefei, Anhui, China
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
| | - Chunyuan Zheng
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
| | - Honghong Wang
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
- Xiangya Center for Evidence-Based Practice & Healthcare Innovation: A Joanna Briggs Institute Affiliated Group, Xiangya Nursing School, Central South University, Changsha, Hunan, China
| | - Maritta Välimäki
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
- Xiangya Center for Evidence-Based Practice & Healthcare Innovation: A Joanna Briggs Institute Affiliated Group, Xiangya Nursing School, Central South University, Changsha, Hunan, China
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Min Wang
- The Institute of HIV/AIDS, The First Hospital of Changsha, Hunan, China
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Grudniewicz A, Gray CS, Boeckxstaens P, De Maeseneer J, Mold J. Operationalizing the Chronic Care Model with Goal-Oriented Care. THE PATIENT 2023; 16:569-578. [PMID: 37642918 PMCID: PMC10570240 DOI: 10.1007/s40271-023-00645-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 08/31/2023]
Abstract
The Chronic Care Model has guided quality improvement in health care for almost 20 years, using a patient-centered, disease management approach to systems and care teams. To further advance efforts in person-centered care, we propose strengthening the Chronic Care Model with the goal-oriented care approach. Goal-oriented care is person-centered in that it places the focus on what matters most to each person over the course of their life. The person's goals inform care decisions, which are arrived at collaboratively between clinicians and the person. In this paper, we build on each of the elements of the Chronic Care Model with person-centered, goal-oriented care and provide clinical examples on how to operationalize this approach. We discuss how this adapted approach can support our health care systems, in particular in the context of growing multi-morbidity.
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Affiliation(s)
| | - Carolyn Steele Gray
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Canada
| | | | - Jan De Maeseneer
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - James Mold
- George Lynn Cross Emeritus Professor, Family and Preventive Medicine, University of Oklahoma, Oklahoma City, USA
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Krtickova J, Svec JG, Haviger J, Phadke KV, Drsata J, Skoloudik L, Homolac M, Svejdova A, Mejzlik J, Hodacova L, Chrobok V. Validation of the Czech Version of the Voice Handicap Index. J Voice 2023:S0892-1997(23)00145-5. [PMID: 37344245 DOI: 10.1016/j.jvoice.2023.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/22/2023] [Accepted: 04/24/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVE(S) The present study aims to evaluate the reliability and construct validity of the Czech version of the Voice Handicap Index (VHI-CZ) and determine the cut-off value to distinguish dysphonic patients from nondysphonic individuals. STUDY DESIGN Prospective study, Parallel group design. METHODS The study investigated 100 adult patients with dysphonia, divided into three groups based on the etiology of the voice problem (neurogenic, functional, and structural). Out of these, 25 patients were used for test-retest analysis, and 45 patients to determine the responsiveness to change. The control group consisted of 51 healthy subjects. All 151 individuals completed the VHI-CZ and were examined with the videolaryngostroboscopy. The internal consistency (Cronbach's alpha), the test-retest reliability (Intra-class Correlation Coefficient, ICC), and the construct validity were analyzed and the normative cut-off value was determined. RESULTS The internal consistency of the VHI-CZ was excellent (Cronbach α = 0.984), and test-retest reliability was also excellent (ICC = 0.95, P < 0.001). The correlation between the self-assessed severity of the voice disorder and the VHI-CZ score was strong (Spearman's ρ = 0.877, P < 0.001). The VHI scores differences between dysphonic and nondysphonic patients were statistically significant (Mann-Whitney U test, P < 0.001). The differences among the three etiological subgroups (neurogenic, functional, and structural) were also statistically significant (Kruskal-Wallis test, P < 0.001). Moreover, the differences in the VHI-CZ total scores between pretreatment and posttreatment were statistically significant (Wilcoxon test, P < 0.001). The cut-off score of 13 points was found, by the analysis of the Receiver Operating Characteristic (ROC, Youden Index), to be most suitable for preselecting dysphonic individuals. CONCLUSION The existing VHI-CZ showed excellent reliability and construct validity. The Czech VHI is a useful and valid monitoring tool for clinicians.
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Affiliation(s)
- Jana Krtickova
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic; Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic.
| | - Jan G Svec
- Voice Research Laboratory, Department of Experimental Physics, Faculty of Science, Palacky University, Olomouc, Czech Republic
| | - Jiri Haviger
- Department of Informatics and Quantitative Methods, Faculty of Informatics and Management, University of Hradec Kralove, Hradec Kralove, Czech Republic
| | - Ketaki Vasant Phadke
- Voice Research Laboratory, Department of Experimental Physics, Faculty of Science, Palacky University, Olomouc, Czech Republic
| | - Jakub Drsata
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic; Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Lukas Skoloudik
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic; Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Michal Homolac
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic; Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Anna Svejdova
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic; Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Jan Mejzlik
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic; Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Lenka Hodacova
- Department of Preventive Medicine, Charles University, Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Viktor Chrobok
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic; Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
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Chen A, Väyrynen K, Leskelä R, Torkki P, Heinonen S, Tekay A, Acharya G. The acceptability of implementing patient-reported measures in routine maternity care: A systematic review. Acta Obstet Gynecol Scand 2023; 102:406-419. [PMID: 36647292 PMCID: PMC10008272 DOI: 10.1111/aogs.14506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/10/2022] [Accepted: 12/18/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Patient-reported measures (PRMs) are becoming popular as they might influence clinical decisions, help to deliver patient-centered care, and improve health care quality. However, the limited knowledge and consensus about the acceptability of implementing PRMs in maternity care hinder their widespread use in clinical practice, and evidence-based recommendations are lacking. This systematic review aims to synthesize available evidence on the acceptability of implementing PRMs in routine maternity care. MATERIAL AND METHODS Literature on the implementation of PRMs in maternity care was electronically searched in six databases (PsycARTICLES, PubMed, Scopus, Web of Science, Cochrane Database of Systematic Reviews, and CINAHL), screened and selected for the topic of "acceptability". Theoretical Framework of Acceptability was used as the basic framework guiding data analysis and synthesis. Evidence was thematically analyzed and synthesized. Mixed Method Appraisal Tool and GRADE-CERQual approach were used to assess the quality of studies and evaluate the confidence in the review findings. RESULTS Overall, 4971 articles were screened. From 24 studies, we identified five themes regarding the acceptability of implementing PRMs in routine maternity care: (1) user's action and behavior, (2) stakeholders' attitudes, (3) perceived benefits, (4) perceived challenges and risks, and (5) stakeholders' preferences and suggestions on implementation. While pregnant and postpartum women, health professionals and other stakeholders involved in maternity care were generally positive about the implementation of PRMs in routine care and recognized the potential benefits (eg health improvement, women empowerment, care and services improvement and healthcare system advancement), they pointed out possible challenges and risks in answering PRMs questions, responding to answers, and setting up integrated information systems as well as suggested solutions in the aspects of PRMs data collection, follow-up care, and system-level management. The confidence in the review findings was moderate due to methodological limitations of included studies. CONCLUSIONS Available empirical evidence suggested that the use of PRMs in routine maternity care is acceptable among stakeholders involved in maternity care and the potential benefits of its integration in routine clinical practice to healthcare improvement has been recognized. However, possible challenges in data collection, follow-up care arrangement and system-level integration should be appropriately addressed.
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Affiliation(s)
- An Chen
- Institute of Healthcare Engineering, Management and Architecture (HEMA), Department of Industrial Engineering and ManagementAalto UniversityEspooFinland
- Department of Obstetrics and GynecologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
- Nordic Healthcare Group OyHelsinkiFinland
| | - Kirsi Väyrynen
- Department of Obstetrics and GynecologyCentral Finland Central HospitaJyväskyläFinland
| | | | - Paulus Torkki
- Institute of Healthcare Engineering, Management and Architecture (HEMA), Department of Industrial Engineering and ManagementAalto UniversityEspooFinland
- Nordic Healthcare Group OyHelsinkiFinland
- Department of Public Health, Faculty of MedicineHelsinki UniversityHelsinkiFinland
| | - Seppo Heinonen
- Department of Obstetrics and GynecologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Aydin Tekay
- Department of Obstetrics and GynecologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Ganesh Acharya
- Division of Obstetrics & Gynecology, Department of Clinical Science, Intervention and Technology (CLINTEC)Karolinska InstitutetStockholmSweden
- Women`s Health and Perinatology Research grroup, Department of Clinical MedicineUiT The Arctic University of NorwayTromsøNorway
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Integration and Implementation of Patient-Reported Outcomes: A Prospective, Observational Clinical Quality Improvement Study. Plast Reconstr Surg 2023; 151:184-193. [PMID: 36251864 DOI: 10.1097/prs.0000000000009772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Implementation of patient-reported outcomes (PROs) represents a critical barrier to their widespread use and poses challenges to workflow and patient satisfaction. The authors sought to implement PRO surveys into surgical practice and identify principles for successful and broader implementation. METHODS Outpatient surgical encounters from 2016 through 2019 related to hernia, breast surgery, or postbariatric body contouring were assessed with the Abdominal Hernia-Q, BREAST-Q, or BODY-Q surveys, respectively. Outcomes were implementation rates per quarter and time to optimal implementation (≥80%). Successful implementation principles were identified during the first implemented PRO instrument and applied to subsequent ones. Logistic regression models were used to estimate increase in rate of implementation per quarter by instrument controlling for clinic volume. Risk-adjusted generalized linear models determined predicted mean differences in total clinic time and patient satisfaction. RESULTS A total of 1206 encounters were identified. The overall survey implementation rate increased from 15% in the first quarter to 90% in the last quarter ( P < 0.01). Abdominal Hernia-Q optimal implementation was reached by 15 months. Principles for successful implementation of PROs were workflow optimization, appropriate patient selection, staff engagement, and electronic survey integration. Consistent application of these principles optimized time to optimal implementation for BREAST-Q [9 months; 18.1% increase in implementation per quarter (95% CI, 1.5 to 37.5); P < 0.01] and BODY-Q [3 months; 56.3% increase in implementation per quarter (95% CI, 26.8 to 92.6); P = 0.03]. Neither patient clinic time ( P = 0.16) nor patient satisfaction differed during the implementation of PROs process ( P = 0.98). CONCLUSIONS Prospective implementation of PROs can be achieved in surgical practice without an adverse effect on patient satisfaction or workflow. The proposed principles of implementation may be used to optimize efficiency for implementation of PROs.
