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Westerink HJ, Bresser CC, Garvelink MM, van Uden-Kraan CF, Zouitni O, Bart HAJ, van der Wees PJ, van der Nat PB. The use of outcome data in patient consultations from the healthcare professionals' and patients' perspectives: A mixed methods study. PATIENT EDUCATION AND COUNSELING 2024; 118:108043. [PMID: 37925975 DOI: 10.1016/j.pec.2023.108043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 10/23/2023] [Accepted: 10/28/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES To gain insight into healthcare professionals' (HCPs') perspectives on the use of outcome data in consultations and to understand which aggregated outcomes patients find important. METHODS This study had a mixed-methods design and consisted of two steps: RESULTS: HCPs indicated that aggregated outcome data are not routinely used in consultations. They pointed out various barriers to using outcome data, e.g., low response rates of PROMs, and suggested actions to address these barriers, including training of HCPs in outcome data usage. Patients rated the majority of aggregated outcomes as important, although preferences differed between the studied health conditions. CONCLUSION Both HCPs and patients underscored the importance of discussing outcome data in consultations. Nevertheless, HCPs encountered several barriers to using outcome data. Furthermore, patients with different health conditions have somewhat different information needs. PRACTICE IMPLICATIONS The study identified several actionable steps to enhance the collection and application of outcome data in consultations.
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Affiliation(s)
- Henrike J Westerink
- Department of Value Improvement, St. Antonius Hospital, Nieuwegein, Utrecht, the Netherlands; Scientific Center for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Cato C Bresser
- Department of Value Improvement, St. Antonius Hospital, Nieuwegein, Utrecht, the Netherlands; Scientific Center for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mirjam M Garvelink
- Department of Value Improvement, St. Antonius Hospital, Nieuwegein, Utrecht, the Netherlands
| | | | - Ouisam Zouitni
- Client Council, St. Antonius Hospital, Nieuwegein, Utrecht, the Netherlands
| | | | - Philip J van der Wees
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Paul B van der Nat
- Department of Value Improvement, St. Antonius Hospital, Nieuwegein, Utrecht, the Netherlands; Scientific Center for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, Nijmegen, the Netherlands
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Wang XS, Ramirez PT, Shi Q, Kamal M, Garcia-Gonzalez A, Iniesta MD, Cleeland CS, Meyer LA. Patient-reported symptoms at discharge and risk of complications after gynecologic surgery. Int J Gynecol Cancer 2023; 33:271-277. [PMID: 36600503 PMCID: PMC10009896 DOI: 10.1136/ijgc-2022-004016] [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: 12/13/2022] Open
Abstract
OBJECTIVE Current gaps in knowledge limit clinicians from fully implementing patient-reported outcomes in routine post-operative care. METHODS This prospective study assessed symptoms via the gynecologic module of the MD Anderson Symptom Inventory (MDASI-PeriOp-GYN) in patients who underwent open laparotomy. RESULTS At discharge, patient-reported moderate to severe (≥4 on a 0-10 scale) abdominal bloating or abdominal cramping, combined with length of stay of ≥4 days, were found to be associated with a higher risk of 30-day post-operative grade II-IV complications by the Clavien-Dindo system (all p values <0.01). Also, length of stay of ≥4 days and moderate to severe urinary urgency at discharge were found to be associated with the need for re-admission (all p values <0.01). CONCLUSION This study defined the clinically meaningful symptoms that related to the risk of developing important complications after discharge from major open gynecological surgery.These findings support the integration of assessment of patient-reported outcomes into patient-centered post-operative care.
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Affiliation(s)
- Xin Shelley Wang
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Pedro T Ramirez
- Department of Gynecologic Oncology and Reproductive Medicine, MD Anderson Cancer Center, Houston, Texas, USA
| | - Qiuling Shi
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Chongqing Medical University, Chongqing, China
| | - Mona Kamal
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Araceli Garcia-Gonzalez
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Maria D Iniesta
- Department of Gynecologic Oncology and Reproductive Medicine, MD Anderson Cancer Center, Houston, Texas, USA
| | - Charles S Cleeland
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Larissa A Meyer
- Department of Gynecologic Oncology and Reproductive Medicine, MD Anderson Cancer Center, Houston, Texas, USA
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Bundled Payment Episodes Initiated by Physician Group Practices: Medicare Beneficiary Perceptions of Care Quality. J Gen Intern Med 2022; 37:1052-1059. [PMID: 34319560 PMCID: PMC8971231 DOI: 10.1007/s11606-021-06848-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/22/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The Bundled Payments for Care Improvement (BPCI) initiative incentivizes participating providers to reduce total Medicare payments for an episode of care. However, there are concerns that reducing payments could reduce quality of care. OBJECTIVE To assess the association of BPCI with patient-reported functional status and care experiences. DESIGN We surveyed a stratified random sample of Medicare beneficiaries with BPCI episodes attributed to participating physician group practices, and matched comparison beneficiaries, after hospitalization for one of the 18 highest volume clinical episodes. The sample included beneficiaries discharged from the hospital from February 2017 through September 2017. Beneficiaries were surveyed approximately 90 days after their hospital discharge. We estimated risk-adjusted differences between the BPCI and comparison groups, pooled across all 18 clinical episodes and separately for the five largest clinical episodes. PARTICIPANTS Medicare beneficiaries with BPCI episodes (n=16,898, response rate=44.5%) and comparison beneficiaries hospitalized for similar conditions selected using coarsened exact matching (n=14,652, response rate=46.2%). MAIN MEASURES Patient-reported functional status, care experiences, and overall satisfaction with recovery. KEY RESULTS Overall, we did not find differences between the BPCI and comparison respondents across seven measures of change in functional status or overall satisfaction with recovery. Both BPCI and comparison respondents reported generally positive care experiences, but BPCI respondents were less likely to report positive care experience for 3 of 8 measures (discharged at the right time, -1.2 percentage points (pp); appropriate level of care, -1.8 pp; preferences for post-discharge care taken into account, -0.9 pp; p<0.05 for all three measures). CONCLUSIONS The proportion of respondents with favorable care experiences was smaller for BPCI than comparison respondents. However, we did not detect differences in self-reported change in functional status approximately 90 days after hospital discharge, indicating that differences in care experiences did not affect functional recovery.
