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Munger Clary HM, Snively BM, Kumi-Ansu Y, Alexander HB, Kimball J, Duncan P, Conner K, Christopher J, Lohana P, Brenes GA. Quality of life during usual epilepsy care for anxiety or depression symptoms: Secondary patient-reported outcomes in a randomized trial of remote assessment methods. Epilepsy Res 2024; 204:107396. [PMID: 38908323 DOI: 10.1016/j.eplepsyres.2024.107396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/28/2024] [Accepted: 06/13/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND AND OBJECTIVES Anxiety and depression are highly prevalent and impactful in epilepsy. American Academy of Neurology quality measures emphasize anxiety and depression screening and quality of life (QOL) measurement, yet usual epilepsy care QOL and anxiety/depression outcomes are poorly characterized. The main objective was to assess 6-month QOL, anxiety and depression during routine care among adults with epilepsy and baseline anxiety or depression symptoms; these were prespecified secondary outcomes within a pragmatic randomized trial of remote assessment methods. METHODS Adults with anxiety or depression symptoms and no suicidal ideation were recruited from a tertiary epilepsy clinic via an electronic health record (EHR)-embedded process. Participants were randomized 1:1 to 6 month outcome collection via patient portal EHR questionnaires vs. telephone interview. This report focuses on an a priori secondary outcomes of the overall trial, focused on patient-reported health outcomes in the full sample. Quality of life, (primary health outcome), anxiety, and depression measures were collected at 3 and 6 months (Quality of Life in Epilepsy-10, QOLIE-10, Generalized Anxiety Disorder-7, Neurological Disorders Depression Inventory-Epilepsy). Change values and 95 % confidence intervals were calculated. In post-hoc exploratory analyses, patient-reported anxiety/depression management plans at baseline clinic visit and healthcare utilization were compared with EHR-documentation, and agreement was calculated using the kappa statistic. RESULTS Overall, 30 participants (15 per group) were recruited and analyzed, of mean age 42.5 years, with 60 % women. Mean 6-month change in QOLIE-10 overall was 2.0(95 % CI -6.8, 10.9), and there were no significant differences in outcomes between the EHR and telephone groups. Mean anxiety and depression scores were stable across follow-up (all 95 % CI included zero). Outcomes were similar regardless of whether an anxiety or depression action plan was documented. During the baseline interview, most participants with clinic visit EHR documentation indicating action to address anxiety and/or depression reported not being offered a treatment(7 of 12 with action plan, 58 %), and there was poor agreement between patient report and EHR documentation (kappa=0.22). Healthcare utilization was high: 40 % had at least one hospitalization or emergency/urgent care visit reported and/or identified via EHR, but a third (4/12) failed to self-report an EHR-identified hospitalization/urgent visit. DISCUSSION Over 6 months of usual care among adults with epilepsy and anxiety or depression symptoms, there was no significant average improvement in quality of life or anxiety/depression, suggesting a need for interventions to enhance routine neurology care and achieve quality of life improvement for this group.
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Affiliation(s)
- Heidi M Munger Clary
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Beverly M Snively
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Yaw Kumi-Ansu
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Halley B Alexander
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - James Kimball
- Department of Psychiatry, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Pamela Duncan
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Kelly Conner
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC, USA; Physician Assistant Studies, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jerryl Christopher
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Paneeni Lohana
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Gretchen A Brenes
- Department of Internal Medicine, Section of Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Dan B. Advancing definitions of paediatric neurological disorders: Lessons from adult neurology. Dev Med Child Neurol 2024; 66:270-271. [PMID: 37990477 DOI: 10.1111/dmcn.15818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 11/10/2023] [Indexed: 11/23/2023]
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Silveira Bianchim M, Crane E, Jones A, Neukirchinger B, Roberts G, Mclaughlin L, Noyes J. The implementation, use and impact of patient reported outcome measures in value-based healthcare programmes: A scoping review. PLoS One 2023; 18:e0290976. [PMID: 38055759 DOI: 10.1371/journal.pone.0290976] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/08/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Value-Based Healthcare (VBHC) focuses on the value of patient outcomes and is achieved by ensuring resources already available are managed to realise the best possible individual and population health outcomes. Patient reported outcome measures (PROMs) measure the impact of illnesses from the patient perspective. We conducted a scoping review to understand how PROMs were implemented and used, and their impact in the context of VBHC. METHODS Arksey and O'Malley's overarching framework supplemented by principles from mixed-methods Framework Synthesis were used. CINAHL, Cochrane Library, EMBASE, MEDLINE, PsycINFO, Web of Science, Google Scholar and reference lists were searched. An a priori data extraction framework was created using the review question and objectives as key domains against which to extract data. Mixed-methods data were organised, integrated and preserved in original format and reported for each domain. RESULTS Forty-three studies were included with 60,200 participants. Few studies reported a well-developed programme theory and we found little robust evidence of effect. PROMs were universally considered to have the potential to increase patient satisfaction with treatment and services, enhance patient awareness of symptoms and self-management, and improve health outcomes such as quality of life and global health status. Evidence is currently limited on how PROMs work and how best to optimally implement PROMs to achieve the target outcome. Implementation challenges commonly prevented the realisation of optimal outcomes and patients generally needed better and clearer communication about why PROMs were being given and how they could optimally be used to support their own self-management. CONCLUSION PROMSs have yet to demonstrate their full potential in a VBHC context. Optimal PROMs implementation is poorly understood by clinicians and patients. Future studies should explore different models of PROM implementation and use within VBHC programmes to understand what works best and why for each specific context, condition, and population.
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Affiliation(s)
| | - Ellie Crane
- School of Medical and Health Sciences, Bangor University, Bangor, United Kingdom
| | - Anwen Jones
- School of Medical and Health Sciences, Bangor University, Bangor, United Kingdom
| | | | - Gareth Roberts
- Aneurin Bevan University Health Board, Newport, United Kingdom
| | - Leah Mclaughlin
- School of Medical and Health Sciences, Bangor University, Bangor, United Kingdom
| | - Jane Noyes
- School of Medical and Health Sciences, Bangor University, Bangor, United Kingdom
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Nuthalapati P, Thomas L, Donahue MA, Moura LMVR, DeStefano S, Simpson JR, Buchhalter J, Fureman BE, Pellinen J. Improving Seizure Frequency Documentation and Classification. Neurol Clin Pract 2023; 13:e200212. [PMID: 37873534 PMCID: PMC10586801 DOI: 10.1212/cpj.0000000000200212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 09/01/2023] [Indexed: 10/25/2023]
Abstract
Background and Objectives Accurate and reliable seizure data are essential for evaluating treatment strategies and tracking the quality of care in epilepsy clinics. This quality improvement project aimed to increase seizure documentation (i.e., documentation of seizure frequency from 80% to 100%, date of last seizure from 35% to 50%, and International League Against Epilepsy (ILAE) seizure classification from 35% to at least 50%) over 6 months. Methods We surveyed 7 epileptologists to determine their perceived seizure frequency, ILAE classification, and date of last seizure documentation habits. Baseline data were collected weekly from September to December 2021. Subsequently, we implemented a newly created flowsheet in our Electronic Health Record (EHR) based on the Epilepsy Learning Healthcare System (ELHS) Case Report Forms to increase seizure documentation in a standardized way. Two epileptologists tested this flowsheet tool in their epilepsy clinics between February 2022 and July 2022. Data were collected weekly and compared with documentation from other epileptologists within the same group. Results Epileptologists at our center believed they documented seizure frequency for 84%-87% of clinic visits, which aligned with baseline data collection, showing they recorded seizure frequency for 83% of clinic visits. Epileptologists believed they documented ILAE classification for 47%-52% of clinic visits, and baseline data showed this was documented in 33% of clinic visits. They also reported documenting the date of the last seizure for 52%-63% of clinic visits, but this occurred in only 35% of clinic visits. After implementing the new flowsheet, documentation increased to nearly 100% for all fields being completed by the providers who tested the flowsheet. Discussion We demonstrated that by implementing an easy-to-use standardized EHR documentation tool, our documentation of critical metrics, as defined by the ELHS, improved dramatically. This shows that simple and practical interventions can substantially improve clinically meaningful documentation.