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Chen A, Väyrynen K, Schmidt A, Leskelä R, Torkki P, Heinonen S, Tekay A, Acharya G. The impact of implementing patient-reported measures in routine maternity care: a systematic review. Acta Obstet Gynecol Scand 2022; 101:1184-1196. [PMID: 36065150 PMCID: PMC9812106 DOI: 10.1111/aogs.14446] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/04/2022] [Accepted: 08/09/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION While there is growing interest in applying patient-reported measures (PRMs) in clinical routine, limited collective evidence of the impact of PRMs hinder their widespread use in specific contexts, such as maternity care. Our objective was to synthesize existing emperical evidence on the impact of implementing PRMs in routine maternity care. MATERIAL AND METHODS We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines (version 2020). We electronically searched six databases for the literature on the implementation of PRMs in maternity care. A multi-level (woman, clinical, organizational, national and societal) analytic framework for analyzing and synthesizing emperically proven impacts of PRMs was developed. Quality was assessed using the Mixed Method Appraisal Tool. The GRADE-CERQual approach was used to assess the confidence in the review findings and arguments. The protocol was registered in PROSPERO (CRD42021234501). RESULTS Overall, 4971 articles were screened. The emperical evidence, collected from 11 relevant studies, showed that the use of PRMs in routine maternity care could produce positive effects on clinical process (assessment and detection of health problems, clinical visit preparation, resource use, woman-professional communication, decision-making, woman-professional relationship, and care quality), and health behavior and outcomes (women's health and wellbeing, quality of life, health behavior, experiences and satisfaction with healthcare services), awareness, engagement and self-management of own health, and disclosure of health issues. The confidence in the review findings was low to moderate due to a limited number of studies, inadequate data and methodological limitations of included studies. CONCLUSIONS The limited emperical evidence available suggested that the use of PRMs may have positive effects at the individual health level and clinical process level. However, the evidence was not strong enough to provide policy recommendations on the use of PRMs in routine maternity care. This review revealed limitations of currently available research, such as lack of generalizability and narrow scopes in investigating impact. Efforts are needed to improve the quality of research on the use of PRMs in routine maternity care by widening the study population, including different types of PRMs, and considering the effects of PRMs at different levels and domains of healthcare.
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Affiliation(s)
- An Chen
- Department of Industrial Engineering and ManagementInstitute of Healthcare Engineering, Management and Architecture (HEMA), Aalto UniversityEspooFinland,Department of Obstetrics and GynecologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland,Nordic Healthcare Group OyHelsinkiFinland
| | - Kirsi Väyrynen
- Department of Obstetrics and GynecologyCentral Finland Central HospitaJyväskyläFinland
| | | | - Riikka‐Leena Leskelä
- Nordic Healthcare Group OyHelsinkiFinland,Department of Public Health, Faculty of MedicineHelsinki UniversityHelsinkiFinland
| | - Paulus Torkki
- Department of Industrial Engineering and ManagementInstitute of Healthcare Engineering, Management and Architecture (HEMA), Aalto UniversityEspooFinland,Nordic Healthcare Group OyHelsinkiFinland,Department of Public Health, Faculty of MedicineHelsinki UniversityHelsinkiFinland
| | - Seppo Heinonen
- Department of Obstetrics and GynecologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Aydin Tekay
- Department of Obstetrics and GynecologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Ganesh Acharya
- Division of Obstetrics & Gynecology, Department of Clinical ScienceIntervention and Technology (CLINTEC), Karolinska InstitutetStockholmSweden,Women's Health and Perinatology Research Group, Department of Clinical MedicineUiT ‐ The Arctic University of NorwayTromsøNorway
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12
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Lebherz L, Fraune E, Thomalla G, Frese M, Appelbohm H, Rimmele DL, Härter M, Kriston L. Implementability of collecting patient-reported outcome data in stroke unit care - a qualitative study. BMC Health Serv Res 2022; 22:346. [PMID: 35292028 PMCID: PMC8925160 DOI: 10.1186/s12913-022-07722-y] [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: 06/16/2021] [Accepted: 02/23/2022] [Indexed: 12/02/2022] Open
Abstract
Background Patient-reported outcome measures (PROMs) assess patient-relevant effects of medical treatments. We aimed to evaluate the implementation of the International Consortium for Health Outcomes Measurement Standard Set for Stroke (ICHOM-SSS) into routine inpatient care of a stroke unit. Methods The ICHOM-SSS was administered in a certified stroke unit during and after inpatient care. Semi-structured interviews with medical staff (n = 5) and patients or their proxies (n = 19) about their experience were audio-recorded and analysed using thematic analyses. Implementation outcomes were chosen in advance and adhered to current standards of implementation science. Results Patients perceived the ICHOM-SSS to be relevant and feasible. They reported limited understanding of why the assessment was introduced. The overall acceptance of using PROMs was high. While medical staff, too, perceived the assessment to be appropriate and relevant, their appraisal of feasibility, sustainability, and their acceptance of the implementation were low. Conclusions For a sustainable implementation of PROMs in clinical practice, IT resources need to be adapted, medical care needs to be reorganized, and additional clinical resources are required. Future research should investigate benefits of the ICHOM-SSS and a simpler, automated implementation in stroke care. Trial registration ClinicalTrials.gov Identifier: NCT03795948, retrospectively registered on 8 January 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07722-y.
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Affiliation(s)
- Lisa Lebherz
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
| | - Elisa Fraune
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Marc Frese
- Office for Quality Management and Clinical Process Management, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Hannes Appelbohm
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - David Leander Rimmele
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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13
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Process Mining for Healthcare: Characteristics and Challenges. J Biomed Inform 2022; 127:103994. [DOI: 10.1016/j.jbi.2022.103994] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/16/2021] [Accepted: 01/10/2022] [Indexed: 12/23/2022]
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Rosenlund L, Jakobsson S, Lloyd H, Lundgren-Nilsson Å, Hermansson M, Dencker A. Measuring patient experiences of person-centred care: Translation, cultural adaption and qualitative evaluation of item candidates for use in England and Sweden. Scand J Caring Sci 2021; 36:235-244. [PMID: 33942913 DOI: 10.1111/scs.12982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 03/01/2021] [Accepted: 03/07/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND To facilitate change for person-centred care, there is a need to invest in measures to assess if and how healthcare systems are delivering care based on the principles of person-centred care. This paper describes the first phase in developing an item bank to measure patients' experiences of person-centred care. AIM The aim was to translate, culturally adapt and evaluate candidate items to measure person-centred care from the patient's perspective. METHODS The Centre for person-centred care at Gothenburg university and the UK Person-centred and coordinated care model informed our conceptual framework. The initial pool of item candidates originated from a previous systematic review where 855 items were identified. In this study, a mixed method design was used involving persons with experience as patients, caregivers, healthcare professionals and researchers in person-centred care or questionnaire design (n = 84). The item analysis included two validation rounds using web questionnaires, a focus group and cognitive interviews. RESULTS From the initial pool, 155 items covering core domains and subdomains of person-centred and coordinated care were selected for translation and qualitative item analysis. After translation, 44 items were excluded (duplicates). After the first validation round, 21 items were rephrased and 35 were excluded (due to low ratings, lack of comprehensibility, were duplicates or too specifically phrased). To reflect the ethical basis of person-centred care, rewordings were also made to encompass the patient as an active partner in care and where communication and information goes two-ways and care is co-created. After the second round, 11 items were rephrased and 25 items were excluded (for being redundant/repetitive). Six new items were added (covering access to care, patient capabilities, mental well-being and identifying goals). CONCLUSION We have developed a first set of 57 items to proceed towards developing an item bank to measure the patient experiences of person-centred care.
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Affiliation(s)
- Lena Rosenlund
- Centre for Person-Centred Care (GPCC, Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sofie Jakobsson
- Centre for Person-Centred Care (GPCC, Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Helen Lloyd
- Centre for Person-Centred Care (GPCC, Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,School of Psychology, University of Plymouth, Plymouth, UK
| | - Åsa Lundgren-Nilsson
- Centre for Person-Centred Care (GPCC, Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Institute of Neuroscience and Physiology, Rehabilitation Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Miriam Hermansson
- Centre for Person-Centred Care (GPCC, Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Anna Dencker
- Centre for Person-Centred Care (GPCC, Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Molima CEN, Karemere H, Bisimwa G, Makali S, Mwene-Batu P, Malembaka EB, Macq J. Barriers and facilitators in the implementation of bio-psychosocial care at the primary healthcare level in South Kivu, Democratic Republic of Congo. Afr J Prim Health Care Fam Med 2021; 13:e1-e10. [PMID: 33881334 PMCID: PMC8063565 DOI: 10.4102/phcfm.v13i1.2608] [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: 06/11/2020] [Revised: 10/24/2020] [Accepted: 12/30/2020] [Indexed: 11/17/2022] Open
Abstract
Background In the Democratic Republic of Congo (DRC), healthcare services are still focused on disease control and mortality reduction in specific groups. The need to broaden the scope from biomedical criteria to bio-psychosocial (BPS) dimensions has been increasingly recognized. Aim The objective of this study was to identify the barriers and facilitators to providing healthcare at the health centre (HC) level to enable BPS care. Settings This qualitative study was conducted in six HCs (two urban and four rural) in South-Kivu (eastern DRC) which were selected based on their accessibility and their level of primary healthcare organization. Methods Seven focus group discussions (FGDs) involving 29 healthcare workers were organized. A data synthesis matrix was created based on the Rainbow Model framework. We identified themes related to plausible barriers and facilitators for BPS approach. Results Our study reports barriers common to a majority of HCs: misunderstanding of BPS care by healthcare workers, home visits mainly used for disease control, solidarity initiatives not locally promoted, new resources and financial incentives expected, accountability summed up in specific indicators reporting. Availability of care teams and accessibility to patient information were reported as facilitators to change. Conclusion This analysis highlighted major barriers that condition providers’ mindset and healthcare provision at the primary care level in South-Kivu. Accessibility to the information regarding BPS status of individuals within the community, leadership of HC authorities, dynamics of HC teams and local social support initiatives should be considered in order to develop an effective BPS approach in this region.