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Holeman TA, Groberg J, Beckstrom JL, Brooke BS. Patient Reported Physical Function as a Preoperative Predictor of Recovery After Vascular Surgery. J Vasc Surg 2022; 76:564-571.e1. [DOI: 10.1016/j.jvs.2022.02.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/06/2022] [Indexed: 11/27/2022]
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Møller PK, Pappot H, Bernchou U, Schytte T, Mortensen ZV, Brúnni MFÁ, Dieperink KB. Feasibility, usability and acceptance of weekly electronic patient-reported outcomes among patients receiving pelvic CT- or online MR-guided radiotherapy - A prospective pilot study. Tech Innov Patient Support Radiat Oncol 2022; 21:8-15. [PMID: 34977367 PMCID: PMC8686059 DOI: 10.1016/j.tipsro.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/11/2021] [Accepted: 12/06/2021] [Indexed: 12/20/2022] Open
Abstract
Recruitment for weekly self-reporting of symptoms in radiotherapy is feasible. The frequency and time spent on responding to 18 symptomatic AEs weekly is feasible. Adherence to weekly self-reporting is high in a population with a sizable proportion of patients age 70 or above. Real-time feedback from clinicians is requested by the patients.
Introduction The potential of patient symptoms being monitored longitudinally in radiotherapy (RT) is still unexploited. When novel technologies like online adaptive MR-guided radiotherapy (MRgRT) are evaluated, weekly electronic patient-reported outcomes (ePROs) may add knowledge about the symptom trajectory. This study aimed at evaluating feasibility, usability and acceptance of weekly ePRO among patients receiving pelvic radiotherapy. Materials and Methods In a mixed-methods convergent design, a prospective pilot study enrolled patients referred to pelvic radiotherapy with curative intent. Patients used their own device at home to self-report PRO weekly during and four weeks following radiotherapy and week 8, 12, and 24 (paper-questionnaire as an alternative). Feasibility was extracted from the ePRO software. The Patient Feedback Form and patient interviews were used to explore usability and patient acceptance. Patients were informed that clinicians had no access to PRO responses. Results In total, 40 patients were included; 32 patients with prostate cancer and 8 with cervical cancer (consent rate 87%), median age 68 (36–76). The majority did digital reporting (93%). 85% of patients responded to ≥80% of the weekly questionnaires with 91% average adherence to weekly completion (60% for follow-up), although lower for patients ≥age 70. Time spent on ePRO (97%) and frequency of reporting (92%) was considered appropriate. Interviews (n = 14) revealed the application was usable and the patients requested real-time feedback from the clinicians. Conclusion Recruitment for ePRO during radiotherapy was feasible and adherence to weekly self-reporting high. The digital application was usable and weekly frequency and time spent acceptable. Real-time feedback from the clinicians is requested by the patients.
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Key Words
- AE, Adverse event
- Acceptance
- CTCAE, Common Terminology Criteria of Adverse Events
- ECOG, Eastern Cooperative Oncology Group
- EORTC, European Organization for Research and Treatment of Cancer
- Feasibility
- Gy, Gray
- MR, Magnetic resonance
- MRgRT, Magnetic resonance guided radiotherapy
- NCI, National Cancer Institute
- Online MRgRT
- PRO, Patient-Reported Outcome
- PRO-CTCAE, Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events
- Patient-reported outcome (PRO)
- QLQ-C30, EORTC general core module
- QoL, Quality of life
- RT, Radiotherapy
- Radiotherapy
- Usability
- WHO, World Health Organization Performance Status
- ePRO, Electronic Patient-Reported Outcome
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Affiliation(s)
- P K Møller
- Department of Oncology, AgeCare, Academy of Geriatric Cancer Research, Odense University Hospital, Denmark.,Department of Clinical Research, University of Southern Denmark, Denmark
| | - H Pappot
- Department of Oncology, Rigshospitalet, University Hospital of Copenhagen and Department of Clinical Medicine, University of Copenhagen, Denmark
| | - U Bernchou
- Department of Clinical Research, University of Southern Denmark, Denmark.,Laboratory of Radiation Physics, Odense University Hospital, Denmark
| | - T Schytte
- Department of Oncology, Odense University Hospital, Denmark.,Department of Clinical Research, University of Southern Denmark, Denmark
| | - Z V Mortensen
- Department of Oncology, Odense University Hospital, Denmark
| | - M F Á Brúnni
- Department of Oncology, Odense University Hospital, Denmark
| | - K B Dieperink
- Department of Oncology, AgeCare, Academy of Geriatric Cancer Research, Odense University Hospital, Denmark.,Department of Clinical Research, University of Southern Denmark, Denmark
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Zia A, Stanek J, Christian‐Rancy M, Savelli S, O'Brien SH. Iron deficiency and fatigue among adolescents with bleeding disorders. Am J Hematol 2022; 97:60-67. [PMID: 34710246 DOI: 10.1002/ajh.26389] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/22/2021] [Accepted: 10/24/2021] [Indexed: 01/01/2023]