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Affiliation(s)
- Poojith Nuthalapati
- Department of Neurology (PN, MAD, LMVRM), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (LT, SD, JRS, JP), University of Colorado School of Medicine, Aurora; Department of Pediatrics (JB), Cumming School of Medicine, University of Calgary, AB, CA; and Mission Outcomes Team (BEF), Epilepsy Foundation, Landover, MD
| | - Lionel Thomas
- Department of Neurology (PN, MAD, LMVRM), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (LT, SD, JRS, JP), University of Colorado School of Medicine, Aurora; Department of Pediatrics (JB), Cumming School of Medicine, University of Calgary, AB, CA; and Mission Outcomes Team (BEF), Epilepsy Foundation, Landover, MD
| | - Maria A Donahue
- Department of Neurology (PN, MAD, LMVRM), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (LT, SD, JRS, JP), University of Colorado School of Medicine, Aurora; Department of Pediatrics (JB), Cumming School of Medicine, University of Calgary, AB, CA; and Mission Outcomes Team (BEF), Epilepsy Foundation, Landover, MD
| | - Lidia M V R Moura
- Department of Neurology (PN, MAD, LMVRM), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (LT, SD, JRS, JP), University of Colorado School of Medicine, Aurora; Department of Pediatrics (JB), Cumming School of Medicine, University of Calgary, AB, CA; and Mission Outcomes Team (BEF), Epilepsy Foundation, Landover, MD
| | - Samuel DeStefano
- Department of Neurology (PN, MAD, LMVRM), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (LT, SD, JRS, JP), University of Colorado School of Medicine, Aurora; Department of Pediatrics (JB), Cumming School of Medicine, University of Calgary, AB, CA; and Mission Outcomes Team (BEF), Epilepsy Foundation, Landover, MD
| | - Jennifer R Simpson
- Department of Neurology (PN, MAD, LMVRM), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (LT, SD, JRS, JP), University of Colorado School of Medicine, Aurora; Department of Pediatrics (JB), Cumming School of Medicine, University of Calgary, AB, CA; and Mission Outcomes Team (BEF), Epilepsy Foundation, Landover, MD
| | - Jeffrey Buchhalter
- Department of Neurology (PN, MAD, LMVRM), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (LT, SD, JRS, JP), University of Colorado School of Medicine, Aurora; Department of Pediatrics (JB), Cumming School of Medicine, University of Calgary, AB, CA; and Mission Outcomes Team (BEF), Epilepsy Foundation, Landover, MD
| | - Brandy E Fureman
- Department of Neurology (PN, MAD, LMVRM), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (LT, SD, JRS, JP), University of Colorado School of Medicine, Aurora; Department of Pediatrics (JB), Cumming School of Medicine, University of Calgary, AB, CA; and Mission Outcomes Team (BEF), Epilepsy Foundation, Landover, MD
| | - Jacob Pellinen
- Department of Neurology (PN, MAD, LMVRM), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology (LT, SD, JRS, JP), University of Colorado School of Medicine, Aurora; Department of Pediatrics (JB), Cumming School of Medicine, University of Calgary, AB, CA; and Mission Outcomes Team (BEF), Epilepsy Foundation, Landover, MD
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Vonck K, Biraben A, Bosak M, Jennum PJ, Kimiskidis VK, Marusic P, Mitchell JW, Ferreira LN, Ondrušová M, Pana A, Persson U, von Oertzen TJ, Lattanzi S. Usage and impact of patient-reported outcomes in epilepsy. Brain Behav 2023; 13:e3342. [PMID: 37997564 PMCID: PMC10726862 DOI: 10.1002/brb3.3342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/09/2023] [Accepted: 11/12/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND The use of patient-reported outcomes (PRO) in clinical practice is gaining increasing attention. This study aimed to provide a critical assessment of the current state-of-the-art and beliefs about the use of PRO in the management of people with epilepsy across some European countries. METHODS Structured interviews were conducted with European experts to collect insights about (I) the personal experience with PRO; (II) the value and impact of PRO in the decision-making process at the national level; and (III) the interest for and use of PRO by national health authorities. RESULTS Nine neurologists (Austria, Belgium, Czechia, Denmark, France, Greece, Italy, Poland, and United Kingdom), three health economists (Portugal, Romania, and Sweden), and one epidemiologist (Slovakia) participated. They all stated that PRO are collected at their own countries in the context of clinical trials and/or specific projects. During everyday clinical practice, PRO are collected routinely/almost routinely in Austria and Sweden and only at the discretion of the treating physicians in Czechia, Denmark, France, Greece, and Portugal. There was complete consensus about the favorable impact that the PRO can have in terms of clinical outcomes, healthcare resources utilization, and general patient satisfaction. Only participants from Portugal and Sweden answered that the PRO are perceived as very important by the National Health Authorities of their respective countries. CONCLUSIONS Differences exist in attitudes and perspectives about PRO in epilepsy across Europe. An active plan is warranted to harmonize the measurement of PRO and ensure they can be relevant to people with epilepsy and health services.
