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Brady RE, Lyons KD, Stevens CJ, Godzik CM, Smith AJ, Bagley PJ, Vitale EJ, Bernstein SL. Implementing evidence-based practices in rural settings: a scoping review of theories, models, and frameworks. FRONTIERS IN HEALTH SERVICES 2024; 4:1326777. [PMID: 39036464 PMCID: PMC11258036 DOI: 10.3389/frhs.2024.1326777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 06/10/2024] [Indexed: 07/23/2024]
Abstract
Background Rural healthcare has unique characteristics that affect the dissemination and implementation of evidence-based interventions. Numerous theories, models, and frameworks have been developed to guide implementation of healthcare interventions, though not specific to rural healthcare. The present scoping review sought to identify the theories, models, and frameworks most frequently applied to rural health and propose an approach to rural health research that harnesses selected constructs from these theories, models, and frameworks. This resulting synthesis can serve as a guide to researchers, policy makers, and clinicians seeking to employ commonly used theories, models, and frameworks to rural health. Methods We used the Scopus abstract indexing service to identify peer-reviewed literature citing one or more of theories, models, or frameworks used in dissemination and implementation research and including the word "rural" in the Title, Abstract, or Keywords. We screened the remaining titles and abstracts to ensure articles met additional inclusion criteria. We conducted a full review of the resulting 172 articles to ensure they identified one or more discrete theory, model, or framework applied to research or quality improvement projects. We extracted the theories, models, and frameworks and categorized these as process models, determinant frameworks, classic theories, or evaluation frameworks. Results We retained 61 articles of which 28 used RE-AIM, 11 used Community-Based Participatory Research (CBPR) framework, eight used the Consolidated Framework for Implementation Research (CFIR), and six used the integrated-Promoting Action on Research Implementation in Health Services (iPARIHS). Additional theories, models, and frameworks were cited in three or fewer reports in the literature. The 14 theories, models, and frameworks cited in the literature were categorized as seven process models, four determinant frameworks, one evaluation framework, and one classic theory. Conclusions The RE-AIM framework was the most frequently cited framework in the rural health literature, followed by CBPR, CFIR, and iPARIHS. A notable advantage of RE-AIM in rural healthcare settings is the focus on reach as a specified outcome, given the challenges of engaging a geographically diffuse and often isolated population. We present a rationale for combining the strengths of these theories, models, and frameworks to guide a research agenda specific to rural healthcare research. Systematic Review Registration https://osf.io/fn2cd/.
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Affiliation(s)
- Robert E. Brady
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Kathleen D. Lyons
- Department of Occupational Medicine, Massachusetts General Hospital Institute of Health Professions, Boston, MA, United States
| | - Courtney J. Stevens
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Cassandra M. Godzik
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Andrew J. Smith
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States
- Lyda Hill Institute for Human Resilience, University of Colorado, Colorado Springs, Colorado Springs, CO, United States
| | - Pamela J. Bagley
- Biomedical Libraries, Dartmouth College, Hanover, NH, United States
| | - Elaina J. Vitale
- Biomedical Libraries, Dartmouth College, Hanover, NH, United States
| | - Steven L. Bernstein
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States
- Department of Emergency Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
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van der Knaap-Kind LS, Schipper LA, Bonifacio CC, Wolvius EB, Kragt L. Self-perceived oral health and orofacial aesthetics of cleft patients. Eur Arch Paediatr Dent 2024; 25:359-366. [PMID: 38575757 PMCID: PMC11233304 DOI: 10.1007/s40368-024-00891-w] [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: 05/08/2023] [Accepted: 02/28/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE To evaluate the self-perceived oral health and aesthetics of the dentition and jaw in patients with different types of oral cleft, measured by patient-reported outcome measures (PROMs). Additionally, to compare the results of the PROMs between cleft lip and or/palate (CL/P) patients and non-affected controls. METHODS 420 CL/P patients treated at the cleft team of the Erasmus Medical Center, Rotterdam, The Netherlands, were included, and 138 non-cleft patients were recruited as control-group. Patient's perceptions were retrospectively evaluated using the CLEFT-Q Teeth for dental aesthetics at ages 8, 12 and 22, CLEFT-Q Jaw for jaw aesthetics at ages 12 and 22, and the Child Oral Health Impact Profile-Oral Symptoms Subscale (COHIP-OSS) for oral health at ages 8 and 12. One-way ANOVA was used to compare differences in oral health and aesthetic perceptions among age-groups, cleft types, as well as between cases and controls. RESULTS CL/P patients were significantly less satisfied than controls with their dental aesthetics (p = 0.001). CL/P patients reported significantly lower satisfaction on CLEFT-Q Teeth scores at ages 8 and 12, than at 22 years (p < 0.001). Patients with the most extensive cleft phenotype, Cleft Lip and Palate (CLAP), reported lowest satisfaction on the CLEFT-Q Teeth. No differences in perceptions of oral health nor in aesthetics of the jaw were found in the different cleft types, ages, nor in study versus control group. CONCLUSION This study found differences in self-perceived dental aesthetics: CL/P patients are less satisfied than non-affected controls. CLAP patients are least satisfied, but satisfaction increases with age.