Abstract
Iron deficiency anemia is associated with heavy menstrual bleeding (HMB) and, by extension, a bleeding disorder (BD). It is unknown if iron deficiency without anemia is associated with a BD in adolescents. Moreover, the threshold of ferritin associated with fatigue in adolescents with HMB is unclear. In this multicenter study, we enrolled adolescents with HMB without BD. Participants underwent BD and anemia work-up in Young Women's Hematology Clinics and completed the Peds QL™ fatigue scale. BDs were defined as von Willebrand Disease, platelet function defect, clotting factor deficiencies, and hypermobility syndrome. Two hundred and fifty consecutive adolescents were enrolled, of whom 196 met eligibility criteria. Overall, 43% (95% confidence interval: 36%-50%) were diagnosed with BD. A total of 61% (n = 119) had serum ferritin levels < 15 ng/mL, 23.5% (n = 46) had iron deficiency only, and 37% (n = 73) had iron deficiency anemia. Low ferritin or ferritin dichotomized as < 15 or ≥ 15 ng/mL was not associated with BD on univariable analysis (p = .24) or when accounting for age, race, ethnicity, body mass index, and hemoglobin (p = .35). A total of 85% had total fatigue score below the population mean of 80.5, and 52% (n = 102) were > 2 SD (or < 54) below the mean, the cut-off associated with severe fatigue. A ferritin threshold of < 6 ng/mL had a specificity of 79.8% but a sensitivity of 36% for severe fatigue. In conclusion, iron deficiency without anemia is not a predictor of BD in adolescents with HMB in a specialty setting. Severe fatigue, especially sleep fatigue, is prevalent in adolescents with BD. Ferritin of < 6 ng/mL has ~80% specificity for severe fatigue in adolescents with HMB.
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Affiliation(s)
- Ayesha Zia
- Division of Pediatric Hematology/Oncology University of Texas Southwestern Medical Center Dallas Texas USA
- Department of Pediatrics University of Texas Southwestern Medical Center Dallas Texas USA
| | - Joseph Stanek
- Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital Columbus Ohio USA
| | - Myra Christian‐Rancy
- Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital Columbus Ohio USA
| | - Stephanie Savelli
- Department of Pediatrics, Akron Children's Hospital, The Ohio State University Columbus Ohio USA
- Northeastern Ohio Universities College of Medicine Columbus Ohio USA
| | - Sarah H. O'Brien
- Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital Columbus Ohio USA
- Department of Pediatrics The Ohio State University, College of Medicine Columbus Ohio USA
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Kruger KM, Constantino CS, Graf A, Flanagan A, Smith PA, Krzak JJ. What are the long-term outcomes of lateral column lengthening for pes planovalgus in cerebral palsy? J Clin Orthop Trauma 2021; 24:101717. [PMID: 34926149 PMCID: PMC8646176 DOI: 10.1016/j.jcot.2021.101717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Lateral column lengthening (LCL) is commonly performed on children and adolescents with cerebral palsy (CP) for correction of pes planovalgus (PPV). There are limited reports of the long-term outcomes of this procedure. The purpose of this study was to examine the long-term results of LCL for correction of PPV in individuals with CP by evaluating subjects when they had transitioned to adulthood and were entering the workforce. METHODS Clinical assessments, quantitative gait analysis including the Milwaukee Foot Model (MFM) for segmental foot kinematics, and patient reported outcomes were collected from 13 participants with CP treated with LCL for PPV in childhood (average age 24.4 ± 5.7 years, average 15.3 ± 8.5 years since LCL). Additionally, 27 healthy adults average age 24.5 ± 3.6 years functioned as controls. RESULTS Strength and joint range of motion were reduced in the PPV group (p < 0.05). Sixty nine percent showed operative correction of PPV based on radiologic criteria. Gait analysis showed reduced walking speed and stride length, as well as midfoot break and residual forefoot abduction. Patient reported outcomes indicated that foot pain was not the only factor that caused limited activity and participation. LCL surgery for PPV in childhood resulted in long-term operative correction. Decreased ankle passive range of motion and strength, subtalar joint arthritic changes, inefficient and less stable ambulation, and problems with participation (difficulties in physical function, education, and employment) were observed in the long-term. CONCLUSION This study identified postoperative impairments and limitations to guide future clinical decision-making. These results provide clinicians and researchers the common residual and recurrent issues for these individuals as they age. The inclusion of contextual factors that influence the disease and impairments can equip these individuals with enhanced skills they need as they transition into adulthood.
