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Kwong E, Neuburger J, Black N. Agreement between retrospectively and contemporaneously collected patient-reported outcome measures (PROMs) in hip and knee replacement patients. Qual Life Res 2018; 27:1845-1854. [PMID: 29484536 PMCID: PMC5997728 DOI: 10.1007/s11136-018-1823-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2018] [Indexed: 11/26/2022]
Abstract
Purpose To investigate the relationship between retrospectively and contemporaneously collected patient-reported outcome measures (PROMs) and the influence on this relationship of patients’ age and socio-economic status and the length of time. Methods Patients undergoing hip or knee replacement in four hospitals who had completed a pre-operative questionnaire were invited to recall their pre-operative health status shortly after surgery. The questionnaires included a disease-specific (Oxford Hip Score; Oxford Knee Score) and generic (EQ-5D-3L) PROM. Consistency and absolute agreement between contemporary and retrospective reports were investigated using intraclass correlations (ICCs). Differences were visualised using Bland–Altman plots. Linear regression analysis explored whether retrospective can predict contemporary PROMs. Results Patients’ recalled health statuses were similar to their contemporaneous reports, with no significant systematic bias. Absolute agreement for disease-specific PROMs was very strong (ICC 0.82) and stronger than for the generic PROM (ICC 0.60, 0.62). Agreement was consistently strong across the range of severity of a patient’s condition, age and socio-economic status. Patients’ age and socio-economic status had no significant influence on size of difference and direction of recall, although reliability of recall was slightly worse among the over-75s versus under-60s for hips (Oxford Hip Score ICC 0.88 vs. 0.78). Mean retrospective PROMs for groups or populations of patients can reliably predict what mean contemporary reports of PROMs would have been. Conclusion Retrospective PROMs can be used to obtain a baseline assessment of health status when contemporary collection is not feasible or cost effective. Research is needed to determine the feasibility of retrospective PROMs in emergency admissions.
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Affiliation(s)
- Esther Kwong
- Department of Health Services Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
| | | | - Nick Black
- Department of Health Services Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
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Kwong E, Black N. Retrospectively patient-reported pre-event health status showed strong association and agreement with contemporaneous reports. J Clin Epidemiol 2016; 81:22-32. [PMID: 27622778 DOI: 10.1016/j.jclinepi.2016.09.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 07/30/2016] [Accepted: 09/05/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The unpredictability of the occurrence of illnesses and injuries leading to most emergency admissions to hospital makes it impossible prospectively to collect preadmission patient-reported outcome measures (PROMs). Our aims were to review the evidence for using retrospective PROMs to determine pre-event health status and the validity of using general population norms instead of retrospective PROMs. STUDY DESIGN AND SETTING Searches of Medline, PsycINFO, Embase, Global Health, and Health Management information. Six studies met the inclusion criteria for the first aim, and 11 studies addressed the second aim. Narrative syntheses were conducted. RESULTS Strong associations were found between retrospective and contemporary PROMs in 21 of 30 comparisons (correlation coefficients over 0.68) and 20 of 24 showed strong agreement for continuous measures (intraclass correlations over 0.75). Categorical measures revealed only fair to moderate levels of agreement (kappa 0.3-0.6). Associations were stronger for indices than for individual items and for shorter time intervals. The direction of differences was inconsistent. Retrospective PROMs reported by elderly patients were similar to the general population but younger adults had been healthier. CONCLUSION Retrospective collection offers a means of assessing PROMs in unexpected emergency admissions. However, further research is needed to establish the best policy for their use.
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Affiliation(s)
- Esther Kwong
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WS1H 9SH, UK.