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Affiliation(s)
- L S van der Knaap-Kind
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
| | - L A Schipper
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
- Department of Paediatric Dentistry, Academic Center for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - C C Bonifacio
- Department of Paediatric Dentistry, Academic Center for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - E B Wolvius
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - L Kragt
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
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Sarilita E, Sjamsudin E, Mossey PA. Scoping review of outcome measures in cleft care used in research and reports. Orthod Craniofac Res 2024; 27 Suppl 1:42-48. [PMID: 37767819 DOI: 10.1111/ocr.12711] [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: 12/06/2022] [Revised: 08/10/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023]
Abstract
Treatment outcome measures are critical in the decision making of best practices in the OFC field. OFC consortium working groups provided standardization of outcome measures based on previous treatment outcome studies. However, the implementation of such standardization in OFC centres worldwide is unknown. This study presented mapped outcome measures in cleft care using a structured review method complemented by quantitative overview of the relevant published research to provide initial guidelines for the implementation of treatment outcome standardization. A scoping review of the literature of treatment outcomes in cleft care following Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines was performed. The selected indexed paper in outcome measures mapped following the international consortium in standard set of outcome measures in cleft care. Three hundred and sixty-five articles were filtered. The most discussed domains of cleft care were dental and oral health, appearance and speech/communication. Overall, the majority of publications were produced in high-income countries. The current review indicates that there are inequalities of treatment outcome studies among the domain of cleft care. In addition, there are also inequalities of published articles from HIC versus LMIC in treatment outcomes. This information can be used to develop targeted interventions aimed at encouraging cleft centres worldwide to adapt standardized outcome measures.
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Affiliation(s)
- Erli Sarilita
- Department of Oral Biology, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia
| | - Endang Sjamsudin
- Department of Oral Maxillofacial Surgery, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia
| | - Peter A Mossey
- Division of Oral Health Sciences and WHO Collaborating Centre for Oral Health & Craniofacial Anomalies, University of Dundee, Dundee, Scotland, UK
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Apon I, van Leeuwen N, Polinder S, Versnel SL, Wolvius EB, Koudstaal MJ. Healthcare use and direct medical costs in a cleft lip and palate population: an analysis of observed and protocolized care and costs. Int J Oral Maxillofac Surg 2024; 53:286-292. [PMID: 37734991 DOI: 10.1016/j.ijom.2023.08.007] [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: 12/17/2022] [Revised: 07/26/2023] [Accepted: 08/15/2023] [Indexed: 09/23/2023]
Abstract
This study was performed to describe observed healthcare utilization and medical costs for patients with a cleft, compare these costs to the expected costs based on the treatment protocol, and explore the additional costs of implementing the International Consortium for Health Outcomes Measurement (ICHOM) Standard Set for Cleft Lip and Palate (CL/P). Forty patients with unilateral CL/P between 0 and 24 years of age, treated between 2012 and 2019 at Erasmus University Medical Center, were included. Healthcare services (consultations, diagnostic and surgical procedures) were counted and costs were calculated. Expected costs based on the treatment protocol were calculated by multiplying healthcare products by the product prices. Correspondingly, the additional expected costs after implementing the ICHOM Standard Set (protocol + ICHOM) were calculated. Observed costs were compared with protocol costs, and the additional expected protocol + ICHOM costs were described. The total mean costs were highest in the first year after birth (€5596), mainly due to surgeries. The mean observed total costs (€40,859) for the complete treatment (0-24 years) were 1.6 times the expected protocol costs (€25,198) due to optional, non-protocolized procedures. Hospital admissions including surgery were the main cost drivers, accounting for 42% of observed costs and 70% of expected protocol costs. Implementing the ICHOM Standard Set increased protocol-based costs by 7%.