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Affiliation(s)
- Christian E N Molima
- École Régionale de Santé Publique (ERSP), Faculté de Médecine, Université Catholique de Bukavu, Bukavu, The Democratic Republic of Congo; and, Institute of Health and Society (IRSS), Ecole de Santé Publique, Université Catholique de Louvain, Brussels.
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Schick-Makaroff K, Karimi-Dehkordi M, Cuthbertson L, Dixon D, Cohen SR, Hilliard N, Sawatzky R. Using Patient- and Family-Reported Outcome and Experience Measures Across Transitions of Care for Frail Older Adults Living at Home: A Meta-Narrative Synthesis. THE GERONTOLOGIST 2021; 61:e23-e38. [PMID: 31942997 PMCID: PMC8023359 DOI: 10.1093/geront/gnz162] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Our aim was to create a "storyline" that provides empirical explanation of stakeholders' perspectives underlying the use of patient- and family-reported outcome and experience measures to inform continuity across transitions in care for frail older adults and their family caregivers living at home. RESEARCH DESIGN AND METHODS We conducted a meta-narrative synthesis to explore stakeholder perspectives pertaining to use of patient-reported outcome and experience measures (PROMs and PREMs) across micro (patients, family caregivers, and healthcare providers), meso (organizational managers/executives/programs), and macro (decision-/policy-makers) levels in healthcare. Systematic searches identified 9,942 citations of which 40 were included based on full-text screening. RESULTS PROMs and PREMS (54 PROMs; 4 PREMs; 1 with PROM and PREM elements; 6 unspecified PROMs) were rarely used to inform continuity across transitions of care and were typically used independently, rarely together (n = 3). Two overarching traditions motivated stakeholders' use. The first significant motivation by diverse stakeholders to use PROMs and PREMs was the desire to restore/support independence and care at home, predominantly at a micro-level. The second motivation to using PROMs and PREMs was to evaluate health services, including cost-effectiveness of programs and hospital discharge (planning); this focus was rarely at a macro-level and more often split between micro- and meso-levels of healthcare. DISCUSSION AND IMPLICATIONS The motivations underlying stakeholders' use of these tools were distinct, yet synergistic between the goals of person/family-centered care and healthcare system-level goals aimed at efficient use of health services. There is a missed opportunity here for PROMs and PREMs to be used together to inform continuity across transitions of care.
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Affiliation(s)
| | - Mehri Karimi-Dehkordi
- Department of Medicine and Community Health Sciences, University of Calgary, Vancouver
| | - Lena Cuthbertson
- Office of Patient-Centered Measurement, British Columbia, Ministry of Health, Vancouver
| | - Duncan Dixon
- Norma Marion Alloway Library, Trinity Western University, Langley
| | - S Robin Cohen
- Department of Oncology and Medicine, McGill University, Montréal
- Lady Davis Institute, Palliative Care Research, Montréal
| | | | - Richard Sawatzky
- School of Nursing, Trinity Western University, Langley
- Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, Vancouver, Canada
- Sahlgrenska Academy, University of Gothenburg, Sweden
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17
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Cox ED, Dobrozsi SK, Forrest CB, Gerhardt WE, Kliems H, Reeve BB, Rothrock NE, Lai JS, Svenson JM, Thompson LA, Tran TDN, Tucker CA. Considerations to Support Use of Patient-Reported Outcomes Measurement Information System Pediatric Measures in Ambulatory Clinics. J Pediatr 2021; 230:198-206.e2. [PMID: 33271193 PMCID: PMC7914197 DOI: 10.1016/j.jpeds.2020.11.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 11/19/2020] [Accepted: 11/24/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To identify challenges to the use of Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric measures in the ambulatory pediatric setting and possible solutions to these challenges. STUDY DESIGN Eighteen semistructured telephone interviews of health system leaders, measurement implementers, and ambulatory pediatric clinicians were conducted. Five coders used applied thematic analysis to iteratively identify and refine themes in interview data. RESULTS Most interviewees had roles in leadership or the implementation of patient-centered outcomes; 39% were clinicians. Some had experience using PROMIS clinically (44%) and 6% were considering this use. Analyses yielded 6 themes: (1) selection of PROMIS measures, (2) method of administration, (3) use of PROMIS Parent Proxy measures, (4) privacy and confidentiality of PROMIS responses, (5) interpretation of PROMIS scores, and (6) using PROMIS scores clinically. Within the themes, interviewees illuminated specific unique considerations for using PROMIS with children, including care transitions and privacy. CONCLUSIONS Real-world challenges continue to hamper PROMIS use. Ongoing efforts to disseminate information about the integration of PROMIS measures in clinical care is critical to impacting the health of children.
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Affiliation(s)
- Elizabeth D. Cox
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Sarah K. Dobrozsi
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | | | - Wendy E. Gerhardt
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center (retired), Cincinnati, OH
| | - Harald Kliems
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Bryce B. Reeve
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Nan E. Rothrock
- Departments of Medical Social Sciences, Psychiatry and Behavioral Sciences, and Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jin-Shei Lai
- Departments of Medical Social Sciences and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jacob M. Svenson
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Lindsay A. Thompson
- Departments of Pediatrics and Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL
| | - Thuy Dan N. Tran
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Carole A. Tucker
- Department of Health and Rehabilitation Sciences, Temple University College of Public Health, Philadelphia, PA
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Santana MJ, Tomkins DJ. Patient-led use of patient-reported outcome measure in self-Management of a Rotator Cuff Injury. J Patient Rep Outcomes 2021; 5:8. [PMID: 33439372 PMCID: PMC7806676 DOI: 10.1186/s41687-020-00283-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 12/29/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The patient is the person who experiences both the processes and the outcomes of care. Information held by the patient is vital for clinical and self-management, improving health outcomes, delivery of care, organization of health systems, and formulation of health policies. Patient-reported outcome measures (PROMs) play an important role in supporting patient's self-management. This narrative describes a patient-led use of a PROM to self-manage after a rotator cuff injury. METHODS This is a narrative of a patient who tore the supraspinatus tendon in her right shoulder in an accident. The Disabilities of the Arm, Shoulder and Hand, the DASH questionnaire, was used to monitor and self-manage recovery after the accident. The DASH questionnaire is a self-reported questionnaire that measures the difficulty in performing upper extremity activities and pain in the arm, shoulder or hand. It has been widely used in research studies, but here the patient initiated its use for self-management while waiting for and after rotator cuff surgery. The patient created separate sub-scale scores for function and for pain to answer questions from healthcare providers about her recovery. RESULTS There was noticeable improvement over 3 months of conservative treatment, from a high level of disability of 56 to 39 (score changed 17); however, the scores were nowhere near the general population normative score of 10.1. Surgery improved the score from 39 pre-surgery to 28. Post-surgical interventions included physiotherapy, pain management and platelet-riched plasma treatment (PRP). The score was 14 4 weeks post-PRP. CONCLUSIONS The patient found the DASH useful in monitoring recovery from a rotator cuff injury (before and after surgery). The DASH contributed to communication with healthcare professionals and supported the clinical management. The DASH questionnaire was able to capture the patient's experience with the injury and surgical recovery, corroborating an improvement in function while there was persistent post-surgical pain.
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Affiliation(s)
- Maria J. Santana
- Departments of Pediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, TRW Building, 3rd Floor, Calgary, Alberta T2N 4Z6 Canada
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Papadimitriou C, Caddick N, Stone DA. Re-thinking patient motivation in clinical rehabilitation encounters: insights from different theoretical perspectives. QUALITATIVE RESEARCH IN PSYCHOLOGY 2021. [DOI: 10.1080/14780887.2018.1464090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
| | - Nick Caddick
- Veterans and Families Institute & Anglia Ruskin University, Chelmsford Campus, Chelmsford, United Kingdom
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20
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Thestrup Hansen S, Kjerholt M, Friis Christensen S, Brodersen J, Hølge-Hazelton B. User experiences on implementation of patient reported outcome measures (PROMs)in a Haematological outpatient clinic. J Patient Rep Outcomes 2020; 4:87. [PMID: 33113030 PMCID: PMC7593370 DOI: 10.1186/s41687-020-00256-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 10/11/2020] [Indexed: 12/26/2022] Open
Abstract
Background PROMs can help healthcare professionals gain an improved understanding of patients’ physical burdens, functional levels, and (health-related) quality of life throughout disease and medical treatment. The aim of this study was to investigate the barriers and potential opportunities PROMs may present in a haematological outpatient clinic from three different perspectives: patients, nurses and haematologists. Methods The present study synthesizes three previously published studies that separately explored the experiences of patients, nurses and haematologists when implementing PROMs. The studies were all guided by the qualitative methodology Interpretive Description, including a focused ethnographic approach, to develop implications for future practice. Results The overall themes that emerged from the analysis were “Structural similarities influence the adoption of PROMs” and “Different perspectives on the potential of PROMs.” Conclusion Across the different user groups in the haematological outpatient clinic, the use of PROMs was thwarted due to an unquestioned commitment to biomedical knowledge and the system’s rationality and norms: PROM data was not used in patient consultations. Nurses and haematologists expressed different preferences related to potential future PROMs and different objectives for PROMs in clinical practice. From the different perspectives of the patients, nurses and haematologists, PROMs were not compatible with clinical practice. Further research is recommended to develop PROMs validated for use in haematological outpatient clinics. Moreover, implementation strategies adjusted to the structural barriers of the system are crucial. Supplementary information Supplementary information accompanies this paper at 10.1186/s41687-020-00256-z.