| | - Nick Black
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WS1H 9SH, UK
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Helfand BT, Fought A, Manvar AM, McVary KT. Determining the Utility of Recalled Lower Urinary Tract Symptoms. Urology 2010; 76:442-7. [DOI: 10.1016/j.urology.2009.12.052] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Revised: 11/30/2009] [Accepted: 12/22/2009] [Indexed: 11/28/2022]
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Bjelic-Radisic V, Dorfer M, Tamussino K, Frudinger A, Kern P, Winter R, Greimel E. The Incontinence Outcome Questionnaire: an instrument for assessing patient-reported outcomes after surgery for stress urinary incontinence. Int Urogynecol J 2007; 18:1139-49. [PMID: 17308862 DOI: 10.1007/s00192-007-0302-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2006] [Accepted: 01/04/2007] [Indexed: 10/23/2022]
Abstract
The aim of this study is to develop and psychometrically test a questionnaire (Incontinence Outcome Questionnaire, IOQ) for assessing quality of life (QOL) after surgery for stress urinary incontinence that can be used as a single measurement after the intervention. A total of 171 patients who underwent the tension-free vaginal tape (TVT/TVT-O) operation for stress urinary incontinence completed the King s Health Questionnaire (KHQ), the Short Form-12 (SF-12) and the IOQ. The internal consistency, internal and external validity and responsiveness of the IOQ were tested. The IOQ-QOL subscale showed good internal consistency (Cronbach's alpha=0.83) and significant correlations with the KHQ and the SF-12 scales (r=0.30-0.56). Partial correlations with objective parameters showed a significant relation for the IOQ-QOL subscale with objective continence/incontinence. The results of our study suggest that the IOQ is a valid and reliable instrument for assessing QOL after incontinence surgery and can be used if baseline or pre-operative data are unavailable.
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Affiliation(s)
- Vesna Bjelic-Radisic
- Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, Graz, 8036, Austria.
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Jonkers RE, Lettinga KD, Pels Rijcken TH, Prins JM, Roos CM, van Delden OM, Verbon A, Bresser P, Jansen HM. Abnormal radiological findings and a decreased carbon monoxide transfer factor can persist long after the acute phase of Legionella pneumophila pneumonia. Clin Infect Dis 2004; 38:605-11. [PMID: 14986242 DOI: 10.1086/381199] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2003] [Accepted: 10/07/2003] [Indexed: 11/03/2022] Open
Abstract
Pulmonary abnormalities may persist long after the acute phase of legionnaires disease (LD). In a cohort of 122 survivors of an outbreak of LD, 57% were still experiencing an increased number of symptoms associated with dyspnea at a mean of 16 months after recovery from acute-phase LD. For 86 of these patients, additional evaluation involving high-resolution computed tomography (HRCT) of the lung revealed pulmonary abnormalities in 21 (24%); abnormal HRCT findings generally presented as discrete and multiple radiodensities. Residual pulmonary abnormalities were associated with a mean reduction of 20% in the gas transport capacity of the lung. This latter sign could not be used to explain the increased symptoms of dyspnea reported by patients. Receipt of mechanical ventilation during the acute phase of LD, delayed initiation of adequate antibiotic therapy, and chronic obstructive pulmonary disease were identified as risk factors for the persistence of lung abnormalities.
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Affiliation(s)
- R E Jonkers
- Department of Pulmonology, Division of Infectious Diseases, Tropical Medicine, and AIDS, Amsterdam, The Netherlands.
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Henderson A, Laing RW, Langley SEM. Quality of Life Following Treatment for Early Prostate Cancer: Does Low Dose Rate (LDR) Brachytherapy Offer a Better Outcome? A Review. Eur Urol 2004; 45:134-41. [PMID: 14733996 DOI: 10.1016/j.eururo.2003.09.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Due to a lack of evidence from randomised studies, there is little agreement on the best form of treatment among men who require curative treatment for prostate cancer. The relative impact of the various treatments on symptoms and health-related quality of life is also controversial. We review the literature on quality of life changes following low dose rate brachytherapy (BXT) and compare BXT to other treatments for early prostate cancer. METHODS Systematic literature review 1988-2003 (Medline). KEYWORDS Brachytherapy; Radical prostatectomy; External beam radiotherapy; Quality of life; Symptoms. RESULTS Review of the current literature suggests that radical prostatectomy, external beam radiotherapy and BXT either alone or in combination with supplementary external beam radiotherapy offer good long-term health-related quality of life. However differences exist in the toxicity of treatment in terms of erectile function, voiding difficulty, incontinence and bowel function. These differences seem to persist for at least 3-5 years post-treatment though longer-term quality of life outcomes from modern techniques are unknown. CONCLUSION BXT offers a high probability of maintaining continence, potency and normal rectal function though both storage and voiding urinary symptoms have been reported. Addition of androgen deprivation and EBRT to BXT may increase urinary, bowel and sexual toxicity of treatment. Quality of life outcome following brachytherapy compares favourably with other radical treatment options for the management of early prostate cancer.
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Affiliation(s)
- Alastair Henderson
- Department of Urology, Royal Surrey County Hospital, St. Luke's Cancer Center, Egerton Road, GU2 5XX. Guildford, UK.