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Affiliation(s)
- I Apon
- Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - N van Leeuwen
- Medical Decision-Making Section, Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - S Polinder
- Health Technology Assessment and Implementation Section, Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - S L Versnel
- Department of Plastic and Reconstructive Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - E B Wolvius
- Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - M J Koudstaal
- Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
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Dunworth K, Sharif-Askary B, Grames L, Jones C, Kern J, Nyswonger-Sugg J, Suárez A, Thompson K, Ching J, Golden B, Merrill C, Nguyen P, Patel K, Rogers-Vizena CR, Rottgers SA, Skolnick GB, Allori AC. Using "Real-World Data" to Study Cleft Lip/Palate Care: An Exploration of Speech Outcomes from a Multi-Center US Learning Health Network. Cleft Palate Craniofac J 2023:10556656231207469. [PMID: 37844605 DOI: 10.1177/10556656231207469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023] Open
Abstract
OBJECTIVE To assess the ability of a cleft-specific multi-site learning health network registry to describe variations in cleft outcomes by cleft phenotypes, ages, and treatment centers. Observed variations were assessed for coherence with prior study findings. DESIGN Cross-sectional analysis of prospectively collected data from 2019-2022. SETTING Six cleft treatment centers collected data systematically during routine clinic appointments according to a standardized protocol. PARTICIPANTS 714 English-speaking children and adolescents with non-syndromic cleft lip/palate. INTERVENTION Routine multidisciplinary care and systematic outcomes measurement by cleft teams. OUTCOME MEASURES Speech outcomes included articulatory accuracy measured by Percent Consonants Correct (PCC), velopharyngeal function measured by Velopharyngeal Competence (VPC) Rating Scale (VPC-R), intelligibility measured by caregiver-reported Intelligibility in Context Scale (ICS), and two CLEFT-Q™ surveys, in which patients rate their own speech function and level of speech distress. RESULTS 12year-olds exhibited high median PCC scores (91-100%), high frequency of velopharyngeal competency (62.50-100%), and high median Speech Function (80-91) relative to younger peers parsed by phenotype. Patients with bilateral cleft lip, alveolus, and palate reported low PCC scores (51-91%) relative to peers at some ages and low frequency of velopharyngeal competency (26.67%) at 5 years. ICS scores ranged from 3.93-5.0 for all ages and phenotypes. Speech Function and Speech Distress were similar across phenotypes. CONCLUSIONS This exploration of speech outcomes demonstrates the current ability of the cleft-specific registry to support cleft research efforts as a source of "real-world" data. Further work is focused on developing robust methodology for hypothesis-driven research and causal inference.
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Affiliation(s)
- Kristina Dunworth
- Department of Surgery, Division of Plastic, Maxillofacial, and Oral Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Banafsheh Sharif-Askary
- Department of Surgery, Division of Plastic, Maxillofacial, and Oral Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Lynn Grames
- Cleft Palate and Craniofacial Institute, St. Louis Children's Hospital, St. Louis, USA
| | - Carlee Jones
- Duke Cleft & Craniofacial Center, Duke Children's Hospital, Durham, NC, USA
- Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, NC, USA
| | - Jennifer Kern
- Duke Cleft & Craniofacial Center, Duke Children's Hospital, Durham, NC, USA
- Department of Speech Pathology & Audiology, Duke University Hospital, Durham, NC, USA
| | - Jillian Nyswonger-Sugg
- Duke Cleft & Craniofacial Center, Duke Children's Hospital, Durham, NC, USA
- Department of Speech Pathology & Audiology, Duke University Hospital, Durham, NC, USA
| | - Arthur Suárez
- Duke Cleft & Craniofacial Center, Duke Children's Hospital, Durham, NC, USA
- Department of Speech Pathology & Audiology, Duke University Hospital, Durham, NC, USA
| | - Karen Thompson
- Cleft Lip and Palate Program/Craniofacial Program, Boston Children's Hospital, Boston, MA, USA
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
| | - Jessica Ching
- University of Florida Craniofacial Center, University of Florida, Gainesville, FL, USA
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Florida, Gainesville, FL, USA
| | - Brent Golden
- Pediatric Cleft Lip and Palate Surgery Program, Orlando Health Arnold Palmer Hospital for Children, Orlando, FL, USA
| | - Corinne Merrill
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, USA
| | - Phuong Nguyen
- Division of Plastic Surgery, Department of Surgery, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Kamlesh Patel
- Cleft Palate and Craniofacial Institute, St. Louis Children's Hospital, St. Louis, USA
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, USA
| | - Carolyn R Rogers-Vizena
- Cleft Lip and Palate Program/Craniofacial Program, Boston Children's Hospital, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, MA, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
| | - S Alex Rottgers
- Cleft and Craniofacial Center, Johns Hopkins Children's Center, Baltimore, MD, USA
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Gary B Skolnick
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, USA
| | - Alexander C Allori
- Department of Surgery, Division of Plastic, Maxillofacial, and Oral Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke Cleft & Craniofacial Center, Duke Children's Hospital, Durham, NC, USA
- Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, NC, USA
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Martin HL, Poehlein ER, Allori AC, Marcus JR, Cheng J, Lee H, Raynor EM. Relevance of cleft palatal width in short-term otologic outcomes. Int J Pediatr Otorhinolaryngol 2023; 171:111647. [PMID: 37429111 DOI: 10.1016/j.ijporl.2023.111647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 05/21/2023] [Accepted: 07/02/2023] [Indexed: 07/12/2023]
Abstract