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Affiliation(s)
- Kristl Vonck
- Department of Neurology, 4BrainGhent University HospitalGentBelgium
| | - Arnaud Biraben
- Unité d’épileptologie, CHU Pontchaillou RennesRennesFrance
| | - Magdalena Bosak
- Department of NeurologyMedical CollegeJagiellonian UniversityKrakowPoland
| | - Poul Jørgen Jennum
- Department of Clinical Neurophysiology, Danish Center for Sleep MedicineRigshospitaletDenmark
| | - Vasilios K Kimiskidis
- First Department of NeurologyAHEPA University Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Petr Marusic
- Department of NeurologySecond Faculty of Medicine and Motol University Hospital, Charles UniversityPragueCzech Republic
| | - James W. Mitchell
- Institute of Systems, Molecular and Integrative BiologyUniversity of LiverpoolLiverpoolUK
| | - Lara N. Ferreira
- Universidade do Algarve—ESGHTFaroPortugal
- Centre for Health Studies and Research of the University of Coimbra (CEISUC), Centre for Innovative Biomedicine and Biotechnology (CIBB)CoimbraPortugal
- Research Centre for TourismSustainability and Well‐Being (CinTurs), Universidade do AlgarveFaroPortugal
| | - Martina Ondrušová
- Department of Epidemiology and Biostatistics, Pharm‐In, Ltd.BratislavaSlovakia
- Faculty of Public HealthSlovak Medical UniversityBratislavaSlovakia
| | - Adrian Pana
- School of Public Health, Babes Bolyai University Cluj NapocaCenter for Health Outcomes & EvaluationCluj‐NapocaRomania
| | - Ulf Persson
- The Swedish Institute for Health EconomicsLundSweden
| | - Tim J. von Oertzen
- Center for Medicine of the Elderly, Kepler University HospitalJohannes Kepler UniversityLinzAustria
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical MedicineMarche Polytechnic UniversityAnconaItaly
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Rafiq RB, Yount S, Jerousek S, Roth EJ, Cella D, Albert MV, Heinemann AW. Feasibility of PROMIS using computerized adaptive testing during inpatient rehabilitation. J Patient Rep Outcomes 2023; 7:44. [PMID: 37162607 PMCID: PMC10172423 DOI: 10.1186/s41687-023-00567-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/21/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND There has been an increased significance on patient-reported outcomes in clinical settings. We aimed to evaluate the feasibility of administering patient-reported outcome measures by computerized adaptive testing (CAT) using a tablet computer with rehabilitation inpatients, assess workload demands on staff, and estimate the extent to which rehabilitation inpatients have elevated T-scores on six Patient Reported Outcomes Measurement Information System® (PROMIS®) measures. METHODS Patients (N = 108) with stroke, spinal cord injury, traumatic brain injury, and other neurological disorders participated in this study. PROMIS computerized adaptive tests (CAT) were administered via a web-based platform. Summary scores were calculated for six measures: Pain Interference, Sleep Disruption, Anxiety, Depression, Illness Impact Positive, and Illness Impact Negative. We calculated the percent of patients with T-scores equivalent to 2 standard deviations or greater above the mean. RESULTS During the first phase, we collected data from 19 of 49 patients; of the remainder, 61% were not available or had cognitive or expressive language impairments. In the second phase of the study, 40 of 59 patients participated to complete the assessment. The mean PROMIS T-scores were in the low 50 s, indicating an average symptom level, but 19-31% of patients had elevated T-scores where the patients needed clinical action. CONCLUSIONS The study demonstrated that PROMIS assessment using a CAT administration during an inpatient rehabilitation setting is feasible with the presence of a research staff member to complete PROMIS assessment.
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Affiliation(s)
- Riyad Bin Rafiq
- Department of Computer Science and Engineering, University of North Texas, Denton, TX, 76201, USA.
| | - Susan Yount
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Evanston, USA
| | - Sara Jerousek
- Ann & Robert H. Lurie Children's Hospital, Chicago, USA
| | - Elliot J Roth
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Evanston, USA
| | - David Cella
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Evanston, USA
| | - Mark V Albert
- Department of Computer Science and Engineering, University of North Texas, Denton, TX, 76201, USA
- Department of Biomedical Engineering, University of North Texas, Denton, USA
| | - Allen W Heinemann
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Evanston, USA
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, USA
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Johnson-Kerner BL, Colao K, Evanson NK, Taylor JM. Attitudes and practices of specialty physicians regarding the return to school process after pediatric acquired brain injury. J Pediatr Rehabil Med 2023; 16:497-505. [PMID: 36847024 DOI: 10.3233/prm-210130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
PURPOSE More than 50,000 children are hospitalized yearly in the U.S. for acquired brain injury (ABI) with no established standards or protocols for school re-entry and limited resources for hospital-school communication. While ultimately the school has autonomy over curricula and services, specialty physicians were asked about their participation and perception of barriers in the school re-entry process. METHODS Approximately 545 specialty physicians were sent an electronic survey. RESULTS 84 responses (43% neurologists and 37% physiatrists) were obtained with a response rate of ∼15%. Thirty-five percent reported that specialty clinicians currently make the plan for school re-entry. The biggest challenge for school re-entry noted by physicians was cognitive difficulties (63%). The biggest gaps perceived by physicians were a lack of hospital-school liaisons to help design and implement a school re-entry plan (27%), schools' inability to implement a school re-entry plan (26%), and an evidence-based cognitive rehab curriculum (26%). Forty-seven percent of physicians reported that they did not have adequate medical personnel to support school re-entry. The most commonly used outcome measure was family satisfaction. Ideal outcome measures included satisfaction (33%) and formal assessment of quality of life (26%). CONCLUSION These data suggest that specialty physicians identify a lack of school liaisons in the medical setting as an important gap in hospital-school communication. Satisfaction and formal assessment of quality of life are meaningful outcomes for this provider group.
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Affiliation(s)
- Bethany L Johnson-Kerner
- Department of Neurology and Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Kathleen Colao
- Department of Neurology and Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Nathan K Evanson
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - J Michael Taylor
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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8
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Grampurohit N, Bell A, Duff SV, Mulcahey MJ, Thielen CC, Kaplan G, Marino RJ. Highlighting gaps in spinal cord injury research in activity-based interventions for the upper extremity: A scoping review. NeuroRehabilitation 2021; 49:23-38. [PMID: 33967071 DOI: 10.3233/nre-210042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Upper extremity activity-based therapy for neurologic disorders employs high-intensity, high repetition functional training to exploit neuroplasticity and improve function. Research focused on high-intensity upper extremity activity-based therapy for persons with spinal cord injury (SCI) is limited. OBJECTIVE To summarize high-intensity activity-based interventions used in neurological disorders for their current or potential application to SCI. METHODS The scoping review included articles from MEDLINE, CINAHL, Cochrane CENTRAL, and OTSeeker with the criteria: non-invasive activity-based interventions delivered at least three times/week for two weeks, upper extremity functional outcomes, age 13 years or older, English language, and neurological disorders three months post onset/injury. RESULTS The search yielded 172 studies. There were seven studies with SCI, all in adults. Activity-based interventions in SCI included task-specific training and gaming, with and without electrical stimulation, and a robotic exoskeleton. The other populations found in the review included studies in stroke, cerebral palsy, and multiple sclerosis. Thirty-four different interventions were reported in other populations. In comparison to the extensive stroke research, work in SCI was not found for high-intensity interventions using virtual reality, brain stimulation, rehabilitation devices, and applications to the home and telerehab settings. CONCLUSION The results highlight critical gaps within upper extremity high-intensity activity-based research in SCI.