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Affiliation(s)
- Karen M. Kruger
- Orthopaedic and Rehabilitation Engineering Center, Marquette University & Medical College of Wisconsin, 1250 W. Wisconsin Ave., Milwaukee, WI, 53233, USA
- Motion Analysis Center, Shriners Hospital for Children, 2211 N. Oak Park Ave., Chicago, IL, 60707, USA
- Corresponding author. Orthopaedic and Rehabilitation Engineering Center, Marquette University & Medical College of Wisconsin, 1250 W. Wisconsin Ave., Milwaukee, WI, 53233, USA.
| | - Christopher S. Constantino
- Department of Anatomy, University of the Philippines Manila – College of Medicine, 547 Pedro Gil St., Ermita Manila, Philippines
| | - Adam Graf
- Motion Analysis Center, Shriners Hospital for Children, 2211 N. Oak Park Ave., Chicago, IL, 60707, USA
| | - Ann Flanagan
- Motion Analysis Center, Shriners Hospital for Children, 2211 N. Oak Park Ave., Chicago, IL, 60707, USA
| | - Peter A. Smith
- Motion Analysis Center, Shriners Hospital for Children, 2211 N. Oak Park Ave., Chicago, IL, 60707, USA
| | - Joseph J. Krzak
- Motion Analysis Center, Shriners Hospital for Children, 2211 N. Oak Park Ave., Chicago, IL, 60707, USA
- Midwestern University, Physical Therapy Program, College of Health Sciences, 555 31st St., Downers Grove, IL, 60515, USA
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Pourmarzi D, Smirnov A, Hall L, FitzGerald G, Rahman T. 'I'm over the moon!': patient-perceived outcomes of hepatitis C treatment. Aust J Prim Health 2021; 26:319-324. [PMID: 32580867 DOI: 10.1071/py20013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/29/2020] [Indexed: 12/15/2022]
Abstract
Understanding patient-perceived outcomes is crucial for assessing the effectiveness and acceptability of hepatitis C virus (HCV) treatment. This study aimed to explore patient-perceived outcomes of receiving direct-acting antivirals (DAAs). This study was a part of a mixed-methods case study of the Prince Charles Hospital program for improving access to HCV treatment in community settings. Data were collected using semi-structured interviews with nine patients who were in different stages of their treatment for HCV. The participants were recruited using purposive sampling. All interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. Patients emphasised 'having more energy' when reporting improvements in their physical health following treatment. They also reported a newly developed sense of freedom and hope. Improved physical and mental health empowered them to start a healthy lifestyle and to practise self-protection from the risk of re-infection. Patients highlighted their desire to help other patients to receive treatment, which was connected to their experience of the services that they received and their perceived health outcomes. Patients expect and experience various outcomes that are related to the physical, psychological and social aspects of living with, and being cured of HCV. Emphasis on the short-term outcomes of receiving HCV treatment may improve HCV treatment uptake and adherence rates.
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Affiliation(s)
- Davoud Pourmarzi
- School of Public Health and Social Work, Faculty of Health, Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, Brisbane, Qld 4059, Australia; and National Centre for Epidemiology and Population Health, Research School of Population Health, College of Health and Medicine, The Australian National University, Canberra, ACT 2601, Australia; and Corresponding author.
| | - Andrew Smirnov
- National Centre for Epidemiology and Population Health, Research School of Population Health, College of Health and Medicine, The Australian National University, Canberra, ACT 2601, Australia
| | - Lisa Hall
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Qld 4006, Australia
| | - Gerard FitzGerald
- School of Public Health and Social Work, Faculty of Health, Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, Brisbane, Qld 4059, Australia
| | - Tony Rahman
- Department of Gastroenterology and Hepatology, The Prince Charles Hospital, Brisbane, Qld 4032, Australia
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Patient-Surgeon Agreement in Assessment of Frailty, Physical Function, & Social Activity. J Surg Res 2020; 256:368-373. [DOI: 10.1016/j.jss.2020.06.059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/08/2020] [Accepted: 06/16/2020] [Indexed: 11/18/2022]
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Ettridge K, Caruso J, Roder D, Prichard I, Scharling-Gamba K, Wright K, Miller C. A randomised online experimental study to compare responses to brief and extended surveys of health-related quality of life and psychosocial outcomes among women with breast cancer. Qual Life Res 2020; 30:407-423. [PMID: 32990882 DOI: 10.1007/s11136-020-02651-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE Collecting patient-reported outcomes is important in informing the well-being of women with breast cancer. Consumer perceptions are important for successful implementation of monitoring systems, but are rarely formally assessed. We compared reactions to two different surveys (assessing psychosocial outcomes and/or Health-related Quality of Life (HrQoL) outcomes) among Australian women with breast cancer. METHODS Women (18 + years) within 5 years diagnosis of breast cancer were randomly allocated to complete one of two online surveys: (i) minimum HrQoL measures or (ii) minimum HrQoL measures plus psychosocial outcomes (body image, depression, anxiety stress, fear of cancer recurrence, decisional difficulties and unmet need). Participants completed questions regarding their perceptions of the survey, including qualitative feedback. RESULTS Data were available for 171 participants (n(i) = 89; n(ii) = 82), with 92% (n = 158) providing 95-100% complete data. Perceptions were comparable between survey groups, and high (80-100%) regarding time burden, ease of completion, comprehensible, appropriateness and willingness to participate again and moderately high (67-74%) regarding willingness to answer more questions and relevance. Qualitative feedback indicated gaps across both surveys, including financial/work-related issues, satisfaction with information and care, need for nuanced questions, and impact of side effects/treatment, and from the minimum set only, emotional well-being and support. Impairment in some HrQoL and psychosocial outcomes were observed among participants. CONCLUSIONS Assessment of HrQoL and psychosocial outcomes was well received by consumers. Results alleviate concern regarding possible patient burden imposed by longer more in-depth surveys. The importance placed on assessment brevity should not outweigh the need to assess outcomes that consumers consider important.