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Affiliation(s)
- Stine Thestrup Hansen
- Department of Haematology, Zealand University Hospital, Vestermarksvej 9, 1.sal, 4000, Roskilde, Denmark. .,Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark. .,Department of Plastic Surgery and Breast Surgery, Zealand University Hospital, Roskilde, Denmark.
| | - Mette Kjerholt
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Sarah Friis Christensen
- Department of Haematology, Zealand University Hospital, Vestermarksvej 9, 1.sal, 4000, Roskilde, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - John Brodersen
- Section of General Practice and Research Unit for General practice, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Primary Health Care Research Unit, Zealand Region, Denmark
| | - Bibi Hølge-Hazelton
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,The Research Support Unit, Zealand University Hospital, Roskilde, Denmark
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Perazzo MF, Serra-Negra JM, Firmino RT, Pordeus IA, Martins-JÚnior PA, Paiva SM. Patient-centered assessments: how can they be used in dental clinical trials? Braz Oral Res 2020; 34 Suppl 2:e075. [PMID: 32785488 DOI: 10.1590/1807-3107bor-2020.vol34.0075] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 09/22/2019] [Indexed: 11/22/2022] Open
Abstract
Recently, there has been greater interest in adopting a more holistic approach to healthcare. However, this trend should not limit itself merely to the notion that a human being lies behind the mouth being treated. Rather, it should embrace the understanding that this human can actively participate in and contribute to the treatment process. Patient Report Outcome Measures (PROMs) and Patient Report Experience Measures (PREMs) provide means for measuring data from the patient's perspective, and enable health-related feelings and functions to be evaluated. Accordingly, this critical review aims to provide definitions, rationales and applications of patient-centered approaches in dental clinical research. Some patient-centered constructs are especially relevant to dental clinical trials, such as oral health-related quality of life, pain/discomfort, aesthetics and satisfaction concerning treatment and services. The selection and application of patient-reported measures can vary according to condition (generic, disease-specific or treatment-specific) and to the specific population evaluated (age and cognitive impairment). These measures can help weigh risks and benefits, as well as assess the cost effectiveness of treatments, thus influencing treatment recommendations and health policies. The incorporation of these measures into a professional's daily life not only represents an improvement in professional performance, but also addresses a humanitarian concern.
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Affiliation(s)
- Matheus França Perazzo
- Department of Pediatric Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Júnia Maria Serra-Negra
- Department of Pediatric Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Ramon Targino Firmino
- Department of Pediatric Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Isabela Almeida Pordeus
- Department of Pediatric Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Paulo Antônio Martins-JÚnior
- Department of Pediatric Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Saul Martins Paiva
- Department of Pediatric Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Value Lies in the Eye of the Patients: The Why, What, and How of Patient-reported Outcomes Measures. Clin Ther 2020; 42:25-33. [DOI: 10.1016/j.clinthera.2019.11.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 11/23/2019] [Accepted: 11/27/2019] [Indexed: 12/22/2022]
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Bele S, Chugh A, Mohamed B, Teela L, Haverman L, Santana MJ. Patient-Reported Outcome Measures in Routine Pediatric Clinical Care: A Systematic Review. Front Pediatr 2020; 8:364. [PMID: 32850521 PMCID: PMC7399166 DOI: 10.3389/fped.2020.00364] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/01/2020] [Indexed: 01/23/2023] Open
Abstract
Introduction: Integration of patient-reported outcome measures (PROMs) in routine clinical care is growing but lacks consolidated evidence around its impact on pediatric care. This systematic review aims to evaluate the impact of integrating PROMs in routine pediatric clinical care on various outcomes in pediatric clinical care. Data Sources: MEDLINE, Embase, CINAHL, PsycINFO, and Cochrane Library. Web of Science database was searched selectively to ensure extended coverage. Study Selection: We included longitudinal studies reporting on the integration of PROMs in routine pediatric clinical care of chronic diseases. Studies in languages other than English, published prior to the year 2000, and reporting on secondary data were excluded. Data Extraction: Two reviewers independently extracted data from included studies. Extracted data included citation of each study, type of healthcare setting, location of the study, characteristics of patient population, type of chronic disease, name and type of PROM, mode of administration, and reported outcomes. Results: Out of 6,869 articles, titles and abstracts of 5,416 articles and full text of 23 articles were screened in duplicate. Seven articles reporting results from six studies met eligibility criteria. Integration of PROMs increased the identification and discussion around health-related quality of life (HRQOL), especially in psychosocial and emotional domains, but showed mixed results with the impact on quality of care. No studies assessed the impact of integrating PROMs on healthcare utilization. Limitations: Due to significant heterogeneity in the studies, a meta-analysis was not conducted. Conclusions: Integrating PROMs could have a positive impact on HRQOL; however, further studies are required to determine the impact of PROMs in routine pediatric clinical care.
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Affiliation(s)
- Sumedh Bele
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Postgraduate Medical Education, Harvard Medical School, Harvard University, Boston, MA, United States
| | - Ashton Chugh
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Bijan Mohamed
- School of Physical Therapy, Western University, London, ON, Canada
| | - Lorynn Teela
- Psychosocial Department, Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Lotte Haverman
- Psychosocial Department, Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Maria J Santana
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Experienced Quality of Post-Acute and Long-Term Care From the Care Recipient's Perspective–A Conceptual Framework. J Am Med Dir Assoc 2019; 20:1386-1390.e1. [DOI: 10.1016/j.jamda.2019.03.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/18/2019] [Accepted: 03/22/2019] [Indexed: 11/18/2022]
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25
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Alwashmi MF, Fitzpatrick B, Davis E, Gamble JM, Farrell J, Hawboldt J. Perceptions of Health Care Providers Regarding a Mobile Health Intervention to Manage Chronic Obstructive Pulmonary Disease: Qualitative Study. JMIR Mhealth Uhealth 2019; 7:e13950. [PMID: 31199330 PMCID: PMC6592475 DOI: 10.2196/13950] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/12/2019] [Accepted: 05/29/2019] [Indexed: 12/12/2022] Open
Abstract
Background Using a mobile health (mHealth) intervention, consisting of a smartphone and compatible medical device, has the potential to enhance chronic obstructive pulmonary disease (COPD) treatment outcomes while mitigating health care costs. Objective The aim of this study was to explore the potential facilitators and barriers among health care providers (HCPs) regarding the use of mHealth interventions for COPD management. Methods This was a qualitative study. Semistructured individual interviews were conducted with HCPs, including nurses, pharmacists, and physicians who work directly with patients with COPD. A flexible prompts guide was used to facilitate discussions. Interview topics included the following: demographics, mHealth usage, perceptions toward challenges of mHealth adoption, factors facilitating mHealth adoption, and preferences regarding features of the mHealth intervention for COPD management. Interviews were conversational in nature, and items were not asked verbatim or in the order presented. The interviews were transcribed verbatim and compared against the digital recordings to ensure the accuracy of the content. After creating a codebook for analysis, 2 researchers independently coded the remaining interview data using pattern coding. They discussed commonalities and differences in coding until a consensus was reached. Results A total of 30 nurses, physicians, and pharmacists participated. The main facilitators to mHealth adoption are possible health benefits for patients, ease of use, educating patients and their HCPs, credibility, and reducing cost to the health care system. Alternatively, the barriers to adoption are technical issues, privacy and confidentiality issues, lack of awareness, potential limited uptake from the elderly, potential limited connection between patients and HCPs, and finances. Conclusions It is important to understand the perceptions of HCPs regarding the adoption of innovative mHealth interventions for COPD management. This study identifies some potential facilitators and barriers that may inform the successful development and implementation of mHealth interventions for COPD management.
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Affiliation(s)
| | | | - Erin Davis
- Memorial University of Newfoundland, St John's, NL, Canada
| | - John-Michael Gamble
- School of Pharmacy, Faculty of Science, University of Waterloo, Waterloo, ON, Canada
| | - Jamie Farrell
- Memorial University of Newfoundland, St John's, NL, Canada
| | - John Hawboldt
- Memorial University of Newfoundland, St John's, NL, Canada
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Mourelatou I, Gaete J, Fewings S, Hickie O, Kyriakopoulos M. What Was Helpful Questionnaire (WHQ): Psychometric Properties of a Novel Tool Designed to Capture Parental Perceived Helpfulness of Interventions in Children Requiring Mental Health Inpatient Care. Front Psychiatry 2019; 10:80. [PMID: 30863325 PMCID: PMC6399118 DOI: 10.3389/fpsyt.2019.00080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 02/05/2019] [Indexed: 11/20/2022] Open
Abstract
Background: Children in mental health inpatient care require multiple treatments. There is not a comprehensive instrument to assess perceived helpfulness of this combination of interventions. Aims: To develop and evaluate the psychometric properties of the What was Helpful Questionnaire (WHQ), a tool designed to capture parental perceived helpfulness of the multidimensional management approach used in inpatient children's units. Methods: A total of 73 inpatients and their families were included in this study. The WHQ consists of six items exploring the perceived helpfulness of different aspects of care. Demographic and clinical variables were collected on admission and discharge. An exploratory factor analysis using polychoric correlations was performed to assess the item structure of the scale and the Cronbach's alpha coefficient was used for internal reliability. Associations were assessed using regressions models. Results: WHQ is a unidimensional scale with an internal reliability of 0.77. No associations were identified between WHQ total score and age, gender, and Children's Global Assessment Scale scores change. A strong relationship between the WHQ total score and parental Acorn Satisfaction Questionnaire total score was found. Conclusions: Results add evidence for the validity and the reliability of the WHQ to measure parental perceived helpfulness of interventions offered in inpatient children's units.
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Affiliation(s)
- Ifigeneia Mourelatou
- National and Specialist Acorn Lodge Inpatient Children's Unit, South London and Mausdley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, United Kingdom
| | - Jorge Gaete
- National and Specialist Acorn Lodge Inpatient Children's Unit, South London and Mausdley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, United Kingdom.,Department of Public Health and Epidemiology, Faculty of Medicine, Universidad de los Andes, Santiago, Chile
| | - Sandra Fewings
- National and Specialist Acorn Lodge Inpatient Children's Unit, South London and Mausdley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, United Kingdom
| | - Oona Hickie
- National and Specialist Acorn Lodge Inpatient Children's Unit, South London and Mausdley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, United Kingdom
| | - Marinos Kyriakopoulos
- National and Specialist Acorn Lodge Inpatient Children's Unit, South London and Mausdley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, United Kingdom.,Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Fernandes S, Fond G, Zendjidjian X, Michel P, Baumstarck K, Lancon C, Berna F, Schurhoff F, Aouizerate B, Henry C, Etain B, Samalin L, Leboyer M, Llorca PM, Coldefy M, Auquier P, Boyer L. The Patient-Reported Experience Measure for Improving qUality of care in Mental health (PREMIUM) project in France: study protocol for the development and implementation strategy. Patient Prefer Adherence 2019; 13:165-177. [PMID: 30718945 PMCID: PMC6345324 DOI: 10.2147/ppa.s172100] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Measuring the quality and performance of health care is a major challenge in improving the efficiency of a health system. Patient experience is one important measure of the quality of health care, and the use of patient-reported experience measures (PREMs) is recommended. The aims of this project are 1) to develop item banks of PREMs that assess the quality of health care for adult patients with psychiatric disorders (schizophrenia, bipolar disorder, and depression) and to validate computerized adaptive testing (CAT) to support the routine use of PREMs; and 2) to analyze the implementation and acceptability of the CAT among patients, professionals, and health authorities. METHODS This multicenter and cross-sectional study is based on a mixed method approach, integrating qualitative and quantitative methodologies in two main phases: 1) item bank and CAT development based on a standardized procedure, including conceptual work and definition of the domain mapping, item selection, calibration of the item bank and CAT simulations to elaborate the administration algorithm, and CAT validation; and 2) a qualitative study exploring the implementation and acceptability of the CAT among patients, professionals, and health authorities. DISCUSSION The development of a set of PREMs on quality of care in mental health that overcomes the limitations of previous works (ie, allowing national comparisons regardless of the characteristics of patients and care and based on modern testing using item banks and CAT) could help health care professionals and health system policymakers to identify strategies to improve the quality and efficiency of mental health care. TRIAL REGISTRATION NCT02491866.