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Affiliation(s)
- Namrata Grampurohit
- Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alison Bell
- Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
| | - Susan V Duff
- Crean College of Health and Behavioral Sciences, Chapman University, Irvine, CA, USA
| | - M J Mulcahey
- Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Gary Kaplan
- Scott Memorial Library, Academic Commons, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ralph J Marino
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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Lens C, Demeestere J, Vanhaecht K, Lemmens R. Patient Reported Outcomes Measurements Information System in Stroke Patients in Full and Shortened Format. Front Neurol 2021; 11:630850. [PMID: 33551985 PMCID: PMC7864084 DOI: 10.3389/fneur.2020.630850] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 12/29/2020] [Indexed: 11/20/2022] Open
Abstract
Introduction: The modified Rankin Scale (mRS) after 90 days documents outcome in stroke patients, but focusses only on activities of daily living. Here we studied stroke outcome beyond these activities by the Dutch-Flemish version of the Patient Reported Outcomes Measurement Information System (PROMIS) questionnaire. Patients and Methods: We documented the mRS at day 90 in stroke patients who filled out a questionnaire on pain intensity and seven PROMIS domains: physical function, ability to participate in social roles, anxiety, fatigue, depression, sleep disturbance, pain interference. In a subgroup of patients this questionnaire was reduced to one overall question per PROMIS domain. We correlated these findings with the mRS. Results: We received 102 questionnaires and identified physical function as the most affected PROMIS domain. The strongest correlation with mRS was found for the health domains of physical function (ρs = 0.70, p < 0.001) and ability to participate in social roles (ρs = 0.61, p < 0.001). The other domains with substantial proportions of patients with worse scores compared to the general population (19-44%) correlated weakly with the mRS. We identified a strong correlation between the single question per health domain and the overall score per PROMIS domain. Discussion and Conclusion: PROMIS better reflects the overall health status of stroke patients beyond functional outcome as measured by the mRS. Simplification of the questionnaire with a single question per PROMIS domain could potentially replace the full questionnaire, but needs further validation.
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Affiliation(s)
- Charlotte Lens
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
- Department of Neurosciences, Experimental Neurology, KU Leuven – University of Leuven, Leuven, Belgium
- Center for Brain & Disease Research, Laboratory of Neurobiology, VIB, Leuven, Belgium
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium
| | - Jelle Demeestere
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
- Department of Neurosciences, Experimental Neurology, KU Leuven – University of Leuven, Leuven, Belgium
- Center for Brain & Disease Research, Laboratory of Neurobiology, VIB, Leuven, Belgium
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
| | - Robin Lemmens
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
- Department of Neurosciences, Experimental Neurology, KU Leuven – University of Leuven, Leuven, Belgium
- Center for Brain & Disease Research, Laboratory of Neurobiology, VIB, Leuven, Belgium
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Grinspan ZM, Patel AD, Shellhaas RA, Berg AT, Axeen ET, Bolton J, Clarke DF, Coryell J, Gaillard WD, Goodkin HP, Koh S, Kukla A, Mbwana JS, Morgan LA, Singhal NS, Storey MM, Yozawitz EG, Abend NS, Fitzgerald MP, Fridinger SE, Helbig I, Massey SL, Prelack MS, Buchhalter J. Design and implementation of electronic health record common data elements for pediatric epilepsy: Foundations for a learning health care system. Epilepsia 2021; 62:198-216. [PMID: 33368200 PMCID: PMC10508354 DOI: 10.1111/epi.16733] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 09/28/2020] [Accepted: 09/28/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Common data elements (CDEs) are standardized questions and answer choices that allow aggregation, analysis, and comparison of observations from multiple sources. Clinical CDEs are foundational for learning health care systems, a data-driven approach to health care focused on continuous improvement of outcomes. We aimed to create clinical CDEs for pediatric epilepsy. METHODS A multiple stakeholder group (clinicians, researchers, parents, caregivers, advocates, and electronic health record [EHR] vendors) developed clinical CDEs for routine care of children with epilepsy. Initial drafts drew from clinical epilepsy note templates, CDEs created for clinical research, items in existing registries, consensus documents and guidelines, quality metrics, and outcomes needed for demonstration projects. The CDEs were refined through discussion and field testing. We describe the development process, rationale for CDE selection, findings from piloting, and the CDEs themselves. We also describe early implementation, including experience with EHR systems and compatibility with the International League Against Epilepsy classification of seizure types. RESULTS Common data elements were drafted in August 2017 and finalized in January 2020. Prioritized outcomes included seizure control, seizure freedom, American Academy of Neurology quality measures, presence of common comorbidities, and quality of life. The CDEs were piloted at 224 visits at 10 centers. The final CDEs included 36 questions in nine sections (number of questions): diagnosis (1), seizure frequency (9), quality of life (2), epilepsy history (6), etiology (8), comorbidities (2), treatment (2), process measures (5), and longitudinal history notes (1). Seizures are categorized as generalized tonic-clonic (regardless of onset), motor, nonmotor, and epileptic spasms. Focality is collected as epilepsy type rather than seizure type. Seizure frequency is measured in nine levels (all used during piloting). The CDEs were implemented in three vendor systems. Early clinical adoption included 1294 encounters at one center. SIGNIFICANCE We created, piloted, refined, finalized, and implemented a novel set of clinical CDEs for pediatric epilepsy.
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Affiliation(s)
- Zachary M Grinspan
- Departments of Population Health Sciences and Pediatrics, Weill Cornell Medicine, New York, NY
| | - Anup D Patel
- Division of Neurology, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Renée A Shellhaas
- Department of Pediatrics (Pediatric Neurology), Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Anne T Berg
- Division of Neurology, Epilepsy Center, Ann & Robert H. Lurie Children’s Hospital of Chicago and Department of Pediatrics, Northwestern Feinberg School of Medicine, United States of America
| | - Erika T Axeen
- Department of Neurology, University of Virginia, Charlottesville, Virginia
| | - Jeffrey Bolton
- Harvard Medical School, Boston, MA
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts, U.S.A
| | - David F Clarke
- Division of Pediatric Neurology, Department of Neurology, Dell Medical School University of Texas at Austin, Austin, Texas
| | - Jason Coryell
- Departments of Pediatrics and Neurology, Oregon Health and Sciences University, Portland, Oregon
| | - William D Gaillard
- Department of Neurology, Children’s National Health System and School of Medicine, The George Washington University, Washington, District of Columbia
| | - Howard P Goodkin
- Department of Neurology, University of Virginia, Charlottesville, Virginia
| | - Sookyong Koh
- Department of Pediatrics, Emory University School of Medicine, Emory Children’s Center, 2015 Uppergate Drive NE, Atlanta, GA
| | | | - Juma S Mbwana
- Department of Neurology, Children’s National Health System and School of Medicine, The George Washington University, Washington, District of Columbia
| | | | - Nilika S Singhal
- Departments of Pediatrics and Neurology, Seattle Children’s Hospital, University of Washington, and Center for Integrative Brain Research, Seattle Children’s Research Institute, Seattle, WA
| | - Margaret M Storey
- Department of History, College of Liberal Arts & Social Sciences, DePaul University, Chicago, IL
| | - Elissa G Yozawitz
- Saul Korey Department of Neurology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
| | - Nicholas S Abend
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Mark P Fitzgerald
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Sara E Fridinger
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Ingo Helbig
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
- The Epilepsy NeuroGenetics Initiative (ENGIN), Children’s Hospital of Philadelphia, Philadelphia
- Department of Biomedical and Health Informatics (DBHi), Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Shavonne L Massey
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Marisa S Prelack
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Jeffrey Buchhalter
- Department of Neurology, St Joseph’s Hospital and Medical Center, Phoenix, Arizona
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11
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Yamada J, Kouri A, Simard SN, Segovia SA, Gupta S. Barriers and Enablers to Using a Patient-Facing Electronic Questionnaire: A Qualitative Theoretical Domains Framework Analysis. J Med Internet Res 2020; 22:e19474. [PMID: 33030437 PMCID: PMC7582145 DOI: 10.2196/19474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/24/2020] [Accepted: 09/01/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Electronic patient questionnaires are becoming ubiquitous in health care. To address care gaps that contribute to poor asthma management, we developed the Electronic Asthma Management System, which includes a previsit electronic patient questionnaire linked to a computerized clinical decision support system. OBJECTIVE This study aims to identify the determinants (barriers and enablers) of patient uptake and completion of a previsit mobile health questionnaire. METHODS We conducted semistructured interviews with adult patients with asthma in Toronto, Canada. After demonstrating the questionnaire, participants completed the questionnaire using their smartphones and were then interviewed regarding perceived barriers and enablers to using and completing the questionnaire. Interview questions were based on the Theoretical Domains Framework to identify the determinants of health-related behavior. We generated themes that addressed the enablers and barriers to the uptake and completion of the questionnaire. RESULTS In total, 12 participants were interviewed for saturation. Key enablers were as follows: the questionnaire was easy to complete without additional knowledge or skills and was perceived as a priority and responsibility for patients, use could lead to more efficient and personalized care, completion on one's own time would be convenient, and uptake and completion could be optimized through patient reminders. Concerns about data security, the usefulness of questionnaire data, the stress of completing it accurately and on time, competing priorities, and preferences to complete the questionnaire on other devices were the main barriers. CONCLUSIONS The barriers and enablers identified by patients should be addressed by developing implementation strategies to enhance e-questionnaire use and completion by patients. As the use of e-questionnaires grows, our findings will contribute to implementation efforts across settings and diseases.