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Affiliation(s)
- Kerry Ettridge
- South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA, Australia.
| | - Joanna Caruso
- South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA, Australia
| | - David Roder
- University of South Australia, Adelaide, SA, Australia
| | - Ivanka Prichard
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Katrine Scharling-Gamba
- South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA, Australia
| | - Kathleen Wright
- South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA, Australia
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Lin CR, Fan KH, Lin CY, Hung TM, Huang BS, Chen EYC, Kang CJ, Huang SF, Chang JTC, Chang CH. Development and evaluation of a computerized clinical outcome assessment tool for head and neck cancer patients. Medicine (Baltimore) 2020; 99:e20304. [PMID: 32846748 PMCID: PMC7447395 DOI: 10.1097/md.0000000000020304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Paper-based clinical outcome data collection methods have practical limitations when used in clinical settings, as the data are often not summarized in time to facilitate patient-physician communications and therefore cannot be used in clinical decision making. This study aimed to develop a computerized clinical outcome assessment tool (COAT) and evaluate its acceptability, feasibility, and potential clinical applications during clinical encounters for patients with head and neck cancer (HNC).The traditional Chinese (TChi) character version of the Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N) questionnaire was first transcribed and implemented into a touch-screen computerized administration and reporting system (COAT-HNC for short). Each HNC patient was invited to complete the COAT-HNC during their scheduled clinic visits as part of their clinical care. Upon completion, a structured summary report was generated, and subsequently used for treatment evaluation and planning.A cohort of 385 HNC patients were enrolled. Each scale of the computerized TChi FACT-H&N questionnaire demonstrated acceptable internal consistency, with Cronbach coefficient alpha ranging from 0.74 to 0.90. The touch-screen-based and audio-capable COAT-HNC was reported to be easy to use. Patients and physicians were able to utilize the summary report during their clinical encounters to discuss treatment progress and to plan care.It is practically feasible to design, develop, and implement the COAT-HNC system in routine HNC care. The COAT-HNC has the potential to become a valuable tool for data collection and management of clinical outcomes, and appears useful for HNC patients. However, larger studies to demonstrate its clinical usefulness are still needed.
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Affiliation(s)
- Ching-Rong Lin
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Lin-Kou, Tao-Yuan, Taiwan
| | - Kang-Hsing Fan
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Lin-Kou, Tao-Yuan, Taiwan
- Chang Gung University, Tao-Yuan, Taiwan
| | - Chien-Yu Lin
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Lin-Kou, Tao-Yuan, Taiwan
- Chang Gung University, Tao-Yuan, Taiwan
| | - Tsung-Min Hung
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Lin-Kou, Tao-Yuan, Taiwan
| | - Bing-Shen Huang
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Lin-Kou, Tao-Yuan, Taiwan
| | - Eric Yen-Chao Chen
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Chung-Jan Kang
- Department of E.N.T., Chang Gung Memorial Hospital at Lin-Kou, Tao-Yuan, Taiwan
| | - Shiang-Fu Huang
- Department of E.N.T., Chang Gung Memorial Hospital at Lin-Kou, Tao-Yuan, Taiwan
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Lin-Kou, Tao-Yuan, Taiwan
- Chang Gung University, Tao-Yuan, Taiwan
- Xiamen Chang Gung Memorial Hospital, Xiamen, Fujian, China
| | - Chih-Hung Chang
- Washington University School of Medicine, St. Louis, MO, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- China Medical University, Taichung, Taiwan
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Examination of the relationship between management and clinician perception of patient safety climate and patient satisfaction. Health Care Manage Rev 2020; 44:79-89. [PMID: 28445323 DOI: 10.1097/hmr.0000000000000156] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE The aim of this study was to explore the relationship between managers and clinicians' agreement on deeming the patient safety climate as high or low and the patients' satisfaction with those organizations. DATA SOURCES/STUDY SETTING We used two secondary data sets: the Hospital Survey on Patient Safety Culture (2012) and the Hospital Consumer Assessment of Healthcare Providers and Systems (2012). METHODOLOGY/APPROACH We used ordinary least squares regressions to analyze the relationship between the extent of agreement between managers and clinicians' perceptions of safety climate in relationship to patient satisfaction. The dependent variables were four Hospital Consumer Assessment of Healthcare Providers and Systems patient satisfaction scores: communication with nurses, communication with doctors, communication about medicines, and discharge information. The main independent variables were four groups that were formed based on the extent of managers and clinicians' agreement on four patient safety climate domains: communication openness, feedback and communication about errors, teamwork within units, and teamwork across units. FINDINGS After controlling for hospital and market-level characteristics, we found that patient satisfaction was significantly higher if managers and clinicians reported that patient safety climate is high or if only clinicians perceived the climate as high. Specifically, manager and clinician agreement on high levels of communication openness (β = 2.25, p = .01; β = 2.46, p = .05), feedback and communication about errors (β = 3.0, p = .001; β = 2.89, p = .01), and teamwork across units (β = 2.91, p = .001; β = 3.34, p = .01) was positively and significantly associated with patient satisfaction with discharge information and communication about medication. In addition, more favorable perceptions about patient safety climate by clinicians only yielded similar findings. PRACTICE IMPLICATIONS Organizations should measure and examine patient safety climate from multiple perspectives and be aware that individuals may have varying opinions about safety climate. Hospitals should encourage multidisciplinary collaboration given that staff perceptions about patient safety climate may be associated with patient satisfaction.