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Affiliation(s)
- Sara Fernandes
- Aix-Marseille University, School of Medicine, CEReSS - Health Service Research and Quality of Life Center - EA 3279 Research Unit, Marseille, France, Email
| | - Guillaume Fond
- Aix-Marseille University, School of Medicine, CEReSS - Health Service Research and Quality of Life Center - EA 3279 Research Unit, Marseille, France, Email
| | - Xavier Zendjidjian
- Aix-Marseille University, School of Medicine, CEReSS - Health Service Research and Quality of Life Center - EA 3279 Research Unit, Marseille, France, Email
| | - Pierre Michel
- Aix-Marseille University, School of Medicine, CEReSS - Health Service Research and Quality of Life Center - EA 3279 Research Unit, Marseille, France, Email
| | - Karine Baumstarck
- Aix-Marseille University, School of Medicine, CEReSS - Health Service Research and Quality of Life Center - EA 3279 Research Unit, Marseille, France, Email
| | - Christophe Lancon
- Aix-Marseille University, School of Medicine, CEReSS - Health Service Research and Quality of Life Center - EA 3279 Research Unit, Marseille, France, Email
| | | | | | | | | | | | | | | | | | - Magali Coldefy
- Institute for Research and Information in Health Economics (IRDES), Paris, France
| | - Pascal Auquier
- Aix-Marseille University, School of Medicine, CEReSS - Health Service Research and Quality of Life Center - EA 3279 Research Unit, Marseille, France, Email
| | - Laurent Boyer
- Aix-Marseille University, School of Medicine, CEReSS - Health Service Research and Quality of Life Center - EA 3279 Research Unit, Marseille, France, Email
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van Leeuwen LM, Pronk M, Merkus P, Goverts ST, Anema JR, Kramer SE. Barriers to and enablers of the implementation of an ICF-based intake tool in clinical otology and audiology practice-A qualitative pre-implementation study. PLoS One 2018; 13:e0208797. [PMID: 30533057 PMCID: PMC6289452 DOI: 10.1371/journal.pone.0208797] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 11/26/2018] [Indexed: 12/03/2022] Open
Abstract
The authors are developing an intake tool based on the Brief International Classification of Functioning Disability and Health Core Set for Hearing Loss, by operationalizing its categories into a Patient Reported Outcome Measure. This study was aimed at identifying enablers and barriers to using this tool as perceived by hearing health professionals (HHPs) and patients. Focus groups and interviews were held with HHPs (ENT surgeons, N = 14; audiologists, N = 8) and patients (N = 18). Interview questions were based on the Capability-Opportunity-Motivation-Behavior (COM-B) model. Using the COM-B model and the Theoretical Domains Framework (TDF), transcript fragments were divided into meaning units, which were then categorized into capability-, opportunity- and motivation-related barriers and enablers. These were further specified into TDF domains. HHP barriers included: lack of time to use the tool (O); and fear of being made responsible for addressing any emerging problems, which may be outside the expertise of the HHP (M). Enablers included integration of the tool in the electronic patient record (O); opportunity for the patient to be better prepared for the intake visit (M); and provision of a complete picture of the patient’s functioning via the tool (M). Patient’ barriers included fear of losing personal contact with the HHP (M); and fear that use of the tool might negatively affect conversations with the HHP (M). Enablers included knowledge on the aim and relevance of the tool (C); expected better self-preparation (M); and a more focused intake (M). These findings suggest that an intervention is needed to enhance HHPs’ knowledge, skills and motivation regarding the relevance and the clinical usefulness of the tool. Providing clear and specific information on the purpose of the tool can also enhance patient motivation. For both HHPs and patients, opportunities relating to the (digital) administration and the design of the tool provide additional targets for successful implementation.
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Affiliation(s)
- Lisette M van Leeuwen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology-Head and Neck Surgery, Ear & Hearing, Amsterdam Public Health, De Boelelaan, Amsterdam, Netherlands
| | - Marieke Pronk
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology-Head and Neck Surgery, Ear & Hearing, Amsterdam Public Health, De Boelelaan, Amsterdam, Netherlands
| | - Paul Merkus
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology-Head and Neck Surgery, Ear & Hearing, Amsterdam Public Health, De Boelelaan, Amsterdam, Netherlands
| | - S Theo Goverts
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology-Head and Neck Surgery, Ear & Hearing, Amsterdam Public Health, De Boelelaan, Amsterdam, Netherlands
| | - Johannes R Anema
- Amsterdam UMC, Vrije Universiteit Amsterdam, Public and Occupational Health, Amsterdam Public Health, De Boelelaan, Amsterdam, Netherlands
| | - Sophia E Kramer
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology-Head and Neck Surgery, Ear & Hearing, Amsterdam Public Health, De Boelelaan, Amsterdam, Netherlands
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Greenhalgh J, Gooding K, Gibbons E, Dalkin S, Wright J, Valderas J, Black N. How do patient reported outcome measures (PROMs) support clinician-patient communication and patient care? A realist synthesis. J Patient Rep Outcomes 2018; 2:42. [PMID: 30294712 PMCID: PMC6153194 DOI: 10.1186/s41687-018-0061-6] [Citation(s) in RCA: 273] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 07/09/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In this paper, we report the findings of a realist synthesis that aimed to understand how and in what circumstances patient reported outcome measures (PROMs) support patient-clinician communication and subsequent care processes and outcomes in clinical care. We tested two overarching programme theories: (1) PROMs completion prompts a process of self-reflection and supports patients to raise issues with clinicians and (2) PROMs scores raise clinicians' awareness of patients' problems and prompts discussion and action. We examined how the structure of the PROM and care context shaped the ways in which PROMs support clinician-patient communication and subsequent care processes. RESULTS PROMs completion prompts patients to reflect on their health and gives them permission to raise issues with clinicians. However, clinicians found standardised PROMs completion during patient assessments sometimes constrained rather than supported communication. In response, clinicians adapted their use of PROMs to render them compatible with the ongoing management of patient relationships. Individualised PROMs supported dialogue by enabling the patient to tell their story. In oncology, PROMs completion outside of the consultation enabled clinicians to identify problematic symptoms when the PROM acted as a substitute rather than addition to the clinical encounter and when the PROM focused on symptoms and side effects, rather than health related quality of life (HRQoL). Patients did not always feel it was appropriate to discuss emotional, functional or HRQoL issues with doctors and doctors did not perceive this was within their remit. CONCLUSIONS This paper makes two important contributions to the literature. First, our findings show that PROMs completion is not a neutral act of information retrieval but can change how patients think about their condition. Second, our findings reveal that the ways in which clinicians use PROMs is shaped by their relationships with patients and professional roles and boundaries. Future research should examine how PROMs completion and feedback shapes and is influenced by the process of building relationships with patients, rather than just their impact on information exchange and decision making.
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Affiliation(s)
- Joanne Greenhalgh
- School of Sociology and Social Policy, University of Leeds, Woodhouse Lane, Leeds, LS2 9JT England
| | - Kate Gooding
- School of Sociology and Social Policy, University of Leeds, Woodhouse Lane, Leeds, LS2 9JT England
- Present address: Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA UK
| | - Elizabeth Gibbons
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF UK
| | - Sonia Dalkin
- School of Sociology and Social Policy, University of Leeds, Woodhouse Lane, Leeds, LS2 9JT England
- Present address: Department of Social Work, Education & Community Wellbeing, Northumbria University, H005, Coach Lane Campus East, Newcastle upon Tyne, NE7 7XA England
| | - Judy Wright
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Clarendon Way, Leeds, LS2 9NL England
| | - Jose Valderas
- Health Services and Policy Research, Exeter Medical School, University of Exeter, St Luke’s Campus, Heavitree Road, Exeter, EX1 2LU England
| | - Nick Black
- Health Services Research, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH England
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Mejdahl CT, Schougaard LMV, Hjollund NH, Riiskjær E, Thorne S, Lomborg K. PRO-based follow-up as a means of self-management support - an interpretive description of the patient perspective. J Patient Rep Outcomes 2018; 2:38. [PMID: 30238083 PMCID: PMC6125260 DOI: 10.1186/s41687-018-0067-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 08/20/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND There is an increasing focus on the use of patient-reported outcome (PRO) measures to improve the quality and effectiveness of health care. PRO-based follow-up is a new model of service delivery, where the patient's PRO measures are used as the very basis for outpatient follow-up. OBJECTIVES This study aimed to explore how patients with epilepsy experience the use of PRO-based follow-up in three outpatient clinics in the Central Denmark Region. We also sought to explain how these experiences relate to self-management. METHODS Interpretive description was the methodological approach. We conducted in-depth individual interviews with 29 patients referred to PRO-based follow-up, each of whom had completed at least two PRO questionnaires. Participants were sampled based on purposive and theoretical sampling. RESULTS PRO-based follow-up may support patients' self-management by a) increasing awareness of psychosocial problems, b) improving communication, c) increasing understanding of symptoms, d) facilitating change in health behavior and e) strengthening autonomy. Inhibitors for PRO measures as a means of self-management support were identified as a) feelings of rejection and disconnection, b) incomprehension of purpose of PRO-based follow-up, c) PRO measures being too standardized and negative and d) lack of confidence in own ability to assess PRO questionnaires. CONCLUSION The findings demonstrate broad variation in the influences of PRO measures on patient's self-management in life with epilepsy. Sense of ownership may explain this variation. We suggest supplementary clinical initiatives in order to enhance the benefits from PRO-based follow-up, particularly on how patients are allocated to this health care service.