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Affiliation(s)
- Janet Yamada
- Daphne Cockwell School of Nursing, Faculty of Community Services, Ryerson University, Toronto, ON, Canada
| | - Andrew Kouri
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Respirology, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Sarah-Nicole Simard
- Daphne Cockwell School of Nursing, Faculty of Community Services, Ryerson University, Toronto, ON, Canada
| | - Stephanie A Segovia
- Division of Respirology, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Samir Gupta
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Respirology, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
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12
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Kouri A, Yamada J, Sale JEM, Straus SE, Gupta S. Primary Care Pre-Visit Electronic Patient Questionnaire for Asthma: Uptake Analysis and Predictor Modeling. J Med Internet Res 2020; 22:e19358. [PMID: 32945779 PMCID: PMC7532461 DOI: 10.2196/19358] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/22/2020] [Accepted: 07/26/2020] [Indexed: 01/18/2023] Open
Abstract
Background mHealth tablet-based interventions are increasingly being studied and deployed in various health care settings, yet little knowledge exists regarding patient uptake and acceptance or how patient demographics influence these important implementation metrics. Objective To determine which factors influence the uptake and successful completion of an mHealth tablet questionnaire by analyzing its implementation in a primary care setting. Methods We prospectively studied a patient-facing electronic touch-tablet asthma questionnaire deployed as part of the Electronic Asthma Management System. We describe tablet uptake and completion rates and corresponding predictor models for these behaviors. Results The tablet was offered to and accepted by patients in 891/1715 (52.0%) visits. Patients refused the tablet in 33.0% (439/1330) visits in which it was successfully offered. Patients aged older than 65 years of age (odds ratio [OR] 2.30, 95% CI 1.33-3.95) and with concurrent chronic obstructive pulmonary disease (OR 2.22, 95% CI 1.05-4.67) were more likely to refuse the tablet, and those on an asthma medication (OR 0.55, 95% CI 0.30-0.99) were less likely to refuse it. Once accepted, the questionnaire was completed in 784/891 (88.0%) instances, with those on an asthma medication (OR 0.53, 95% CI 0.32-0.88) being less likely to leave it incomplete. Conclusions Older age predicted initial tablet refusal but not tablet questionnaire completion, suggesting that perceptions of mHealth among older adults may negatively impact uptake, independent of usability. The influence of being on an asthma medication suggests that disease severity may also mediate mHealth acceptance. Although use of mHealth questionnaires is growing rapidly across health care settings and diseases, few studies describe their real-world acceptance and its predictors. Our results should be complemented by qualitative methods to identify barriers and enablers to uptake and may inform technological and implementation strategies to drive successful usage.
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Affiliation(s)
- Andrew Kouri
- Division of Respirology, Department of Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Janet Yamada
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON, Canada
| | - Joanna E M Sale
- Li Ka Sing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Sharon E Straus
- Department of Medicine, Division of Geriatrics, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Samir Gupta
- Division of Respirology, Department of Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
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Jones FJS, Smith JR, Ayub N, Herman ST, Buchhalter JR, Fureman BE, Cash SS, Hoch DB, Moura LMVR. Implementing standardized provider documentation in a tertiary epilepsy clinic. Neurology 2020; 95:e213-e223. [PMID: 32546650 PMCID: PMC7455323 DOI: 10.1212/wnl.0000000000009778] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 12/17/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To incorporate standardized documentation into an epilepsy clinic and to use these standardized data to compare patients' perception of epilepsy diagnosis to provider documentation. METHODS Using quality improvement methodology, we implemented interventions to increase documentation of epilepsy diagnosis, seizure frequency, and type from 49.8% to 70% of adult nonemployee patients seen by 6 providers over 5 months of routine clinical care. The main intervention consisted of an interactive SmartPhrase that mirrored a documentation template developed by the Epilepsy Learning Healthcare System. We assessed the weekly proportion of complete SmartPhrases among eligible patient encounters with a statistical process control chart. We used a subset of patients with established epilepsy care linked to existing patient-reported survey data to examine the proportion of patient-to-provider agreement on epilepsy diagnosis (yes vs no/unsure). We also examined sociodemographic and clinical characteristics of patients who disagreed vs agreed with provider's documentation of epilepsy diagnosis. RESULTS The median SmartPhrase weekly completion rate was 78%. Established patients disagreed with providers with respect to epilepsy diagnosis in 18.5% of encounters (κ = 0.13), indicating that they did not have or were unsure if they had epilepsy despite having a provider-documented epilepsy diagnosis. Patients who disagreed with providers were similar to those who agreed with respect to age, sex, ethnicity, marital status, seizure frequency, type, and other quality-of-life measures. CONCLUSION This project supports the feasibility of implementing standardized documentation of data relevant to epilepsy care in a tertiary epilepsy clinic and highlights an opportunity for improvement in patient-provider communication.