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Damman OC, Jani A, de Jong BA, Becker A, Metz MJ, de Bruijne MC, Timmermans DR, Cornel MC, Ubbink DT, van der Steen M, Gray M, van El C. The use of PROMs and shared decision-making in medical encounters with patients: An opportunity to deliver value-based health care to patients. J Eval Clin Pract 2020; 26:524-540. [PMID: 31840346 PMCID: PMC7155090 DOI: 10.1111/jep.13321] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/26/2019] [Accepted: 09/29/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The recent emphasis on value-based health care (VBHC) is thought to provide new opportunities for shared decision-making (SDM) in the Netherlands, especially when using patient-reported outcome measures (PROMs) in routine medical encounters. It is still largely unclear about how PROMs could be linked to SDM and what we expect from clinicians in this respect. AIM To describe approaches and lessons learned in the fields of SDM and VBHC implementation that converge in using PROMs in medical encounters. APPROACH Based on input from three Dutch forerunner case examples and available evidence about SDM and VBHC, we describe barriers and facilitators regarding the use of PROMs and SDM in the medical encounter. Barriers and facilitators were structured according to a conversational model that included monitoring and managing, team talk, option talk, choice talk, and decision talk. Key lessons learned and recommendations were synthesized. RESULTS The use of individual, N = 1 PROMs scores in the medical encounter has been largely achieved in the forerunner projects. Conversation on monitoring and managing is relatively well implemented, and option talk to some extent, unlike team talk, and decision talk. Aggregated PROMs information describing outcomes of treatment options seemed to be scarcely used. Experienced barriers largely corresponded to what is known from the literature, eg, perceived lack of time and lack of tools summarizing the options. Some concerns were identified about increasing health care consumption as a result of using PROMs and SDM in the medical encounter. CONCLUSION Successful implementation of SDM within VBHC initiatives may not be self-evident, even though individual, N = 1 PROMs scores are being used in the medical encounter. Education and staff resources on meso and macro levels may facilitate the more time-consuming SDM aspects. It seems fruitful to especially target team talk and choice talk in redesigning clinical pathways.
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Affiliation(s)
- Olga C. Damman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational HealthAmsterdam Public Health Research InstituteAmsterdamThe Netherlands
| | - Anant Jani
- Value Based Healthcare Programme, Department of Primary CareUniversity of OxfordOxfordUnited Kingdom
| | - Brigit A. de Jong
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Neurology, MS Center AmsterdamAmsterdam Neuroscience Research InstituteAmsterdamThe Netherlands
| | - Annemarie Becker
- Department of Pulmonary Diseases, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
- Amsterdam UMCUniversiteit van AmsterdamAmsterdamThe Netherlands
| | - Margot J. Metz
- Tranzo Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral SciencesGGz Breburg and Tilburg UniversityTilburgThe Netherlands
| | - Martine C. de Bruijne
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational HealthAmsterdam Public Health Research InstituteAmsterdamThe Netherlands
| | - Danielle R. Timmermans
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational HealthAmsterdam Public Health Research InstituteAmsterdamThe Netherlands
| | - Martina C. Cornel
- Amsterdam Public Health Research Institute, Department of Clinical GeneticsAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Dirk T. Ubbink
- Department of SurgeryAmsterdam UMC, Universiteit van AmsterdamAmsterdamThe Netherlands
| | - Marije van der Steen
- Department of Strategy and PolicyAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Muir Gray
- Value Based Healthcare Programme, Department of Primary CareUniversity of OxfordOxfordUnited Kingdom
| | - Carla van El
- Amsterdam Public Health Research Institute, Department of Clinical GeneticsAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
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Abstract
Posttraumatic stress disorder (PTSD) treatments primarily address traumatic memories, despite PTSD's association with both traumatic and positive memory difficulties. Addressing this gap, we explored the perspectives of trauma-exposed individuals with mental health treatment experience on therapeutically addressing positive memories. A treatment-seeking sample from a community mental health center (n1 = 60) and a community sample from Amazon's Mechanical Turk (n2 = 123) were queried on the acceptability, feasibility, and delivery/components of a pilot positive memory technique. Results indicated interest or willingness in therapeutically discussing positive memories; most endorsed benefits were improved mood, positive thoughts, and self-esteem. Few barriers were identified (e.g., lack of evidence) compared with feasibility factors (ease/usefulness, improved satisfaction/tolerability, and engagement in PTSD treatment). Preferred treatment components included identifying/discussing positive memories, eliciting associated positive affect, and writing about the positive memory as homework. Results provide formative support for the development and integration of a positive memory technique into PTSD treatments.