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Affiliation(s)
- Caroline Trillingsgaard Mejdahl
- Department of Public Health, Aarhus University, Bartholins Allé 2, DK-8000 Aarhus, Denmark
- The Research Program in Patient Involvement, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus, Denmark
| | - Liv Marit Valen Schougaard
- WestChronic, Occupational Medicine, University Research Clinic, Aarhus University, Herning, Gl Landevej 61, DK-7400 Herning, Denmark
| | - Niels Henrik Hjollund
- WestChronic, Occupational Medicine, University Research Clinic, Aarhus University, Herning, Gl Landevej 61, DK-7400 Herning, Denmark
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45. DK-8200 Aarhus N, Aarhus, Denmark
| | - Erik Riiskjær
- DEFACTUM, Social & Health Services and Labour Market, Central Denmark Region, Olof Palmes Allé 15, DK-8200 Aarhus, Denmark
| | - Sally Thorne
- University of British Columbia School of Nursing, 2211 Wesbrook Mall, Vancouver, BC V6T 2B5 Canada
| | - Kirsten Lomborg
- The Research Program in Patient Involvement, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, DK-8200 Aarhus, Denmark
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Faraut B, Malmartel A, Ghosn J, Duracinsky M, Leger D, Grabar S, Viard JP. Sleep Disturbance and Total Sleep Time in Persons Living with HIV: A Cross-Sectional Study. AIDS Behav 2018; 22:2877-2887. [PMID: 29855973 DOI: 10.1007/s10461-018-2179-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Short and long sleep durations have been associated with inflammation and chronic diseases. To study the association between sleep duration/quality and HIV disease severity, a cross-sectional study was conducted in patients living with HIV (PLWHs) using self-administered questionnaires assessing total sleep time, insomnia (ICSD-3 criteria), and poor sleep quality (PSQI > 5). Multivariable logistic regression identified the factors associated with sleep disorders and with HIV features. 640 Parisian ambulatory PLWHs were included. The prevalence of insomnia was 50 and 68% of patients had a PSQI > 5. Patients with CD4 count < 500 cells/mm3 were more likely to be long sleepers (> 8 h/day) (OR 1.49; 95% CI [1.10-1.99]: p < 0.01), and less likely to be short sleepers (< 6 h/day) (OR 0.69; 95% CI[0.50-0.96]; p = 0.04) or to experience insomnia (OR 0.59; 95% CI[0.40-0.86]; p < 0.01). HIV features were not associated with a PSQI > 5. Thus, insomnia and impaired sleep quality were highly prevalent in well-controlled PLWHs and the severity of HIV infection was associated with long sleep times.
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Mejdahl CT, Schougaard LMV, Hjollund NH, Riiskjær E, Lomborg K. Exploring organisational mechanisms in PRO-based follow-up in routine outpatient care - an interpretive description of the clinician perspective. BMC Health Serv Res 2018; 18:546. [PMID: 30001729 PMCID: PMC6044066 DOI: 10.1186/s12913-018-3352-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 07/03/2018] [Indexed: 11/12/2022] Open
Abstract
Background Patient-reported outcome (PRO)-based follow-up is a new model of service delivery, where PRO measures are used as the very basis for demand-driven outpatient follow-up in patients with chronic diseases. Adopting the clinicians’ perspective, we aimed to explore what happens when PRO-based follow-up is implemented in routine clinical practice. We also aimed to identify organisational mechanisms related to PRO-based follow-up. Methods The methodological approach of this interview study is interpretive description, informed by a perspective of critical realism. Semi-structured interviews were conducted with 13 clinicians (eight nurses and five physicians) working with PRO-based follow-up in outpatient care for epilepsy in the Central Denmark Region. Results PRO-based follow-up gave rise to ambivalence in clinicians. Seen from the clinicians’ perspective, PRO-based follow-up could both increase and decrease the quality of follow-up. Moreover, PRO-based follow-up both enhanced and impaired clinicians’ work experiences. Additionally, the clinicians used strategies to ease some of the perceived disadvantages. The clinicians did extra tasks and worked around the scope of PRO-based follow-up. Thus, clinicians constituted a professional buffer as they deflected some of the negative mechanisms associated with PRO-based follow-up. Conclusions As a model of a service delivery, PRO-based follow-up is highly dependent on the clinicians’ day-to-day management of the system, and mechanisms related to routine use of PRO measures in outpatient follow-up are complex. Paying attention to the organisational settings is critical for PRO-based follow-up to improve quality of care and enhance patient-centred care. Electronic supplementary material The online version of this article (10.1186/s12913-018-3352-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Caroline Trillingsgaard Mejdahl
- Department of Public Health, Aarhus University, Bartholins Allé 2, DK-8000, Aarhus, C, Denmark. .,The Research Program in Patient Involvement, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus, N, Denmark.
| | - Liv Marit Valen Schougaard
- WestChronic, Occupational Medicine, University Research Clinic, Aarhus University, Herning Gl Landevej 61, DK-7400, Herning, Denmark
| | - Niels Henrik Hjollund
- WestChronic, Occupational Medicine, University Research Clinic, Aarhus University, Herning Gl Landevej 61, DK-7400, Herning, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Olof Palmes Allé 43-45, DK-8200, Aarhus, N, Denmark
| | - Erik Riiskjær
- DEFACTUM, Social & Health Services and Labour Market, Central Denmark Region, Olof Palmes Allé 15, DK-8200, Aarhus, N, Denmark
| | - Kirsten Lomborg
- The Research Program in Patient Involvement, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus, N, Denmark.,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, DK-8200, Aarhus, N, Denmark
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Ferreira RJO, Duarte C, Ndosi M, de Wit M, Gossec L, da Silva JAP. Suppressing Inflammation in Rheumatoid Arthritis: Does Patient Global Assessment Blur the Target? A Practice-Based Call for a Paradigm Change. Arthritis Care Res (Hoboken) 2018; 70:369-378. [PMID: 28544615 DOI: 10.1002/acr.23284] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 05/16/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE In current management paradigms of rheumatoid arthritis (RA), patient global assessment (PGA) is crucial to decide whether a patient has attained remission (target) or needs reinforced therapy. We investigated whether the clinical and psychological determinants of PGA are appropriate to support this important role. METHODS This was a cross-sectional, single-center study including consecutive ambulatory RA patients. Data collection comprised swollen 28-joint count (SJC28), tender 28-joint count (TJC28), C-reactive protein (CRP) level, PGA, pain, fatigue, function, anxiety, depression, happiness, personality traits, and comorbidities. Remission was categorized using American College of Rheumatology/European League Against Rheumatism Boolean-based criteria: remission, near-remission (only PGA >1), and nonremission. A binary definition without PGA (3v-remission) was also studied. Univariable and multivariable analyses were used to identify explanatory variables of PGA in each remission state. RESULTS A total of 309 patients were included (remission 9.4%, near-remission 37.2%, and nonremission 53.4%). Patients in near-remission were indistinguishable from remission regarding disease activity, but described a disease impact similar to those in nonremission. In multivariable analyses, PGA in near-remission was explained (R2adjusted = 0.50) by fatigue, pain, anxiety, and function. Fatigue and pain had no relationship with disease activity measures. CONCLUSION In RA, a consensually acceptable level of disease activity (SJC28, TJC28, and CRP level ≤1) does not equate to low disease impact: a large proportion of these patients are considered in nonremission solely due to PGA. PGA mainly reflects fatigue, pain, function, and psychological domains, which are inadequate to define the target for immunosuppressive therapy. This consideration suggests that clinical practice should be guided by 2 separate remission targets: inflammation (3v-remission) and disease impact.
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Affiliation(s)
- Ricardo J O Ferreira
- Centro Hospitalar e Universitário de Coimbra and Health Sciences Research Unit: Nursing, Coimbra, Portugal
| | - Cátia Duarte
- Centro Hospitalar e Universitário de Coimbra and University of Coimbra, Coimbra, Portugal
| | | | - Maarten de Wit
- Patient research partner, EULAR Standing Committee of People with Arthritis/Rheumatism in Europe, Zurich, Switzerland, and VU University Medical Centre, Amsterdam, The Netherlands
| | - Laure Gossec
- Sorbonne Universités, UPMC University Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS), and AP-HP, Pitié-Salpetrière Hospital, Paris, France
| | - J A P da Silva
- Centro Hospitalar e Universitário de Coimbra and University of Coimbra, Coimbra, Portugal
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Tang E, Bansal A, Novak M, Mucsi I. Patient-Reported Outcomes in Patients with Chronic Kidney Disease and Kidney Transplant-Part 1. Front Med (Lausanne) 2018; 4:254. [PMID: 29379784 PMCID: PMC5775264 DOI: 10.3389/fmed.2017.00254] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 12/21/2017] [Indexed: 01/31/2023] Open
Abstract
Chronic kidney disease (CKD) is a complex medical condition that is associated with several comorbidities and requires comprehensive medical management. Given the chronic nature of the condition, its frequent association with psychosocial distress, and its very significant symptom burden, the subjective patient experience is key toward understanding the true impact of CKD on the patients’ life. Patient-reported outcome measures are important tools that can be used to support patient-centered care and patient engagement during the complex management of patients with CKD. The routine collection and use of patient-reported outcomes (PROs) in clinical practice may improve quality of care and outcomes, and may provide useful data to understand the disease from both an individual and a population perspective. Many tools used to measure PROs focus on assessing health-related quality of life, which is significantly impaired among patients with CKD. Health-related quality of life, in addition to being an important outcome itself, is associated with clinical outcomes such as health care use and mortality. In Part 1 of this review, we provide an overview of PROs and implications of their use in the context of CKD. In Part 2, we will review the selection of appropriate measures and the relevant domains of interest for patients with CKD.