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Affiliation(s)
- Felipe J S Jones
- From the Department of Neurology (F.J.S.J., J.R.S., N.A., S.S.C., D.B.H., L.M.V.R.M.), Massachusetts General Hospital, Harvard Medical School; Department of Neurology (S.T.H.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Pediatrics (J.R.B.), Cumming School of Medicine, University of Calgary, Alberta, Canada; and Research and New Therapies (B.E.F.), Epilepsy Foundation, Landover, MD.
| | - Jason R Smith
- From the Department of Neurology (F.J.S.J., J.R.S., N.A., S.S.C., D.B.H., L.M.V.R.M.), Massachusetts General Hospital, Harvard Medical School; Department of Neurology (S.T.H.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Pediatrics (J.R.B.), Cumming School of Medicine, University of Calgary, Alberta, Canada; and Research and New Therapies (B.E.F.), Epilepsy Foundation, Landover, MD
| | - Neishay Ayub
- From the Department of Neurology (F.J.S.J., J.R.S., N.A., S.S.C., D.B.H., L.M.V.R.M.), Massachusetts General Hospital, Harvard Medical School; Department of Neurology (S.T.H.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Pediatrics (J.R.B.), Cumming School of Medicine, University of Calgary, Alberta, Canada; and Research and New Therapies (B.E.F.), Epilepsy Foundation, Landover, MD
| | - Susan T Herman
- From the Department of Neurology (F.J.S.J., J.R.S., N.A., S.S.C., D.B.H., L.M.V.R.M.), Massachusetts General Hospital, Harvard Medical School; Department of Neurology (S.T.H.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Pediatrics (J.R.B.), Cumming School of Medicine, University of Calgary, Alberta, Canada; and Research and New Therapies (B.E.F.), Epilepsy Foundation, Landover, MD
| | - Jeffrey R Buchhalter
- From the Department of Neurology (F.J.S.J., J.R.S., N.A., S.S.C., D.B.H., L.M.V.R.M.), Massachusetts General Hospital, Harvard Medical School; Department of Neurology (S.T.H.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Pediatrics (J.R.B.), Cumming School of Medicine, University of Calgary, Alberta, Canada; and Research and New Therapies (B.E.F.), Epilepsy Foundation, Landover, MD
| | - Brandy E Fureman
- From the Department of Neurology (F.J.S.J., J.R.S., N.A., S.S.C., D.B.H., L.M.V.R.M.), Massachusetts General Hospital, Harvard Medical School; Department of Neurology (S.T.H.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Pediatrics (J.R.B.), Cumming School of Medicine, University of Calgary, Alberta, Canada; and Research and New Therapies (B.E.F.), Epilepsy Foundation, Landover, MD
| | - Sydney S Cash
- From the Department of Neurology (F.J.S.J., J.R.S., N.A., S.S.C., D.B.H., L.M.V.R.M.), Massachusetts General Hospital, Harvard Medical School; Department of Neurology (S.T.H.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Pediatrics (J.R.B.), Cumming School of Medicine, University of Calgary, Alberta, Canada; and Research and New Therapies (B.E.F.), Epilepsy Foundation, Landover, MD
| | - Daniel B Hoch
- From the Department of Neurology (F.J.S.J., J.R.S., N.A., S.S.C., D.B.H., L.M.V.R.M.), Massachusetts General Hospital, Harvard Medical School; Department of Neurology (S.T.H.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Pediatrics (J.R.B.), Cumming School of Medicine, University of Calgary, Alberta, Canada; and Research and New Therapies (B.E.F.), Epilepsy Foundation, Landover, MD
| | - Lidia M V R Moura
- From the Department of Neurology (F.J.S.J., J.R.S., N.A., S.S.C., D.B.H., L.M.V.R.M.), Massachusetts General Hospital, Harvard Medical School; Department of Neurology (S.T.H.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Pediatrics (J.R.B.), Cumming School of Medicine, University of Calgary, Alberta, Canada; and Research and New Therapies (B.E.F.), Epilepsy Foundation, Landover, MD
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De Marchi F, Berry JD, Chan J, Caldwell S, Ellrodt A, Scalia J, Burke K, Fang T, Clark Sisodia R, Schwamm LH, Moura LMVR, Paganoni S. Patient reported outcome measures (PROMs) in amyotrophic lateral sclerosis. J Neurol 2020; 267:1754-1759. [DOI: 10.1007/s00415-020-09774-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 02/20/2020] [Accepted: 02/21/2020] [Indexed: 12/14/2022]
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Jones FJS, Ezzeddine FL, Herman ST, Buchhalter J, Fureman B, Moura LMVR. A feasibility assessment of functioning and quality-of-life patient-reported outcome measures in adult epilepsy clinics: A systematic review. Epilepsy Behav 2020; 102:106704. [PMID: 31816482 DOI: 10.1016/j.yebeh.2019.106704] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/11/2019] [Accepted: 11/11/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of the study was to identify functioning and quality-of-life (QOL) patient-reported outcome measurements (PROMs) feasible for use in the waiting room of adult epilepsy clinics. MATERIAL AND METHODS We searched PubMed and Web of Science for articles on in English, Spanish, Portuguese, Italian, and French published by the end of February 15th, 2019. We screened retrieved titles and abstracts looking for publications that reported the use of PROMs to measure functioning and QOL in epilepsy. The authors, clinical experts, and patient advocates from the Epilepsy Foundation of America conceptualized a set of desirable feasibility attributes for PROMs implementation in the waiting room of adult epilepsy clinics. These attributes included brief time for completion (i.e., ≤3 min), free cost, coverage of four minimum QOL domains and respective facets, and good evidence of psychometric properties. We defined QOL domains according to the World Health Organization's classification and created psychometric appraisal criteria based on the Food and Drug Administration's (FDA) Guidance. RESULTS Eighteen candidate instruments were identified and compared with respect to desirable attributes for use in adult epilepsy clinics. We found that the Quality-of-life in epilepsy (QOLIE)-10 and Patient-Reported Outcome Measurement Information System-10 (PROMIS-10) were the most feasible PROMs for implementation in adult epilepsy clinics based on our criteria. The QOLIE-10 and PROMIS-10 still lack ideal evidence of responsiveness in people with epilepsy. CONCLUSION This is the first systematic review that aimed to assess feasibility properties of available functioning and QOL PROMs. The QOLIE-10 and PROMIS-10 are potentially feasible instruments for implementation in the waiting room of adult epilepsy clinics. Further studies assessing the responsiveness of these PROMs are needed and will contribute to the selection of the most appropriate instrument for longitudinal use in adult epilepsy clinical practice.
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Affiliation(s)
- Felipe J S Jones
- Department of Neurology, Massachusetts General Hospital, Wang Ambulatory Care Center, 720, 55 Fruit Street, Boston, MA 02114, United States of America.
| | - Farrah L Ezzeddine
- Department of Epidemiology, Harvard T.H Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, United States of America.
| | - Susan T Herman
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave., Boston, MA 02215, United States of America.
| | - Jeffrey Buchhalter
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, Canada
| | - Brandy Fureman
- Research and New Therapies, Epilepsy Foundation, 8301 Professional Pl #200, Landover, MD 20785, United States of America.
| | - Lidia M V R Moura
- Department of Neurology, Massachusetts General Hospital, Wang Ambulatory Care Center, 720, 55 Fruit Street, Boston, MA 02114, United States of America.