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Rees J, Waldron D, O'Boyle C, Ewings P, MacDonagh R. Prospective vs retrospective assessment of lower urinary tract symptoms in patients with advanced prostate cancer: the effect of ‘response shift’. BJU Int 2003; 92:703-6. [PMID: 14616450 DOI: 10.1046/j.1464-410x.2003.04462.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare prospectively obtained symptom scores (pre-tests) with retrospective assessment (then-tests) in patients with newly diagnosed advanced prostate cancer. PATIENTS AND METHODS Patients with newly diagnosed locally advanced or metastatic prostate cancer were recruited. They completed the International Prostate Symptom Score (IPSS) and Symptom Problem Index (SPI) before starting treatment. At 3 and 6 months after diagnosis they again completed these questionnaires, but also retrospectively reassessed their initial symptom level. Healthy age-matched controls were recruited from primary care and completed the same questionnaires; in all, 76 patients and 17 controls participated. RESULTS The IPSS and SPI scores decreased significantly over the 6 months of the study. Patients retrospectively rated their level of symptoms and symptom bother as higher than their contemporaneous assessments. This was not the case in the control group. CONCLUSION These results question the assumption that contemporaneously collected pre-test scores are interchangeable with retrospectively assessed then-tests. This suggests that caution is required when comparing the results of studies that use these two alternative techniques of data collection. The difference between then-test and pre-test scores may represent an example of a phenomenon termed 'response shift', in which, by adapting to their disease, patients changed the internal standards by which they assessed their symptoms.
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Affiliation(s)
- J Rees
- Taunton and Somerset Hospital, University College Hospital, Galway, and Royal College of Surgeons in Ireland, Dublin, Ireland.
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Broder MS, Kanouse DE, Bernstein SJ. Assessing symptoms before hysterectomy: is the medical record accurate? Am J Obstet Gynecol 2001; 185:97-102. [PMID: 11483911 DOI: 10.1067/mob.2001.107098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Our purpose was to evaluate the agreement between the documentation of symptoms leading to hysterectomy and the assessment of those symptoms by the patient. STUDY DESIGN A retrospective study was performed of 497 women in southern California who had hysterectomies. Sensitivity, specificity, and kappa statistics were calculated for the medical records and were compared with patient interviews for the presence and severity of symptoms. RESULTS The medical record was 93% sensitive and 61% specific for identifying bleeding and 79% sensitive and 55% specific for identifying pain. Overall agreement between physician records and patient interviews was moderate for bleeding (kappa, 0.55-0.58), fair for pain (kappa, 0.29-0.34), and poor for impairment as a result of bleeding or pain (kappa, 0.0-0.14). CONCLUSIONS Physician overestimation of symptoms could lead to overuse of hysterectomy, whereas underestimation could result in underuse. Our results suggest that both underestimation and overestimation occur for patients with abnormal bleeding, pain, or both. If physicians accurately assess symptoms but fail to document them, examinations of appropriateness will be faulty unless patients are interviewed.
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Affiliation(s)
- M S Broder
- Department of Obstetrics and Gynecology, University of California, Los Angeles School of Medicine, Los Angeles, CA 90095, USA.
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Martín-Baranera M, Sancho JJ, Sanz F. Controlling for chance agreement in the validation of medical expert systems with no gold standard: PNEUMON-IA and RENOIR revisited. COMPUTERS AND BIOMEDICAL RESEARCH, AN INTERNATIONAL JOURNAL 2000; 33:380-97. [PMID: 11150233 DOI: 10.1006/cbmr.2000.1552] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
In the validation of medical expert systems, agreement among different human specialists on a random sample of cases may be taken as a substitute to a missing gold standard. Distance measures between pairs of experts, extensively described in previous studies, do not take into account the influence of chance-expected agreement. A weighted kappa index, with three different weighting schemes, is proposed as an alternative to be applied in the general situation of N cases assessed by E experts about K possible diagnoses, each of them qualified with one of G ordinal categories. A hierarchical cluster analysis, applied to the kappa matrices generated, allows for the classification of the expert system among clinical specialists, providing a relative assessment of its diagnostic ability. The above methodology is applied to the validation of two medical expert systems, PNEUMON-IA and RENOIR.
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Affiliation(s)
- M Martín-Baranera
- Department of Medical Informatics, Institut Municipal d'Investigacio Mèdica (IMIM), Universitat Autònoma de Barcelona, Dr. Aiguader 80, E-08003 Barcelona, Spain.
