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Foppiani J, Alvarez AH, Stearns SA, Taritsa IC, Weidman AA, Valentine L, Escobar-Domingo MJ, Foster L, Schuster KA, Ho OA, Rinker B, Lee BT, Lin SJ. Utilization of patient-reported outcome measures in plastic surgery clinical trials: A systematic review. J Plast Reconstr Aesthet Surg 2024; 90:215-223. [PMID: 38387418 DOI: 10.1016/j.bjps.2024.01.036] [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: 11/06/2023] [Revised: 12/14/2023] [Accepted: 01/29/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Patient-reported outcomes (PROs) have evolved to validated questionnaires assessing health-related quality of life. This systematic review evaluates the utilization of PROs in United States plastic and reconstructive surgery (PRS) clinical trials (CTs). METHODS A medical librarian conducted a search strategy for PRS CTs from 2012 to 2022. CTs were identified and assessed for PRO utilization. Summary statistics were performed, and Fisher's exact test was used for subgroup analysis. RESULTS Of the 3609 studies initially identified, 154 were PRS CTs. Approximately half (80 studies) employed PROs, encompassing 13,190 participants, 95% (12,229) of whom were female. Among the CTs, 37 (48%) were in the field of reconstruction, while 25 (32%) were cosmetic. Pain (35%) and patient satisfaction (24%) were the most common primary outcomes. Validated PROs were the main outcome in 61% of these trials, with the visual analog scale (19%) and BREAST-Q (15%) as the top instruments. Funding was primarily private (34%) or not reported (49%). No significant trend in validated PRO usage was observed over the examined decade. CONCLUSIONS The use of PROs is relevant for healthcare delivery and improvement as they provide insight into the efficacy of treatments from a patient-centered viewpoint. PROs are reported in just over half of PRS CTs, and within those CTs, the use of validated questionnaires is inconsistent. Therefore, emerging CTs should strive to incorporate PRO measures and utilize the existing validated tools to assess novel interventions and ensure that the data reported is objective.
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Affiliation(s)
- Jose Foppiani
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Angelica Hernandez Alvarez
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Stephen A Stearns
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Iulianna C Taritsa
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Allan A Weidman
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Lauren Valentine
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Maria J Escobar-Domingo
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Lacey Foster
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kirsten A Schuster
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Olivia A Ho
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Brian Rinker
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Bernard T Lee
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Samuel J Lin
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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Khoo JEJ, Lim CW, Lai YF. Performance management of generalist care for hospitalised multimorbid patients-a scoping review for value-based care. FRONTIERS IN HEALTH SERVICES 2024; 3:1147565. [PMID: 38469170 PMCID: PMC10925702 DOI: 10.3389/frhs.2023.1147565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 12/29/2023] [Indexed: 03/13/2024]
Abstract
Objectives Given the shift towards value-based healthcare and the increasing recognition of generalist care, enacting value-based healthcare for generalist care is critical. This work aims to shed light on how to conduct performance management of generalist care to facilitate value-based care, with a focus on medical care of hospitalised patients. Design and setting A scoping review of published literature was conducted. 30 publications which were relevant to performance management of generalist medical inpatient care were included in the review. Outcome measures The performance measures used across the studies were analysed and other qualitative findings were also obtained. Results We report an overall lack of research on performance management methods for generalist inpatient care. Relevant performance measures found include both outcome and process of care measures and both clinical and reported measures, with clinical outcome measures the most frequently reported. Length of stay, readmission rates and mortality were the most frequently reported. The insights from the papers emphasise the relevance of process of care measures for performance management, the advantages and disadvantages of types of measures and provide suggestions relevant for performance management of generalist inpatient care. Conclusion The findings of this scoping review outline a variety of performance measures valuable for generalist inpatient care including clinical outcome measures, reported outcome measures and process of care measures. The findings also suggest directions for implementation of such performance management, including emphasis on physician level performance management and the importance of documentation training. Further research for selecting and operationalising the measures for specific contexts and developing a comprehensive performance management system involving these measures will be important for achieving value-based healthcare for generalist inpatient care.