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16
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Moura LMVR, Magliocco B, Ney JP, Cheng EM, Esper GJ, Hoch DB. Implementation of quality measures and patient-reported outcomes in an epilepsy clinic. Neurology 2019; 93:e2032-e2041. [PMID: 31666351 DOI: 10.1212/wnl.0000000000008548] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 06/11/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To see if systematic collection of patient-reported epilepsy quality measures can identify opportunities to improve care, and to examine the associations between these measures and physical and mental health. METHODS We developed a patient-reported questionnaire for medication adherence, seizure frequency, medication side effects, and driving that included the Patient-Reported Outcome Measurement Information System-10 (PROMIS-10) (physical and mental health). We offered it to all adult patients seen twice in an epilepsy clinic (January 2017-January 2018). The questionnaire was available on the web as well as a tablet provided at appointment check-in. We used the first completed questionnaire to explore the relationship between patient-reported care quality and measures of physical and mental health. RESULTS A total of 610 unique patients (15% of the total encounters) completed a survey. Respondents were comparable to nonrespondents. Respondents reported gaps in care or opportunities for quality improvement in 48.4% (n = 295) of the encounters. Of patients who reported at least 1 seizure per month over the previous 3 months, 55.2% (n = 100) reported problems with adherence, 30.0% (n = 131) reported having problems believed to be adverse reactions to anticonvulsants, and 15.2% (n = 41) reported driving. In addition, respondents who reported either seizures over the recent 3 months, nonadherence to treatment due to cost, or anticonvulsant-associated adverse effects had consistently worse physical and mental health (all p < 0.05). CONCLUSIONS Systematic collection of epilepsy quality measures endorsed by the American Academy of Neurology can identify opportunities for quality improvement. Measures of epilepsy care quality predict outcomes that matter to patients.
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Affiliation(s)
- Lidia M V R Moura
- From the Department of Neurology (L.M.V.R.M., D.B.H.), Massachusetts General Hospital, Boston; American Academy of Neurology (B.M.), Minneapolis, MN; Department of Neurology (J.P.N.), Boston University, MA; Department of Neurology (E.M.C.), David Geffen School of Medicine, University of California, Los Angeles; and Department of Neurology (G.J.E.), Emory University, Atlanta, GA.
| | - Brandon Magliocco
- From the Department of Neurology (L.M.V.R.M., D.B.H.), Massachusetts General Hospital, Boston; American Academy of Neurology (B.M.), Minneapolis, MN; Department of Neurology (J.P.N.), Boston University, MA; Department of Neurology (E.M.C.), David Geffen School of Medicine, University of California, Los Angeles; and Department of Neurology (G.J.E.), Emory University, Atlanta, GA
| | - John P Ney
- From the Department of Neurology (L.M.V.R.M., D.B.H.), Massachusetts General Hospital, Boston; American Academy of Neurology (B.M.), Minneapolis, MN; Department of Neurology (J.P.N.), Boston University, MA; Department of Neurology (E.M.C.), David Geffen School of Medicine, University of California, Los Angeles; and Department of Neurology (G.J.E.), Emory University, Atlanta, GA
| | - Eric M Cheng
- From the Department of Neurology (L.M.V.R.M., D.B.H.), Massachusetts General Hospital, Boston; American Academy of Neurology (B.M.), Minneapolis, MN; Department of Neurology (J.P.N.), Boston University, MA; Department of Neurology (E.M.C.), David Geffen School of Medicine, University of California, Los Angeles; and Department of Neurology (G.J.E.), Emory University, Atlanta, GA
| | - Gregory J Esper
- From the Department of Neurology (L.M.V.R.M., D.B.H.), Massachusetts General Hospital, Boston; American Academy of Neurology (B.M.), Minneapolis, MN; Department of Neurology (J.P.N.), Boston University, MA; Department of Neurology (E.M.C.), David Geffen School of Medicine, University of California, Los Angeles; and Department of Neurology (G.J.E.), Emory University, Atlanta, GA
| | - Daniel B Hoch
- From the Department of Neurology (L.M.V.R.M., D.B.H.), Massachusetts General Hospital, Boston; American Academy of Neurology (B.M.), Minneapolis, MN; Department of Neurology (J.P.N.), Boston University, MA; Department of Neurology (E.M.C.), David Geffen School of Medicine, University of California, Los Angeles; and Department of Neurology (G.J.E.), Emory University, Atlanta, GA
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Schougaard LMV, Mejdahl CT, Christensen J, Lomborg K, Maindal HT, de Thurah A, Hjollund NH. Patient-initiated versus fixed-interval patient-reported outcome-based follow-up in outpatients with epilepsy: a pragmatic randomized controlled trial. J Patient Rep Outcomes 2019; 3:61. [PMID: 31520247 PMCID: PMC6744536 DOI: 10.1186/s41687-019-0151-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 08/27/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The use of patient-reported outcome (PRO) could potentially contribute to the reorganization of the health care system. AmbuFlex is a PRO system used in remote patient monitoring, in which questionnaires are sent to patients at fixed intervals. The PRO data are used by clinicians to decide whether patients need clinical attention. Better self-management and cost-saving follow-up activities may be achieved by letting patients initiate need of contact. We evaluated the effects of patient-initiated PRO-based outpatient follow-up on health care resource utilization, quality of care, and the patient perspective. METHODS We conducted a parallel two-arm pragmatic randomized controlled trial at the Department of Neurology, Aarhus University Hospital, Denmark. Outpatients with epilepsy (≥ 15 years old), attending fixed-interval PRO-based follow-up with web-based questionnaires, were randomly assigned in a ratio of 0.55:0.45 to either 1) patient-initiated PRO-based follow-up (open access telePRO) or 2) fixed-interval PRO-based follow-up (standard telePRO). The primary outcome was the number of outpatient hospital contacts related to epilepsy retrieved from a regional registry. Hospitals admissions and emergency room visits were also assessed. Secondary self-reported outcomes including general health, well-being, health literacy, self-efficacy, number of seizures, side effects, confidence, safety, and satisfaction were retrieved from questionnaires. Data were analyzed by the intention-to-treat and per-protocol approaches. RESULTS Between January 2016 and July 2016, 593 patients were randomized to either open access telePRO (n = 346) or standard telePRO (n = 247). At 18 months, no statistically significant differences were found between the arms regarding number of telephone consultations or outpatient visits. Patients in the open access arm had a slightly lower, statistically significant number of emergency room visits than patients in the standard arm. Self-reported mental well-being in the open access arm was slightly, statistically significantly lower than in the standard arm. Other secondary outcomes did not differ statistically significantly between arms. CONCLUSION This study did not find, as hypothesized, less use of health care resources or improved patient self-management or satisfaction in the patient-initiated PRO-based initiative compared to fixed-interval PRO-based follow-up. Patient-initiated PRO-based follow-up may be used as an alternative to fixed-interval PRO-based follow-up in patients who prefer this approach, but there is insufficient evidence for recommending a system-wide shift to patient-initiated PRO-based follow-up. TRIAL REGISTRATION Registered 4 February 2016 with ClinicalTrials.gov: NCT02673580 .