OBJECTIVE Children with cleft palate are at increased risk for Eustachian tube dysfunction (ETD) and conductive hearing loss from chronic otitis media. While it has been proposed that the severity of ETD is related to the severity of cleft palate, data are lacking to support this hypothesis. An improved understanding of the relevance of cleft width may have prognostic value that could inform decisions on the timing of tympanostomy tube placement and choice of tympanostomy tube design. The objective of this study was to assess severity of ETD in children with narrow, moderate, and wide cleft palate, with examination of hearing outcomes, number of tympanostomy procedures, and incidence of otologic complications. METHODS Retrospective chart review was conducted on 58 patients with primary palatoplasty performed at a single academic medical center from January 1, 2016-December 31, 2019. The primary outcome was the number of otologic procedures performed after the initial palatoplasty. Secondary outcomes included audiometric findings, number of tympanostomy tube placements, presence of effusion at the time of myringotomy, and occurrence of any postoperative otologic complication. Outcomes were compared for patients with narrow (<10 mm), moderate (10-15 mm), and wide (>15 mm) cleft palate. Analysis included consideration of cleft palatal morphology (Veau I - IV), presence of Robin sequence or syndromes, and risk factors for otitis media. RESULTS Patients with moderate and wide cleft palate underwent higher mean numbers of otologic procedures [narrow: 1.3 (95% confidence interval [CI] 0.9, 1.7); moderate: 1.6 (95% CI 1.1, 2.1); wide: 1.8 (95% CI 1.2, 2.4)]. Moderate and wide cleft palate were less likely to have normal hearing after their first tympanostomy (narrow: 50%, 10/20; moderate: 25%, 6/24; wide: 36%, 5/14). Patients with a wide cleft palate had a shorter median time between first and second tympanostomy procedures (median, IQR; narrow: 27.0, 20.8-35.7; moderate 20.4, 16.3-25.9; wide 17.3, 11.5-23.4). CONCLUSION Our findings suggest that patients with wider cleft palate may be more susceptible to severe ETD. Further large-scale study may help to allow for more informed and personalized clinical decision making for management of cleft palate, incorporating cleft width for prognosis of risks for persistent middle ear dysfunction.
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Affiliation(s)
- H L Martin
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, 40 Duke Medicine Circle, DUMC 3805, 27710, Durham, NC, USA.
| | - E R Poehlein
- Department of Biostatistics and Bioinformatics, Duke University, 2424 Erwin Road, Suite 1102, Hock Plaza Box 2721, 27710, Durham, NC, USA.
| | - A C Allori
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center, 40 Duke Medicine Circle, DUMC 3974, 27710, Durham, NC, USA.
| | - J R Marcus
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center, 40 Duke Medicine Circle, DUMC 3974, 27710, Durham, NC, USA.
| | - J Cheng
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, 40 Duke Medicine Circle, DUMC 3805, 27710, Durham, NC, USA.
| | - H Lee
- Department of Biostatistics and Bioinformatics, Duke University, 2424 Erwin Road, Suite 1102, Hock Plaza Box 2721, 27710, Durham, NC, USA.
| | - E M Raynor
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, 40 Duke Medicine Circle, DUMC 3805, 27710, Durham, NC, USA.
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Benning L, Das-Gupta Z, Sousa Fialho L, Wissig S, Tapela N, Gaunt S. Balancing adaptability and standardisation: insights from 27 routinely implemented ICHOM standard sets. BMC Health Serv Res 2022; 22:1424. [PMID: 36443786 PMCID: PMC9703690 DOI: 10.1186/s12913-022-08694-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 10/18/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Healthcare systems around the world experience increasing pressure to control future growth of healthcare expenditures. Among other initiatives, quality and value-based benchmarking has become an important field to inform clinical evaluation and reimbursement questions. The International Consortium for Health Outcomes Measurement (ICHOM) has become one of the driving forces to translate scientific evidence into standardized assessments that are routinely applicable in day-to-day care settings. These aim to provide a benchmarking tool that allows the comparison and competition of health care delivery on the basis of value-based health care principles. METHODS This work focuses on the consolidation of the ICHOM methodology and presents insights from 27 routinely implemented Standard Sets. The analysis is based on a literature review of the ICHOM literature repository, a process document review and key informant interviews with ICHOM's outcomes research and development team. RESULTS Key findings are that the scope of ICHOM Standard Sets shifted from a more static focus on burden of disease and poorly standardized care pathways to a more dynamic approach that also takes into account questions about the setting of care, feasibility of implementing a benchmarking tool and compatibility of different Standard Sets. Although certain overlaps exist with other initiatives in the field of patient reported outcomes (PRO), their scopes differ significantly and they hence rather complement each other. ICHOM pursues a pragmatic approach to enable the benchmarking and the analysis of healthcare delivery following the principles of value-based healthcare. CONCLUSION The ICHOM Standard Sets complement other initiatives in the field of patient-reported outcomes (PRO) and functional reporting by placing a particular focus on healthcare delivery, while other initiatives primarily focus on evaluation of academic endpoints. Although ICHOM promotes a pragmatic approach towards developing and devising its Standard Sets, the definition of standardized decision making processes emerged as one of the key challenges. Furthermore, the consolidation of core metrics across number of disease areas to enable the parallel implementation of different Standard Sets in the same care setting is an important goal that will enable the widespread implementation of patient-reported outcome measures (PROM).