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Litwin MS, McGuigan KA. Accuracy of recall in health-related quality-of-life assessment among men treated for prostate cancer. J Clin Oncol 1999; 17:2882-8. [PMID: 10561366 DOI: 10.1200/jco.1999.17.9.2882] [Citation(s) in RCA: 127] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine the accuracy of patient recall of health-related quality of life (HRQOL) in men who have undergone radical prostatectomy for early-stage prostate cancer. PATIENTS AND METHODS Patients enrolled onto a longitudinal, observational cohort study of HRQOL after radical prostatectomy for early-stage prostate cancer were asked to assess their baseline HRQOL before surgery. They were later asked to recall their baseline HRQOL at intervals of 7 to 37 months after surgery. The two views of baseline HRQOL (actual and recall) were compared. HRQOL was measured with established instruments (the RAND 12-Item Short-Form Health Survey and a validated short form of the University of California Los Angeles Prostate Cancer Index) that addressed impairment in the physical, mental, urinary, bowel, and sexual domains. RESULTS Overall, recall was poor. Patients tended to remember their baseline HRQOL as being better than it actually was. This effect was particularly striking for urinary and sexual function. Greater education and younger age diminished this effect in some domains. The effect did not vary with time since surgery. CONCLUSION Men undergoing radical prostatectomy for early-stage prostate cancer do not accurately recall their pretreatment HRQOL when asked several months or years later. This recall bias is constant throughout a period of 6 months to 3 years after surgery. By collecting data before treatment and observing subjects longitudinally, investigators can ensure that HRQOL changes are analyzed in the context of any impairment that may have been present at baseline. If a longitudinal study is not feasible, then great caution must be used if patients are asked to recall their pretreatment HRQOL.
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Affiliation(s)
- M S Litwin
- Departments of Urology and Health Services, University of California Los Angeles, Los Angeles, and RAND Health Program, Santa Monica, CA 90095-1738, USA.
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ROWE MELISSAK, KANOUSE DAVIDE, MITTMAN BRIANS, BERNSTEIN STEVENJ. Quality of Life Among Women Undergoing Hysterectomies. Obstet Gynecol 1999. [DOI: 10.1097/00006250-199906000-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lamping DL, Rowe P, Clarke A, Black N, Lessof L. Development and validation of the Menorrhagia Outcomes Questionnaire. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1998; 105:766-79. [PMID: 9692419 DOI: 10.1111/j.1471-0528.1998.tb10209.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To develop and evaluate the acceptability, reliability and validity of a short, patient-based questionnaire for assessing the outcomes of surgical treatment for menorrhagia due to benign disease. DESIGN A psychometric study by postal survey. SETTING Five hospitals in southeast England. SAMPLE One hundred and eleven women undergoing hysterectomy for menorrhagia due to benign disease. METHODS Data from a long research questionnaire used in the North West Thames Hysterectomy Study were analysed using standard psychometric methods to identify the subset of items which were the most scientifically sound indicators of outcome. The Menorrhagia Outcomes questionnaire is a 26-item questionnaire which covers symptoms, post-operative complications, quality of life, and women's satisfaction with outcome. The questionnaire was field tested for acceptability, reliability and validity by postal survey. RESULTS The Menorrhagia Outcomes Questionnaire was found to be highly acceptable to women and showed excellent internal consistency, test-retest reliability, criterion and construct validity. CONCLUSION The Menorrhagia Outcomes Questionnaire is a practical and scientifically sound measure of outcome from the woman's perspective following surgical treatment for menorrhagia due to benign disease. It takes less than five minutes to complete, is appropriate for use with different surgical treatments for menorrhagia (eg. hysterectomy, endometrial resection, laser ablation) and is feasible for routine monitoring of large numbers of women by postal survey. Most importantly, this questionnaire has been shown to perform well from a scientific point view, having met standard psychometric criteria for reliability and validity.