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Agochukwu NQ, Wittmann D, Boileau NR, Dunn RL, Montie J, Kim T, Miller DC, Peabody J, Carlozzi NE. Reply to K.P. Weinfurt et al. J Clin Oncol 2020; 38:654-655. [PMID: 31895615 PMCID: PMC7030898 DOI: 10.1200/jco.19.02642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Nnenaya Q. Agochukwu
- Nnenaya Q. Agochukwu, MD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MIDepartment of Urology, University of California, San Francisco, San Francisco, CA; Daniela Wittmann, PhD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MI; Nicholas R. Boileau, MPH, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI; Rodney L. Dunn, MS; James Montie, MD; Tae Kim, BS; and David C. Miller, MD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MI; James Peabody, MS, Henry Ford Health System, Detroit, MI; and Noelle E. Carlozzi, PhD, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Daniela Wittmann
- Nnenaya Q. Agochukwu, MD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MIDepartment of Urology, University of California, San Francisco, San Francisco, CA; Daniela Wittmann, PhD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MI; Nicholas R. Boileau, MPH, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI; Rodney L. Dunn, MS; James Montie, MD; Tae Kim, BS; and David C. Miller, MD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MI; James Peabody, MS, Henry Ford Health System, Detroit, MI; and Noelle E. Carlozzi, PhD, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Nicholas R. Boileau
- Nnenaya Q. Agochukwu, MD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MIDepartment of Urology, University of California, San Francisco, San Francisco, CA; Daniela Wittmann, PhD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MI; Nicholas R. Boileau, MPH, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI; Rodney L. Dunn, MS; James Montie, MD; Tae Kim, BS; and David C. Miller, MD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MI; James Peabody, MS, Henry Ford Health System, Detroit, MI; and Noelle E. Carlozzi, PhD, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Rodney L. Dunn
- Nnenaya Q. Agochukwu, MD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MIDepartment of Urology, University of California, San Francisco, San Francisco, CA; Daniela Wittmann, PhD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MI; Nicholas R. Boileau, MPH, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI; Rodney L. Dunn, MS; James Montie, MD; Tae Kim, BS; and David C. Miller, MD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MI; James Peabody, MS, Henry Ford Health System, Detroit, MI; and Noelle E. Carlozzi, PhD, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - James Montie
- Nnenaya Q. Agochukwu, MD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MIDepartment of Urology, University of California, San Francisco, San Francisco, CA; Daniela Wittmann, PhD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MI; Nicholas R. Boileau, MPH, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI; Rodney L. Dunn, MS; James Montie, MD; Tae Kim, BS; and David C. Miller, MD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MI; James Peabody, MS, Henry Ford Health System, Detroit, MI; and Noelle E. Carlozzi, PhD, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Tae Kim
- Nnenaya Q. Agochukwu, MD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MIDepartment of Urology, University of California, San Francisco, San Francisco, CA; Daniela Wittmann, PhD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MI; Nicholas R. Boileau, MPH, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI; Rodney L. Dunn, MS; James Montie, MD; Tae Kim, BS; and David C. Miller, MD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MI; James Peabody, MS, Henry Ford Health System, Detroit, MI; and Noelle E. Carlozzi, PhD, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - David C. Miller
- Nnenaya Q. Agochukwu, MD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MIDepartment of Urology, University of California, San Francisco, San Francisco, CA; Daniela Wittmann, PhD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MI; Nicholas R. Boileau, MPH, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI; Rodney L. Dunn, MS; James Montie, MD; Tae Kim, BS; and David C. Miller, MD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MI; James Peabody, MS, Henry Ford Health System, Detroit, MI; and Noelle E. Carlozzi, PhD, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - James Peabody
- Nnenaya Q. Agochukwu, MD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MIDepartment of Urology, University of California, San Francisco, San Francisco, CA; Daniela Wittmann, PhD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MI; Nicholas R. Boileau, MPH, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI; Rodney L. Dunn, MS; James Montie, MD; Tae Kim, BS; and David C. Miller, MD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MI; James Peabody, MS, Henry Ford Health System, Detroit, MI; and Noelle E. Carlozzi, PhD, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Noelle E. Carlozzi
- Nnenaya Q. Agochukwu, MD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MIDepartment of Urology, University of California, San Francisco, San Francisco, CA; Daniela Wittmann, PhD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MI; Nicholas R. Boileau, MPH, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI; Rodney L. Dunn, MS; James Montie, MD; Tae Kim, BS; and David C. Miller, MD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MI; James Peabody, MS, Henry Ford Health System, Detroit, MI; and Noelle E. Carlozzi, PhD, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
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Richter JP, Kazley AS. Social media: How hospital facebook activity may influence patient satisfaction. Health Mark Q 2020; 37:1-9. [PMID: 32013810 DOI: 10.1080/07359683.2020.1713573] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Some hospitals use social media to promote accurate health-related education, information, and engage consumers. We performed multiple linear regression analyses to determine the associations between hospital Facebook activity and patient satisfaction for 390 hospitals. Hospitals that had a Facebook page were active on Facebook in the past 30 days and had more "likes," had more patients willing to definitely recommend the hospital, and had a higher overall satisfaction score. Practitioners can use the results when considering whether a minimal financial investment in social media may be worth customer loyalty and Centers for Medicare and Medicaid Systems (CMS) reimbursement benefits.