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Affiliation(s)
- Leo Benning
- University Emergency Center, Medical Center - University of Freiburg, Freiburg, Germany.
- Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Zofia Das-Gupta
- International Consortium for Health Outcomes Measurement, London, UK
| | - Luz Sousa Fialho
- International Consortium for Health Outcomes Measurement, London, UK
| | - Stephanie Wissig
- International Consortium for Health Outcomes Measurement, Boston, USA
| | - Neo Tapela
- International Consortium for Health Outcomes Measurement, London, UK
| | - Suzanne Gaunt
- International Consortium for Health Outcomes Measurement, Boston, USA
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A systematic analysis of surgical interventions for the airway in the mature unilateral cleft lip nasal deformity: a single case study. Int J Comput Assist Radiol Surg 2022; 17:41-53. [PMID: 34080126 PMCID: PMC8636526 DOI: 10.1007/s11548-021-02396-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/30/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE Individuals with unilateral cleft lip nasal deformity (uCLND) often require rhinoplasty in adolescence to correct nasal obstruction. The intent of this study is to identify sites of greatest nasal obstruction and evaluate the effects of isolated and combinations of simulated surgical procedures on these sites using computational fluid dynamics (CFD). METHODS Computed tomography imaging of an adolescent subject with uCLND was converted to an anatomically accurate three-dimensional nasal airway model. Initial analysis was performed to identify anatomic sites of obstruction based on CFD computed resistance values. Virtual surgery procedures corresponding to common uCLND surgical interventions were simulated. Resulting airspace models were then analyzed after conducting airflow and heat transfer simulations. RESULTS The preoperative model had 21 obstructed sites with a nasal resistance of 0.075 Pa s/mL. Following simulated surgical procedures with functional interventions alone and in combinations, the three virtual surgery models with most improved nasal airflow were inferior turbinate reduction (ITR) with posterior septoplasty (resistance = 0.054 Pa s/ml, reduction in 14 of 21 obstructed sites), ITR with anterior septoplasty (resistance = 0.058 Pa s/ml, reduction in 8 of 21 obstructed sites), and ITR with both anterior and posterior septoplasty (resistance = 0.052 Pa s/ml, reduction in 17 of 21 obstructed sites). CONCLUSION This study introduces a new technique for analysis of the impact of different simulated surgical interventions on uCLND-induced nasal obstruction. In this subject, simulated septoplasty with ITR on the non-cleft side provided maximal relief of nasal obstruction. The proposed technique can be further studied for possible utility in analyzing potential surgical interventions for optimal relief of nasal obstruction in patients with uCLND.
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Discussion: Considerations for Payment Bundling in Cleft Care. Plast Reconstr Surg 2021; 147:933-934. [PMID: 33776037 DOI: 10.1097/prs.0000000000007791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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10
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de Blacam C, Baylis AL, Kirschner RE, Smith S, Sell D, Sie KCY, Harris HE, Orr DJA. Core Outcome Set for Reporting Outcomes of Interventions for Velopharyngeal Dysfunction: Final Results of the COS-VPD Initiative. Cleft Palate Craniofac J 2021; 59:S84-S96. [PMID: 34398725 DOI: 10.1177/10556656211035026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To date, the recording of outcomes of interventions for velopharyngeal dysfunction (VPD) has not been standardized. This makes a comparison of results between studies challenging. The aim of this study was to develop a core outcome set (COS) for reporting outcomes in studies examining the management of VPD. DESIGN A two-round Delphi consensus process was used to develop the COS. PATIENTS, PARTICIPANTS The expert Delphi panel comprised patients and caregivers of patients with VPD, surgeons and speech and language therapists specializing in cleft palate, and researchers with expertise in VPD. INTERVENTIONS A long list of outcomes was derived from the published literature. In each round of a Delphi survey, participants were asked to score outcomes using the Grading of Recommendations, Assessment, Development, and Evaluations scale of 1 to 9, with 1 to 3 labeled "not important," 4 to 6 labeled "important but not critical," and 7 to 9 labeled "critical." MAIN OUTCOME MEASURE Consensus criteria were specified a priori. Outcomes with a rating of 75% or more of the panel rating 7 to 9 and 25% or fewer rating 1 to 3 were included in the COS. RESULTS A total of 31 core outcomes were identified from the Delphi process. This list was condensed to combine topic areas to produce a final COS of 10 outcomes, including both processes of care and patient-reported outcomes that should be considered for reporting in future studies of VPD. CONCLUSIONS Implementation of the COS-VPD will facilitate consistency of outcomes data collection and comparison of results across studies.