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Affiliation(s)
- Evan Tang
- Multi-Organ Transplant Program, Division of Nephrology, University Health Network, Toronto, ON, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Aarushi Bansal
- Multi-Organ Transplant Program, Division of Nephrology, University Health Network, Toronto, ON, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Marta Novak
- Centre for Mental Health, University Health Network, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Istvan Mucsi
- Multi-Organ Transplant Program, Division of Nephrology, University Health Network, Toronto, ON, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
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de Freitas C, dos Reis V, Silva S, Videira PA, Morava E, Jaeken J. Public and patient involvement in needs assessment and social innovation: a people-centred approach to care and research for congenital disorders of glycosylation. BMC Health Serv Res 2017; 17:682. [PMID: 28950866 PMCID: PMC5615629 DOI: 10.1186/s12913-017-2625-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 09/18/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Public and patient involvement in the design of people-centred care and research is vital for communities whose needs are underserved, as are people with rare diseases. Innovations devised collectively by patients, caregivers, professionals and other members of the public can foster transformative change toward more responsive services and research. However, attempts to involve lay and professional stakeholders in devising community-framed strategies to address the unmet needs of rare diseases are lacking. In this study, we engaged with the community of Congenital Disorders of Glycosylation (CDG) to assess its needs and elicit social innovations to promote people-centred care and research. METHODS Drawing on a qualitative study, we conducted three think tanks in France with a total of 48 participants, including patients/family members (n = 18), health care professionals (n = 7), researchers (n = 7) and people combining several of these roles (n = 16). Participants came from 20 countries across five continents. They were selected from the registry of the Second World Conference on CDG through heterogeneity and simple random sampling. Inductive and deductive approaches were employed to conduct interpretational analysis using open, axial and selective coding, and the constant-comparison method to facilitate the emergence of categories and core themes. RESULTS The CDG community has unmet needs for information, quality health care, psychosocial support and representation in decision-making concerned with care and research. According to participants, these needs can be addressed through a range of social innovations, including peer-support communities, web-based information resources and a CDG expertise platform. CONCLUSION This is one of the few studies to engage lay and professional experts in needs assessment and innovation for CDG at a global level. Implementing the innovations proposed by the CDG community is likely to have ethical, legal and social implications associated with the potential donation of patients' clinical and biological material that need to be assessed and regulated with involvement from all stakeholders. To promote people-centred care for the CDG community, and increase its participation in the governance of care and research, it is necessary to create participatory spaces in which the views of people affected by CDG can be fully expressed.
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Affiliation(s)
- Cláudia de Freitas
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Institutional address 1: Rua das Taipas 135, 4050-600, Porto, Portugal
- Centre for Research and Studies in Sociology - University Institute of Lisbon, Porto, Portugal
- Institutional address 2: Avenida das Forças Armadas, 1649-026, Lisbon, Portugal
| | - Vanessa dos Reis
- Founder of the Portuguese Association for CDG (APCDG), Porto, Portugal
- Institutional address: Rua Manuel da Fonseca 46, 2820-389, Almada, Portugal
| | - Susana Silva
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Institutional address 1: Rua das Taipas 135, 4050-600, Porto, Portugal
| | - Paula A. Videira
- Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa, Lisbon, Portugal
- Institutional address: Glycoimmunology group Lab 3.19 - Departamento Ciências da Vida (Ed Departamental), Faculdade de Ciências e Tecnologia, 2829-516 Caparica, Portugal
| | - Eva Morava
- School of Medicine, Tulane University, New Orleans, USA
- Institutional address: Hayward Genetics Center SL#31, Tulane University Medical School, 1430 Tulane Ave, New Orleans, LA 70112 USA
| | - Jaak Jaeken
- Department of Pediatrics, Center for Metabolic Disease, University Hospital Gasthuisberg, Leuven, Belgium
- Institutional Address: Herestraat 49, 3000, Leuven, Belgium
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Noonan VK, Lyddiatt A, Ware P, Jaglal SB, Riopelle RJ, Bingham CO, Figueiredo S, Sawatzky R, Santana M, Bartlett SJ, Ahmed S. Montreal Accord on Patient-Reported Outcomes (PROs) use series – Paper 3: patient-reported outcomes can facilitate shared decision-making and guide self-management. J Clin Epidemiol 2017; 89:125-135. [DOI: 10.1016/j.jclinepi.2017.04.017] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 04/05/2017] [Accepted: 04/09/2017] [Indexed: 01/17/2023]
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Dvorak MF, Cheng CL, Fallah N, Santos A, Atkins D, Humphreys S, Rivers CS, White BA, Ho C, Ahn H, Kwon BK, Christie S, Noonan VK. Spinal Cord Injury Clinical Registries: Improving Care across the SCI Care Continuum by Identifying Knowledge Gaps. J Neurotrauma 2017; 34:2924-2933. [PMID: 28745934 PMCID: PMC5653140 DOI: 10.1089/neu.2016.4937] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Timely access and ongoing delivery of care and therapeutic interventions is needed to maximize recovery and function after traumatic spinal cord injury (tSCI). To ensure these decisions are evidence-based, access to consistent, reliable, and valid sources of clinical data is required. The Access to Care and Timing Model used data from the Rick Hansen SCI Registry (RHSCIR) to generate a simulation of healthcare delivery for persons after tSCI and to test scenarios aimed at improving outcomes and reducing the economic burden of SCI. Through model development, we identified knowledge gaps and challenges in the literature and current health outcomes data collection throughout the continuum of SCI care. The objectives of this article were to describe these gaps and to provide recommendations for bridging them. Accurate information on injury severity after tSCI was hindered by difficulties in conducting neurological assessments and classifications of SCI (e.g., timing), variations in reporting, and the lack of a validated SCI-specific measure of associated injuries. There was also limited availability of reliable data on patient factors such as multi-morbidity and patient-reported measures. Knowledge gaps related to structures (e.g., protocols) and processes (e.g., costs) at each phase of care have prevented comprehensive evaluation of system performance. Addressing these knowledge gaps will enhance comparative and cost-effectiveness evaluations to inform decision-making and standards of care. Recommendations to do so were: standardize data element collection and facilitate database linkages, validate and adopt more outcome measures for SCI, and increase opportunities for collaborations with stakeholders from diverse backgrounds.
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Affiliation(s)
- Marcel F. Dvorak
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Nader Fallah
- Rick Hansen Institute, Vancouver, British Columbia, Canada
| | - Argelio Santos
- Rick Hansen Institute, Vancouver, British Columbia, Canada
| | - Derek Atkins
- Operations and Logistics Division, Sauder School of Business, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | - Chester Ho
- Division of Physical Medicine and Rehabilitation, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Henry Ahn
- University of Toronto Spine Program, Toronto, Ontario, Canada
| | - Brian K. Kwon
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sean Christie
- Research Division of Neurosurgery, Dalhousie University, Halifax, Nova Scotia, Canada
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Wintner LM, Sztankay M, Aaronson N, Bottomley A, Giesinger JM, Groenvold M, Petersen MA, van de Poll-Franse L, Velikova G, Verdonck-de Leeuw I, Holzner B. The use of EORTC measures in daily clinical practice-A synopsis of a newly developed manual. Eur J Cancer 2016; 68:73-81. [PMID: 27721057 DOI: 10.1016/j.ejca.2016.08.024] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 08/29/2016] [Indexed: 12/12/2022]
Abstract
Cancer has increasingly become a chronic condition and the routine collection of patient-reported outcomes (PROs) like quality of life is widely recommended for clinical practice. Nonetheless, the successful implementation of PROs is still a major challenge, although common barriers to and facilitators of their beneficial use are well known. To support health care professionals and other stakeholders in the implementation of the EORTC PRO measures, the EORTC Quality of Life Group provides guidance on issues considered important for their use in daily clinical practice. Herein, we present an outline of the newly developed "'Manual for the use of EORTC measures in daily clinical practice", covering the following issues: * a rationale for using EORTC measures in routine care *selection of EORTC measures, timing of assessments, scoring and presentation of results * aspects of a strategic implementation * electronic data assessment and telemonitoring, and * further use of EORTC measures and ethical considerations. Next to an extensive overview of currently available literature, the manual specifically focuses on knowledge about EORTC measures to give evidence-based recommendations whenever possible and to encourage readers and end-users of EORTC measures to contribute to further needed high-quality research. The manual will be accessible on the EORTC Quality of Life Group website's homepage and will be periodically updated to take into account any new knowledge due to medical, technical, regulatory and scientific advances.
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Affiliation(s)
- Lisa M Wintner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
| | - Monika Sztankay
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
| | - Neil Aaronson
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands.
| | - Andrew Bottomley
- Quality of Life Department, EORTC Headquarters, Avenue E. Mounier 83, 1200, Brussels, Belgium.
| | - Johannes M Giesinger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
| | - Mogens Groenvold
- The Research Unit, Department of Palliative Medicine, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark.
| | - Morten Aa Petersen
- The Research Unit, Department of Palliative Medicine, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark.
| | - Lonneke van de Poll-Franse
- Netherlands Comprehensive Cancer Organisation, Gebouw Janssoenborch, Godebaldkwartier 419, 3511, DT, Utrecht, The Netherlands.
| | - Galina Velikova
- Leeds Institute of Cancer and Pathology, University of Leeds, LS2 9JT, Leeds, UK.
| | - Irma Verdonck-de Leeuw
- Clinical Psychology, VU University Medical Center, De Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands.
| | - Bernhard Holzner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
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Identifying common barriers and facilitators to linkage and retention in chronic disease care in western Kenya. BMC Public Health 2016; 16:741. [PMID: 27503191 PMCID: PMC4977618 DOI: 10.1186/s12889-016-3462-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 08/05/2016] [Indexed: 11/27/2022] Open
Abstract
Background Sub-Saharan Africa is increasingly being challenged in providing care and treatment for chronic diseases, both communicable and non-communicable. In order to address the challenges of linkage to and retention in chronic disease management, there is the need to understand the factors that can influence engagement in care. We conducted a qualitative study to identify barriers and facilitators to linkage and retention in chronic care for HIV, tuberculosis (TB) and Hypertension (HTN) as part of the Academic Model Providing Access to Healthcare (AMPATH) program in western Kenya. Methods In-depth interviews and focus group discussions were conducted July 2012-August 2013. Study participants were purposively sampled from three AMPATH clinics and included patients within the AMPATH program receiving HIV, TB, and HTN care, as well as caregivers of children with HIV, community leaders, and healthcare providers. A set of interview guides were developed to explore perceived barriers and facilitators to chronic disease management, particularly related to linkage to and retention in HIV, TB and HTN care. Data were coded and various themes were identified. We organized the concepts and themes generated using the Andersen-Newman Framework of Health Services Utilization. Results A total of 235 participants including 110 individuals living with HIV (n = 50), TB (n = 39), or HTN (n = 21); 24 caregivers; 10 community leaders; and 62 healthcare providers participated. Barriers and facilitators were categorized as predisposing characteristics, enabling resources and need factors. Many of the facilitators and barriers reported in this study were consistently reported across disease categories including personal drive, patient-provider relationships and the need for social and peer support. Conclusions Our findings provide insight into the individual as well as broader structural factors that can deter or encourage linkage and retention that are relevant across communicable and non-communicable chronic diseases. The findings of the present study suggest that interventions should consider the logistical aspects of accessing care in addition to predisposing and need factors that may affect an individuals’ decision to seek out and remain in appropriate care.