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Affiliation(s)
- Liv Marit Valen Schougaard
- AmbuFlex/WestChronic, Occupational Medicine, University Research Clinic, Aarhus University, Gl. Landevej 61, DK-7400 Herning, Denmark
| | - Caroline Trillingsgaard Mejdahl
- AmbuFlex/WestChronic, Occupational Medicine, University Research Clinic, Aarhus University, Gl. Landevej 61, DK-7400 Herning, Denmark
| | - Jakob Christensen
- Department of Neurology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, DK-8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, DK-8200 Aarhus N, Denmark
| | - Kirsten Lomborg
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, DK-8200 Aarhus N, Denmark
| | | | - Annette de Thurah
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, DK-8200 Aarhus N, Denmark
- Department of Rheumatology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 59, DK-8200 Aarhus N, Denmark
| | - Niels Henrik Hjollund
- AmbuFlex/WestChronic, Occupational Medicine, University Research Clinic, Aarhus University, Gl. Landevej 61, DK-7400 Herning, Denmark
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200 Aarhus N, Denmark
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Wahby S, Karnik V, Brobbey A, Wiebe S, Sajobi T, Josephson CB. Cannabis use is both independently associated with and mediates worse psychosocial health in patients with epilepsy. J Neurol Neurosurg Psychiatry 2019; 90:945-951. [PMID: 30826738 DOI: 10.1136/jnnp-2018-319780] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 02/01/2019] [Accepted: 02/09/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To examine whether cannabis use is associated with or mediates psychosocial health in people with epilepsy. METHODS Consecutive adult epilepsy patients visiting the Calgary Comprehensive Epilepsy Programme clinic were administered validated patient-reported outcome measures (PROMs) including the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), Quality of Life in Epilepsy (QOLIE-10-P), EuroQOL five dimensions five level scale (EQ-5D-5L), Global Assessment of Severity of Epilepsy Scale, Global Assessment of Disability Associated with Seizures Scale and the Treatment Satisfaction Questionnaire for Medication scale. We used multiple regression analyses to investigate associations between cannabis use and PROMs. Mediation analyses were performed to determine the degree to which cannabis modulated the associations between current or past psychiatric disorders, monthly seizure frequency, and 1-year seizure freedom on psychosocial health. RESULTS Of 337 consecutive patients, 71 (21%) reported cannabis use. Cannabis use was independently associated with depression (NDDI-E score≥14; OR 3.90; 95% CI 2.01 to 7.59; p<0.001), lower quality of life (β=-16.73, 95% CI - 26.26 to - 7.20; p=0.001), worse epilepsy-related disability (OR 2.23, 95% CI 1.19 to 4.17; p=0.01) and lower satisfaction with antiepileptic medication (OR 0.41, 95% CI 0.23 to 0.72; p=0.002). Cannabis use mediates 7%-12% of the effect of a psychiatric history on depression, worse quality of life and worse health valuation. CONCLUSIONS There is a strong and independent association between cannabis use and poor psychosocial health, and it partially mediates the deleterious effect of a psychiatric history on these same outcomes. Inclusion of PROMs in future cannabis trials is warranted.
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Affiliation(s)
- Sandra Wahby
- Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Vikram Karnik
- Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Anita Brobbey
- Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Samuel Wiebe
- Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Tolulope Sajobi
- Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.,Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Colin Bruce Josephson
- Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada .,Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
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Leviton A, Oppenheimer J, Chiujdea M, Antonetty A, Ojo OW, Garcia S, Weas S, Fleegler E, Chan E, Loddenkemper T. Characteristics of Future Models of Integrated Outpatient Care. Healthcare (Basel) 2019; 7:healthcare7020065. [PMID: 31035586 PMCID: PMC6627383 DOI: 10.3390/healthcare7020065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 04/23/2019] [Accepted: 04/24/2019] [Indexed: 01/01/2023] Open
Abstract
Replacement of fee-for-service with capitation arrangements, forces physicians and institutions to minimize health care costs, while maintaining high-quality care. In this report we described how patients and their families (or caregivers) can work with members of the medical care team to achieve these twin goals of maintaining-and perhaps improving-high-quality care and minimizing costs. We described how increased self-management enables patients and their families/caregivers to provide electronic patient-reported outcomes (i.e., symptoms, events) (ePROs), as frequently as the patient or the medical care team consider appropriate. These capabilities also allow ongoing assessments of physiological measurements/phenomena (mHealth). Remote surveillance of these communications allows longer intervals between (fewer) patient visits to the medical-care team, when this is appropriate, or earlier interventions, when it is appropriate. Systems are now available that alert medical care providers to situations when interventions might be needed.
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Affiliation(s)
- Alan Leviton
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Julia Oppenheimer
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Madeline Chiujdea
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Annalee Antonetty
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Oluwafemi William Ojo
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Stephanie Garcia
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Sarah Weas
- Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Eric Fleegler
- Division of Emergency Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Eugenia Chan
- Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Tobias Loddenkemper
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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20
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Schougaard LMV, de Thurah A, Christiansen DH, Sidenius P, Hjollund NH. Patient-reported outcome (PRO) measure-based algorithm for clinical decision support in epilepsy outpatient follow-up: a test-retest reliability study. BMJ Open 2018; 8:e021337. [PMID: 30049693 PMCID: PMC6067405 DOI: 10.1136/bmjopen-2017-021337] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 03/26/2018] [Accepted: 06/06/2018] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Patient-reported outcome (PRO) measures have been used in epilepsy outpatient clinics in Denmark since 2011. The patients' self-reported PRO data are used by clinicians as a decision aid to support whether a patient needs contact with the outpatient clinic or not based on a PRO algorithm. Validity and reliability are fundamental to any PRO measurement used at the individual level in clinical practice. The aim of this study was to evaluate the test-retest reliability of the PRO algorithm used in epilepsy outpatient clinics and to analyse whether the method of administration (web and paper) would influence the result. DESIGN AND SETTING Test-retest reliability study conducted in three epilepsy outpatient clinics in Central Denmark Region, Denmark. PARTICIPANTS A total of 554 epilepsy outpatients aged 15 years or more were included from August 2016 to April 2017. The participants completed questionnaires at two time points and were randomly divided into four test-retest groups: web-web, paper-paper, web-paper and paper-web. In total, 166 patients completed web-web, 112 paper-paper, 239 web-paper and 37 paper-web. RESULTS Weighted kappa with squared weight was 0.67 (95% CI 0.60 to 0.74) for the pooled PRO algorithm, and perfect agreement was observed in 82% (95% CI 78% to 85%) of the cases. There was a tendency towards higher test-retest reliability and agreement estimates within same method of administration (web-web or paper-paper) compared with a mixture of methods (web-paper and paper-web). CONCLUSIONS The PRO algorithm used for clinical decision support in epilepsy outpatient clinics showed moderate to substantial test-retest reliability. Different methods of administration produced similar results, but an influence of change in administration method cannot be ruled out.
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Affiliation(s)
- Liv Marit Valen Schougaard
- AmbuFlex/West Chronic, Occupational Medicine, Regional Hospital West Jutland, University Research Clinic, Aarhus University, Herning, Denmark
| | - Annette de Thurah
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - David Høyrup Christiansen
- Department of Occupational Medicine, Regional Hospital West Jutland, University Research Clinic, Herning, Denmark
| | - Per Sidenius
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Henrik Hjollund
- AmbuFlex/West Chronic, Occupational Medicine, Regional Hospital West Jutland, University Research Clinic, Aarhus University, Herning, Denmark
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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21
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Yeshokumar AK, Gordon-Lipkin E, Arenivas A, Cohen J, Venkatesan A, Saylor D, Probasco JC. Neurobehavioral outcomes in autoimmune encephalitis. J Neuroimmunol 2017; 312:8-14. [DOI: 10.1016/j.jneuroim.2017.08.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 08/08/2017] [Accepted: 08/22/2017] [Indexed: 10/19/2022]
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