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Affiliation(s)
- Catherine de Blacam
- 575349Department of Plastic Surgery, 11595Children's Health Ireland at Crumlin, Dublin, Ireland.,8863Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Adriane L Baylis
- Plastic and Reconstructive Surgery, 2650Nationwide Children's Hospital, Columbus, OH, USA.,12305The Ohio State University College of Medicine, Columbus, OH, USA
| | - Richard E Kirschner
- Plastic and Reconstructive Surgery, 2650Nationwide Children's Hospital, Columbus, OH, USA.,12305The Ohio State University College of Medicine, Columbus, OH, USA
| | - Susan Smith
- 162839Department of General Practice, 8863Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Debbie Sell
- Speech and Language Therapy, 4956Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Kathleen C Y Sie
- Pediatric Otolaryngology, 7274Seattle Children's Hospital, Seattle, Washington, USA
| | | | - David J A Orr
- 575349Department of Plastic Surgery, 11595Children's Health Ireland at Crumlin, Dublin, Ireland.,8809Trinity College Dublin, Dublin, Ireland
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Padovano WM, Skolnick GB, Naidoo SD, Snyder-Warwick AK, Patel KB. Long-Term Effects of Nasoalveolar Molding in Patients With Unilateral Cleft Lip and Palate: A Systematic Review and Meta-Analysis. Cleft Palate Craniofac J 2021; 59:462-474. [PMID: 33882703 DOI: 10.1177/10556656211009702] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE The aim of this systematic review and meta-analysis was to investigate long-term treatment effects of nasoalveolar molding (NAM) in patients with unilateral cleft lip and palate (UCLP). DESIGN Included manuscripts met the following criteria: (1) involved patients with UCLP who received NAM; (2) included comparison group(s) who either received non-NAM passive presurgical infant orthopedic appliances (PSIO) or who did not receive any PSIO; (3) reported at least one objective or validated measure of nasolabial, craniofacial, or palatal form; and (4) had patient follow-up beyond 4 years of age. RESULTS A total of 12 studies were included in this review. Meta-analyses were possible for Asher-McDade parameters and cephalometric measurements. Compared to patients who did not receive any PSIO, those who underwent NAM therapy were more likely to have good to excellent frontal nasal form (Risk ratio: 2.4, 95% CI: 1.24-3.68) and vermillion border (Risk ratio: 1.8, 95% CI: 1.19-2.71). However, there were no statistically significant differences in cephalometric measurements between these groups. Additionally, there were no statistically significant differences between patients receiving NAM versus non-NAM PSIO. There was insufficient evidence to determine the impact of NAM on dental arch development. CONCLUSIONS The preponderance of evidence in this review suggests that NAM produces benefits in nasolabial aesthetic form when compared with no appliance-based presurgical treatment. However, there is insufficient evidence to conclude whether NAM produces such benefits when compared with other passive PSIOs.
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Affiliation(s)
- William M Padovano
- Division of Plastic and Reconstructive Surgery, 12275Washington University in St. Louis School of Medicine, MO, USA
| | - Gary B Skolnick
- Division of Plastic and Reconstructive Surgery, 12275Washington University in St. Louis School of Medicine, MO, USA
| | - Sybill D Naidoo
- Division of Plastic and Reconstructive Surgery, 12275Washington University in St. Louis School of Medicine, MO, USA
| | - Alison K Snyder-Warwick
- Division of Plastic and Reconstructive Surgery, 12275Washington University in St. Louis School of Medicine, MO, USA
| | - Kamlesh B Patel
- Division of Plastic and Reconstructive Surgery, 12275Washington University in St. Louis School of Medicine, MO, USA
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12
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Kalf RRJ, Vreman RA, Delnoij DMJ, Bouvy ML, Goettsch WG. Bridging the gap: Can International Consortium of Health Outcomes Measurement standard sets align outcomes accepted for regulatory and health technology assessment decision-making of oncology medicines. Pharmacol Res Perspect 2021; 9:e00742. [PMID: 33749172 PMCID: PMC7982865 DOI: 10.1002/prp2.742] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 01/30/2021] [Indexed: 12/23/2022] Open
Abstract
Standard outcome sets developed by the International Consortium for Health Outcomes Measurement (ICHOM) facilitate value-based health care in healthcare practice and have gained traction from regulators and Health Technology Assessment (HTA) agencies that regularly assess the value of new medicines. We aimed to assess the extent to which the outcomes used by regulators and HTA agencies are patient-relevant, by comparing these to ICHOM standard sets. We conducted a cross-sectional comparative analysis of ICHOM standard sets, and publicly available regulatory and HTA assessment guidelines. We focused on oncology due to many new medicines being developed, which are accompanied by substantial uncertainty regarding the relevance of these treatments for patients. A comparison of regulatory and HTA assessment guidelines, and ICHOM standard sets showed that both ICHOM and regulators stress the importance of disease-specific outcomes. On the other hand, HTA agencies have a stronger focus on generic outcomes in order to allow comparisons across disease areas. Overall, similar outcomes are relevant for market access, reimbursement, and in ICHOM standard sets. However, some differences are apparent, such as the acceptability of intermediate outcomes. These are recommended in ICHOM standard sets, but regulators are more likely to accept intermediate outcomes than HTA agencies. A greater level of alignment in outcomes accepted may enhance the efficiency of regulatory and HTA processes, and increase timely access to new medicines. ICHOM standard sets may help align these outcomes. However, some differences in outcomes used may remain due to the different purposes of regulatory and HTA decision-making.