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Affiliation(s)
- D L Lamping
- Health Services Research Unit, London School of Hygiene and Tropical Medicine, UK
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Lamping DL, Rowe P, Black N, Lessof L. Development and validation of an audit instrument: the Prostate Outcomes Questionnaire. BRITISH JOURNAL OF UROLOGY 1998; 82:49-62. [PMID: 9698662 DOI: 10.1046/j.1464-410x.1998.00670.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To develop a short, patient-based questionnaire for auditing the outcomes of treatment for benign prostatic hyperplasia (BPH) and to evaluate the acceptability, reliability and validity of the measure. PATIENTS AND METHODS Data from a long research questionnaire used in the Oxford/North West Thames Prostatectomy Study were analysed to identify the subset of items which contained the most scientifically sound indicators of outcome. Items were selected on the basis of standard psychometric analyses to develop a short questionnaire, the Prostate Outcomes Questionnaire (POQ), a 27-item instrument covering urinary symptoms, complications after surgery, quality of life and patient satisfaction with outcome. The POQ was field tested for acceptability, reliability and validity in a postal survey of 125 men undergoing transurethral resection of the prostate for BPH from seven hospitals in south-east England. RESULTS The POQ was highly acceptable to patients, as indicated by a 95% response rate, the absence of 'floor' and 'ceiling' effects and a low proportion of missing data. It showed excellent internal consistency reliability (Cronbach's alpha of 0.82-0.93 for the five summary scales and a mean item-total correlation of 0.56) and test-retest reliability (test-retest correlations for items were 0.40-1.00, with a mean test-retest correlation of 0.85, and for summary scales of 0.91-0.95). Construct validity was confirmed by: high intercorrelations between the five summary scales and the total score (0.88-0.95), with a pattern of intercorrelations among specific subscales that showed item-convergent and discriminant validity; higher scores for patients who reported an improvement after surgery than in those who were not improved (P < 0.001); the expected gradient of scores for patients reporting different levels of symptom distress (P < 0.001); high correlations with the longer parent questionnaire (0.75-0.88); and low to moderate correlations with the Nottingham Health Profile and Activities of Daily Living scores (0.15-0.67), with the pattern of correlations providing evidence of scale convergent and discriminant validity. Correlations with age and social class were low, suggesting that responses were not biased by sociodemographic factors. CONCLUSION The POQ is a practical and scientifically sound patient-based measure of outcome after treatment for BPH which can be used for routine audit. It takes < 5 min to complete, is feasible for routine monitoring of large numbers of patients by postal survey, and is accompanied by a Users' Manual which provides practical help in conducting a local patient survey, and a computer program for scoring data. Most importantly, the POQ has been shown scientifically to perform well, having met standard psychometric criteria for reliability and validity.
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Affiliation(s)
- D L Lamping
- Health Services Research Unit, London School of Hygiene & Tropical Medicine, UK
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Emberton M, Neal DE, Black N, Harrison M, Fordham M, McBrien MP, Williams RE, McPherson K, Develin HB. The feasibility and cost of a large multicentre audit of process and outcome of prostatectomy. Qual Health Care 1995; 4:256-62. [PMID: 10156395 PMCID: PMC1055336 DOI: 10.1136/qshc.4.4.256] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objective--To determine the feasibility of performing multicentre process and outcome audits of common interventions taking prostatic procedures as an example. Design--Prospective, cohort study. Setting--All National Health Service and independent hospitals in Northern, Wessex, Mersey, and South West Thames health regions. Patients--5361 men undergoing prostatectomy identified by 103 of the 107 urologists and general surgeons performing prostatectomy in the study regions. Main measures-- Rates of participation by surgeons and patients; completeness of clinical data provided by surgeons; patient response rate and completeness of patient derived data; and cost. Results--Most surgeons (103,96%) agreed to participate. Overall, the proportion of eligible patients invited to take part was high (89%), although this was only measured in South West Thames, where dedicated data collectors were employed. Few men (80, 1.5%) declined to participate. Of those surviving for three months after surgery, 82.4% (4226) completed and returned the postal questionnaire. The response rate was higher in South West Thames (86.7%) than in the other regions (80.6%-80.8%). The audit was well received: 91% of patients found the questionnaire easy to complete and only 2.3% of them disapproved. Completeness of data was high with both the hospital and patient questionnaires. Missing data occurred in less than 5% of responses to most questions. The attributable cost was 34.50 pounds per patient identified or 44 pounds for patients in whom either the treatment outcome or vital status was known three months after their prostatectomy. Conclusions--This multicentre audit of process and outcome of prostatectomy proved feasible in terms of surgeon participation, patient identification, and the quantity and quality of data collection. Whether the cost was warranted will depend on how surgeons use the audit data to modify their practice.
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Affiliation(s)
- M Emberton
- Royal College of Surgeons of England, London
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