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Jesus TS, Bright F, Kayes N, Cott CA. Person-centred rehabilitation: what exactly does it mean? Protocol for a scoping review with thematic analysis towards framing the concept and practice of person-centred rehabilitation. BMJ Open 2016; 6:e011959. [PMID: 27436670 PMCID: PMC4964252 DOI: 10.1136/bmjopen-2016-011959] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Person-centredness is a philosophy for organising and delivering healthcare based on patients' needs, preferences and experiences. Although widely endorsed, the concept suffers from a lack of detail and clarification, in turn accounting for ambiguous implementation and outcomes. While a conceptual framework based on a systematic review defines person/patient-centred care components (Scholl et al, 2014), it applies across healthcare contexts and may not be sensitive to the nuances of the rehabilitation of adults with physical impairments. Accordingly, this study aims to build a conceptual framework, based on existing literature, of what person-centredness means in the rehabilitation of adults with physical impairments in the clinical encounter and broader health service delivery. METHODS AND ANALYSIS We will use a scoping review methodology. Searches on relevant databases will be conducted first, combining keywords for 'rehabilitation', 'person-centered' and associated terms (including patient preferences/experiences). Next, snowball searches (citation tracking, references lists) will be performed. Papers will be included if they fall within predefined selection categories (seen as most likely informative on elements pertaining to person-centred rehabilitation) and are written in English, regardless of design (conceptual, qualitative, quantitative). Two reviewers will independently screen titles and abstracts, followed by screening of the full text to determine inclusion. Experts will then be consulted to identify relevant missing papers. This can include elements other than the peer-reviewed literature (eg, book chapters, policy/legal papers). Finally, information that helps to build the concept and practice of person-centred rehabilitation will be abstracted independently by two reviewers and analysed by inductive thematic analysis to build the conceptual framework. DISSEMINATION The resulting framework will aid clarification regarding person-centred rehabilitation, which in turn is expected to conceptually ground and inform its operationalisation (eg, measurement, implementation, improvement). Findings will be disseminated through local, national and international stakeholders, both at the clinical and service organisation levels.
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Affiliation(s)
- Tiago S Jesus
- Portuguese Ministry of Education. Aggregation of Schools of Escariz, Escariz, Portugal
| | - Felicity Bright
- Centre for Person Centred Research, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Nicola Kayes
- Centre for Person Centred Research, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Cheryl A Cott
- Faculty of Medicine, Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
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Steele Gray C, Gill A, Khan AI, Hans PK, Kuluski K, Cott C. The Electronic Patient Reported Outcome Tool: Testing Usability and Feasibility of a Mobile App and Portal to Support Care for Patients With Complex Chronic Disease and Disability in Primary Care Settings. JMIR Mhealth Uhealth 2016; 4:e58. [PMID: 27256035 PMCID: PMC4911509 DOI: 10.2196/mhealth.5331] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 02/05/2016] [Accepted: 02/23/2016] [Indexed: 12/30/2022] Open
Abstract
Background People experiencing complex chronic disease and disability (CCDD) face some of the greatest challenges of any patient population. Primary care providers find it difficult to manage multiple discordant conditions and symptoms and often complex social challenges experienced by these patients. The electronic Patient Reported Outcome (ePRO) tool is designed to overcome some of these challenges by supporting goal-oriented primary care delivery. Using the tool, patients and providers collaboratively develop health care goals on a portal linked to a mobile device to help patients and providers track progress between visits. Objectives This study tested the usability and feasibility of adopting the ePRO tool into a single interdisciplinary primary health care practice in Toronto, Canada. The Fit between Individuals, Fask, and Technology (FITT) framework was used to guide our assessment and explore whether the ePRO tool is: (1) feasible for adoption in interdisciplinary primary health care practices and (2) usable from both the patient and provider perspectives. This usability pilot is part of a broader user-centered design development strategy. Methods A 4-week pilot study was conducted in which patients and providers used the ePRO tool to develop health-related goals, which patients then monitored using a mobile device. Patients and providers collaboratively set goals using the system during an initial visit and had at least 1 follow-up visit at the end of the pilot to discuss progress. Focus groups and interviews were conducted with patients and providers to capture usability and feasibility measures. Data from the ePRO system were extracted to provide information regarding tool usage. Results Six providers and 11 patients participated in the study; 3 patients dropped out mainly owing to health issues. The remaining 8 patients completed 210 monitoring protocols, equal to over 1300 questions, with patients often answering questions daily. Providers and patients accessed the portal on an average of 10 and 1.5 times, respectively. Users found the system easy to use, some patients reporting that the tool helped in their ability to self-manage, catalyzed a sense of responsibility over their care, and improved patient-centered care delivery. Some providers found that the tool helped focus conversations on goal setting. However, the tool did not fit well with provider workflows, monitoring questions were not adequately tailored to individual patient needs, and daily reporting became tedious and time-consuming for patients. Conclusions Although our study suggests relatively low usability and feasibility of the ePRO tool, we are encouraged by the early impact on patient outcomes and generally positive responses from both user groups regarding the potential of the tool to improve care for patients with CCDD. As is consistent with our user-centered design development approach, we have modified the tool based on user feedback, and are now testing the redeveloped tool through an exploratory trial.
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Affiliation(s)
- Carolyn Steele Gray
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
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Lavallee DC, Chenok KE, Love RM, Petersen C, Holve E, Segal CD, Franklin PD. Incorporating Patient-Reported Outcomes Into Health Care To Engage Patients And Enhance Care. Health Aff (Millwood) 2016; 35:575-82. [DOI: 10.1377/hlthaff.2015.1362] [Citation(s) in RCA: 281] [Impact Index Per Article: 35.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Danielle C. Lavallee
- Danielle C. Lavallee ( ) is a research assistant professor in the Department of Surgery at the University of Washington, in Seattle
| | - Kate E. Chenok
- Kate E. Chenok is president of Chenok Associates, in Orinda, California
| | - Rebecca M. Love
- Rebecca M. Love is a senior consultant on surgical outcomes and analysis at Kaiser Permanente, in San Diego, California
| | - Carolyn Petersen
- Carolyn Petersen is a senior editor at Mayo Clinic, in Rochester, Minnesota
| | - Erin Holve
- Erin Holve is a senior director of research and education in health services research at AcademyHealth, in Washington, D.C
| | - Courtney D. Segal
- Courtney D. Segal is a predoctoral fellow in the Department of Health Services, School of Public Health, at the University of Washington
| | - Patricia D. Franklin
- Patricia D. Franklin is a professor in the Department of Orthopedics and Physical Rehabilitation at the University of Massachusetts Medical School, in Worcester
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Steele Gray C, Khan AI, Kuluski K, McKillop I, Sharpe S, Bierman AS, Lyons RF, Cott C. Improving Patient Experience and Primary Care Quality for Patients With Complex Chronic Disease Using the Electronic Patient-Reported Outcomes Tool: Adopting Qualitative Methods Into a User-Centered Design Approach. JMIR Res Protoc 2016; 5:e28. [PMID: 26892952 PMCID: PMC4777883 DOI: 10.2196/resprot.5204] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 12/04/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Many mHealth technologies do not meet the needs of patients with complex chronic disease and disabilities (CCDDs) who are among the highest users of health systems worldwide. Furthermore, many of the development methodologies used in the creation of mHealth and eHealth technologies lack the ability to embrace users with CCDD in the specification process. This paper describes how we adopted and modified development techniques to create the electronic Patient-Reported Outcomes (ePRO) tool, a patient-centered mHealth solution to help improve primary health care for patients experiencing CCDD. OBJECTIVE This paper describes the design and development approach, specifically the process of incorporating qualitative research methods into user-centered design approaches to create the ePRO tool. Key lessons learned are offered as a guide for other eHealth and mHealth research and technology developers working with complex patient populations and their primary health care providers. METHODS Guided by user-centered design principles, interpretive descriptive qualitative research methods were adopted to capture user experiences through interviews and working groups. Consistent with interpretive descriptive methods, an iterative analysis technique was used to generate findings, which were then organized in relation to the tool design and function to help systematically inform modifications to the tool. User feedback captured and analyzed through this method was used to challenge the design and inform the iterative development of the tool. RESULTS Interviews with primary health care providers (n=7) and content experts (n=6), and four focus groups with patients and carers (n=14) along with a PICK analysis-Possible, Implementable, (to be) Challenged, (to be) Killed-guided development of the first prototype. The initial prototype was presented in three design working groups with patients/carers (n=5), providers (n=6), and experts (n=5). Working group findings were broken down into categories of what works and what does not work to inform modifications to the prototype. This latter phase led to a major shift in the purpose and design of the prototype, validating the importance of using iterative codesign processes. CONCLUSIONS Interpretive descriptive methods allow for an understanding of user experiences of patients with CCDD, their carers, and primary care providers. Qualitative methods help to capture and interpret user needs, and identify contextual barriers and enablers to tool adoption, informing a redesign to better suit the needs of this diverse user group. This study illustrates the value of adopting interpretive descriptive methods into user-centered mHealth tool design and can also serve to inform the design of other eHealth technologies. Our approach is particularly useful in requirements determination when developing for a complex user group and their health care providers.
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Affiliation(s)
- Carolyn Steele Gray
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
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