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Affiliation(s)
- Rachel R J Kalf
- Zorginstituut Nederland, Diemen, the Netherlands.,Department of Pharmacoepidemiology and Clinical Pharmacology, University Utrecht, Utrecht, the Netherlands
| | - Rick A Vreman
- Zorginstituut Nederland, Diemen, the Netherlands.,Department of Pharmacoepidemiology and Clinical Pharmacology, University Utrecht, Utrecht, the Netherlands
| | - Diana M J Delnoij
- Zorginstituut Nederland, Diemen, the Netherlands.,Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Marcel L Bouvy
- Department of Pharmacoepidemiology and Clinical Pharmacology, University Utrecht, Utrecht, the Netherlands
| | - Wim G Goettsch
- Zorginstituut Nederland, Diemen, the Netherlands.,Department of Pharmacoepidemiology and Clinical Pharmacology, University Utrecht, Utrecht, the Netherlands
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13
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Apon I, Rogers-Vizena CR, Koudstaal MJ, Allori AC, Peterson P, Versnel SL, Ramirez JP. Barriers and Facilitators to the International Implementation of Standardized Outcome Measures in Clinical Cleft Practice. Cleft Palate Craniofac J 2021; 59:5-13. [PMID: 33663243 PMCID: PMC8670748 DOI: 10.1177/1055665621997668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objective: To identify barriers and facilitators to international implementation of a prospective system for standardized outcomes measurement in cleft care. Design: Cleft teams that have implemented the International Consortium for Health Outcomes Measurement Standard Set for cleft care were invited to participate in this 2-part qualitative study: (1) an exploratory survey among clinicians, health information technology professionals, and project coordinators, and (2) semistructured interviews of project leads. Thematic content analysis was performed, with organization of themes according to the dimensions of the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) framework: reach, effectiveness, adoption, implementation, and maintenance. Results: Four cleft teams in Europe and North America participated in this study. Thirteen participants completed exploratory questionnaires and 5 interviewees participated in follow-up interviews. Survey responses and thematic content analysis revealed common facilitators and barriers to implementation at all sites. Teams reach patients either via email or during the clinic visit to capture patient-reported outcomes. Adopting routine data collection is enhanced by aligning priorities at the organizational and cleft team level. Streamlining workflows and developing an efficient data collection platform are necessary early on, followed by pilot testing or stepwise implementation. Regular meetings and financial resources are crucial for implementing, sustaining, analyzing collected data, and providing feedback to health care professionals and patients. Fostering patient-centered care was articulated as a positive outcome, whereas time presented challenges across all RE-AIM dimensions. Conclusions: Identified themes can inform ongoing implementation efforts. Intentionally investing time to lay a sound foundation early on will benefit every phase of implementation and help overcome barriers such as lack of support or motivation.
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Affiliation(s)
- Inge Apon
- Department of Oral and Maxillofacial Surgery, 6993Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Maarten J Koudstaal
- Department of Oral and Maxillofacial Surgery, 6993Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Alexander C Allori
- Division of Plastic, Maxillofacial, and Oral Surgery, 22957Duke University Hospital, Durham, NC, USA
| | - Petra Peterson
- Department of Plastic and Craniofacial Surgery, 59562Karolinska University Hospital, Stockholm, Sweden
| | - Sarah L Versnel
- Department of Plastic and Reconstructive Surgery, 6993Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jessily P Ramirez
- International Consortium for Health Outcomes Measurement (ICHOM), Boston, MA, USA
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14
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Weidler EM, Britto MT, Sitzman TJ. Facilitators and Barriers to Implementing Standardized Outcome Measurement for Children With Cleft Lip and Palate. Cleft Palate Craniofac J 2020; 58:7-18. [PMID: 32662298 DOI: 10.1177/1055665620940187] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Identify facilitators and barriers to implementing standardized outcome measurement in cleft care. DESIGN Cross-sectional, qualitative study. SETTING/PARTICIPANTS Participants included 24 providers and staff from a large, multidisciplinary cleft team in the southwest United States, 5 caregivers of children with cleft palate (with or without cleft lip) treated by this team, and 3 experts involved in implementing a cleft-specific standardized outcome measurement in the United Kingdom. INTERVENTIONS Semistructured, qualitative interviews were conducted exploring perceived facilitators and barriers to implementing standardized outcome measurement in cleft care. Interviews were audio-recorded, transcribed, and analyzed for content. The Consolidated Framework for Implementation Research was used to guide the interviews and analysis. The analysis focused on the characteristics of standardized outcome measurement that directly influence its adoption. RESULTS Participants identified both facilitators and barriers to implementing standardized outcome measurement. Facilitators included the strength and quality of evidence supporting improvements in cleft care delivery following implementation of standardized outcome measurement and the relative advantage of standardized outcome measurement over continuing the status quo. Barriers included the difficulty adapting standardized outcome measurement to meet local context and patient-specific needs and the complexity of implementing standardized outcome measurement. CONCLUSIONS Providers, staff, and caregivers involved in cleft care perceive multiple benefits from standardized outcome measurement, while also recognizing substantial barriers to its implementation. Results from this study can be used to guide development of an implementation strategy for standardized outcome measurement that builds upon perceived strengths of the intervention and reduces perceived barriers.