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Affiliation(s)
- Jia En Joy Khoo
- Ministry of Health (MOH) Office for Healthcare Transformation, Singapore, Singapore
- Department of Life Sciences, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Cher Wee Lim
- Ministry of Health (MOH) Office for Healthcare Transformation, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Yi Feng Lai
- Ministry of Health (MOH) Office for Healthcare Transformation, Singapore, Singapore
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore
- School of Public Health, University of Illinois at Chicago, Chicago, IL, United States
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Carey S, Men M, Cunich M. The impact of targeted interventions aimed to improve quality of life in patients receiving home parenteral nutrition: A systematic literature review. J Hum Nutr Diet 2023; 36:1741-1750. [PMID: 37539458 DOI: 10.1111/jhn.13225] [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: 04/16/2023] [Accepted: 08/01/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND Home parenteral nutrition (HPN) is a specialised therapy offered to people suffering from intestinal failure. Underlying disease, HPN complications and limitations of HPN can significantly impact a person's quality-of-life (QOL). The aim of this review was to evaluate the evidence on existing non-surgical/non-pharmacological interventions aimed at improving QOL, clinical, patient-reported and economic outcomes for patients receiving parenteral nutrition therapy at home across adult and paediatric settings. METHODS Online databases Medline (Ovid), Embase and Cinahl were searched to identify studies published between 1937 and 31 March 2022. Identified studies were appraised using the Cochrane Collaboration risk of bias tool and Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment. RESULTS Nine studies were included in this review. Interventions were focused on education (n = 4), telemedicine (n = 2), preparation of infusion mixtures (n = 1), mindfulness-based cognitive therapy (n = 1) and a multi-modal approach (n = 1). Only one study measured QOL before and after the intervention using a validated QOL tool. All studies were assessed at either some, high or critical risk of bias, resulting in low or very low-quality evidence for the interventions evaluated. CONCLUSIONS The findings from this review highlight the lack of high-quality non-surgical/non-pharmacological studies seeking to improve QOL for people on HPN. Because the majority of people receiving HPN are not eligible for surgical or pharmaceutical treatments, higher quality research using clinical trial design, and research focused on improving QOL is needed to inform healthcare managers about the effectiveness (and value) of alternative service delivery models for this vulnerable patient group.
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Affiliation(s)
- Sharon Carey
- Faculty of Medicine and Health, Central Clinical School, Sydney, NSW, Australia
- Nutrition and Dietetics Department, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Institute of Academic Surgery, Camperdown, NSW, Australia
| | - Mohan Men
- Faculty of Medicine and Health, Central Clinical School, Sydney, NSW, Australia
| | - Michelle Cunich
- Sydney Health Economics Collaborative, Sydney Local Health District, Sydney, NSW, Australia
- Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), Sydney, NSW, Australia
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Sasseville M, Chouinard MC, Fortin M. Evaluating the content of a patient-reported outcome measure for people with multimorbidity: a Delphi consensus. Qual Life Res 2021; 30:2951-2960. [PMID: 34036542 DOI: 10.1007/s11136-021-02888-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Evidence supporting multimorbidity-adapted interventions is scarce, mostly due to a lack of adapted outcome measures. Measurement constructs for a novel patient-reported outcome measure (PROM) were defined in previous studies using a literature review, a qualitative description from stakeholders, and an item pool identification process. The aim of this study was to attain consensus on the content of this novel PROM. METHODS A three-round electronic modified Delphi technique was conducted using an academic and clinical expert panel. Using a Likert scale, the panel rated the relevance, improvability, and self-ratability of each construct and item of the preliminary version of the PROM. The main outcome was consensus attainment, defined as strong (≥ 70%), moderate (50-69%) or low agreement (< 50%). Constructs and items with strong consensus were kept, moderate were sent to the next round and low agreement were rejected. RESULTS From the 61 experts contacted, 39 participated in the first round of the Delphi, with a 12.8% attrition at the second round (n = 34) and 38.2% at the third round (n = 21). The panel included mostly female academic experts from nursing and medicine backgrounds. The preliminary PROM included 19 constructs and 70 items; from these, 16 constructs and 50 items attained consensus. The consensus attainment process excluded three constructs and their items: awareness, weight control and social integration. CONCLUSION Consensus was reached for a patient-reported outcome measure adapted for people with multimorbidity including 50 relevant, improvable and self-ratable items categorized under 16 constructs. As more interventions tailored to multimorbidity are implemented, there is an increasing need for a valid measure of the effectiveness of these interventions.
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Affiliation(s)
- Maxime Sasseville
- Research Chair On Chronic Diseases in Primary Care, Department of Family and Emergency Medicine, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, QC, Canada. .,Department of Health Sciences, Université du Québec à Chicoutimi, 555 boulevard de l'Université, Chicoutimi, Saguenay, QC, G7H 2B1, Canada.
| | - Maud-Christine Chouinard
- Nursing Faculty, Université de Montréal, Pavillon Marguerite-d'Youville, C.P. 6128 succ. Centre-ville, Montréal, QC, Canada
| | - Martin Fortin
- Research Chair On Chronic Diseases in Primary Care, Department of Family and Emergency Medicine, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, QC, Canada
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