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Affiliation(s)
- Erica M Weidler
- Department of Clinical Research, Phoenix Children's Hospital, AZ, USA
| | - Maria T Britto
- Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH, USA
| | - Thomas J Sitzman
- Division of Plastic Surgery, Phoenix Children's Hospital, AZ, USA.,Department of Child Health, University of Arizona College of Medicine-Phoenix, AZ, USA.,Barrow Cleft and Craniofacial Center, Phoenix, AZ, USA
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15
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Laureij LT, Been JV, Lugtenberg M, Ernst-Smelt HE, Franx A, Hazelzet JA, de Groot PK, Frauenfelder O, Henriquez D, Lamain-de Ruiter M, Neppelenbroek E, Nij Bijvank SWA, Schaap T, Schagen M, Veenhof M, Vermolen JH. Exploring the applicability of the pregnancy and childbirth outcome set: A mixed methods study. PATIENT EDUCATION AND COUNSELING 2020; 103:642-651. [PMID: 31607633 DOI: 10.1016/j.pec.2019.09.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/20/2019] [Accepted: 09/23/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The International Consortium for Health Outcomes Measurement developed the Pregnancy and Childbirth (PCB) outcome set to improve value-based perinatal care. This set contains clinician-reported outcomes and patient-reported outcomes. We validated the set for use in the Netherlands by exploring its applicability among all end-users prior to implementation. METHODS A mixed-methods design was applied. A survey was performed to assess patients (n = 142), professionals (n = 134) and administrators (n = 35) views on the PCB set. To further explore applicability, separate focus groups were held with representatives of each of these groups. RESULTS The majority of survey participants agreed that the PCB set contains the most important outcomes. Patient-reported experience measures were considered relevant by the majority of participants. Perceived relevance of patient-reported outcome measures varied. Main themes from the focus groups were content of the set, data collection timing, implementation (also IT and transparency), and quality-based governance. CONCLUSION This study supports suitability of the PCB outcome set for implementation, evaluation of quality of care and shared decision making in perinatal care. PRACTICE IMPLICATIONS Implementation of the PCB set may change existing care pathways of perinatal care. Focus on transparency of outcomes is required in order to achieve quality-based governance with proper IT solutions.
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Affiliation(s)
- Lyzette T Laureij
- Department of Obstetrics and Gynecology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, the Netherlands.
| | - Jasper V Been
- Department of Obstetrics and Gynecology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, the Netherlands; Department of Pediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, the Netherlands; Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Marjolein Lugtenberg
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Hiske E Ernst-Smelt
- Department of Obstetrics and Gynecology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, the Netherlands
| | - Arie Franx
- Department of Obstetrics and Gynecology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, the Netherlands
| | - Jan A Hazelzet
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Pieter-Kees de Groot
- Department of Pediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, the Netherlands
| | - Odile Frauenfelder
- Department of Pediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, the Netherlands
| | - Dacia Henriquez
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Marije Lamain-de Ruiter
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | | | - Timme Schaap
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Murielle Schagen
- Department of Obstetrics, Spaarne Gasthuis, Haarlem, the Netherlands
| | - Marieke Veenhof
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
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Allori AC, Marcus JR. Condition-Specific Standard Sets of Outcome Measures Critical for Clinical and Health Services Research. JAMA FACIAL PLAST SU 2020; 21:359-360. [PMID: 31070676 DOI: 10.1001/jamafacial.2019.0229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Alexander C Allori
- Duke Children's Hospital, Durham, North Carolina.,Duke University School of Medicine, Durham, North Carolina
| | - Jeffrey R Marcus
- Duke Children's Hospital, Durham, North Carolina.,Duke University School of Medicine, Durham, North Carolina
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