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Affiliation(s)
- Jason P Richter
- Seymour Johnson Air Force Base Medical Clinic, Goldsboro, North Carolina, USA
| | - Abby S Kazley
- Department of Health Care Leadership and Management, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina, USA
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Billig JI, Sears ED, Travis BN, Waljee JF. Patient-Reported Outcomes: Understanding Surgical Efficacy and Quality from the Patient's Perspective. Ann Surg Oncol 2020; 27:56-64. [PMID: 31489556 PMCID: PMC7446737 DOI: 10.1245/s10434-019-07748-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Indexed: 01/10/2023]
Abstract
In surgery, quality assessment encourages improved care delivery, better outcomes, and helps determine surgical efficacy. Quality is important from a patient, provider, payer, and policy maker standpoint. However, given the growth of outpatient procedures, expansion of surgical indications to enhance function, and the decline of perioperative morbidity and mortality, many traditional quality metrics, such as mortality, readmissions, and complications, may not fully capture quality. As such, patient-reported outcomes (PROs) can be used to complement the established clinical outcomes and describe surgical efficacy and quality from the patient's point of view. Generic and disease-specific PRO measures capture health-related quality of life, functional status, and pain. These measures permit a more holistic understanding of how surgery affects different aspects of a patient's health, augment other clinical outcomes, and are commonly used to determine efficacy in clinical trials. Moreover, our national reimbursement structure is currently evolving to include PROs for certain surgical conditions in measures of quality and with direct linkage to payments. Even so, there continues to be challenges in the implementation of PRO measures in everyday surgical practice, with questions of optimal administration and how to integrate these measures into provider work flow. Despite these challenges, PROs provide vital information regarding surgical efficacy and quality and are critical in the delivery of patient-centered care.
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Affiliation(s)
- Jessica I Billig
- VA/National Clinician Scholars Program, VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Section of Plastic Surgery, Michigan Medicine, Ann Arbor, MI, USA
| | - Erika D Sears
- Section of Plastic Surgery, Michigan Medicine, Ann Arbor, MI, USA
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Section of Plastic Surgery, Michigan Medicine, Ann Arbor, MI, USA
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Damman OC, Verbiest MEA, Vonk SI, Berendse HW, Bloem BR, de Bruijne MC, Faber MJ. Using PROMs during routine medical consultations: The perspectives of people with Parkinson's disease and their health professionals. Health Expect 2019; 22:939-951. [PMID: 31199574 PMCID: PMC6803413 DOI: 10.1111/hex.12899] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/18/2019] [Accepted: 04/05/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The use of patient-reported outcomes measures (PROMs), such as quality of life or symptoms like pain or fatigue, is increasingly embraced within patient-centred care and shared decision making. OBJECTIVES To investigate: (a) how patients and health professionals think about using PROMs during routine medical consultations; (b) for which purpose(s), patients and health professionals want to use PROMs during those consultations; and (c) how patients interpret PROMs information presented in various formats. People with Parkinson's disease and their health professionals served as case example. METHODS We performed semi-structured interviews with patients (N = 13) and professionals (N = 7 neurologists; N = 7 physiotherapists). We also used a survey in which patients (N = 115) were shown six figures displaying different information types. Presentation formats of this information varied (line/bar graphs). Interpretation by patients, perceived usefulness of information, attitude towards using information during routine medical consultations and (hypothetical) decisions were assessed. FINDINGS Patients and professionals were generally positive about using PROMs during medical consultations. Professionals stressed the opportunity to monitor changes in individual PROMs over time. Patients were primarily positive about aggregated PROMs to make treatment decisions. This information was also most often interpreted correctly, especially when presented through a line graph (90.1% correct). Professionals thought patients should take the initiative in discussing PROMs, whereas patients thought professionals should do so. CONCLUSION/DISCUSSION When used in routine medical consultations, PROMs seem to have potential to support shared decision making and facilitate patient-professional communication. However, training seems needed for both patients and professionals to facilitate actual discussion and proper interpretation.
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Affiliation(s)
- Olga C. Damman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Marjolein E. A. Verbiest
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare)Radboud University Medical CenterNijmegenThe Netherlands
- Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Centre for Care and WelfareTilburg UniversityTilburgThe Netherlands
| | - Suzanne I. Vonk
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Henk W. Berendse
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Bastiaan R. Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and BehaviourRadboud University Medical CentreNijmegenThe Netherlands
| | - Martine C. de Bruijne
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Marjan J. Faber
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare)Radboud University Medical CenterNijmegenThe Netherlands
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Best-Worst Scaling to Prioritize Outcomes Meaningful to Caregivers of Youth with Mental Health Multimorbidities: A Pilot Study. J Dev Behav Pediatr 2019; 39:101-108. [PMID: 29461997 DOI: 10.1097/dbp.0000000000000525] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Health care decision-making for youth with mental health multimorbidity is guided by outcomes that are considered most meaningful and important. The study objective was to pilot test a best-worst scaling (BWS) instrument designed to assess trade-offs among caregiver-defined, meaningful health care outcomes. METHODS A BWS was designed with continuous stakeholder involvement to elicit caregiver-defined outcomes in 4 domains: school, behavioral, social, and independence. Four attributes were identified for each outcome domain, for a total of 16 attributes. Using a balanced incomplete block design, a BWS instrument was developed with 16 choice task questions displaying 6 attributes at a time. A convenience sample was selected from Maryland caregivers of children who were 21 years old or younger and had a developmental delay and a comorbid mental health condition. Participants completed a survey that included demographics and the BWS instrument. Conditional logit was used to estimate utility scores and 95% confidence intervals (CI) for each attribute, which were ranked in order of importance. Attribute statements were refined after a respondent debriefing session. RESULTS A total of 38 caregivers participated in the pilot study. Child safety to self was the most important outcome (1.01, CI, 0.78-1.24). This was followed by securing support for an Individualized educational plan in school (0.77, CI, 0.54-1.01) and the child being able to stay in school all day (0.53, CI, 0.29-0.77). CONCLUSION BWS scenarios that resemble real-life decision-making can be a useful tool to identify preferences for health care outcomes.
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Oh, the Places We'll Go: Patient-Reported Outcomes and Electronic Health Records. THE PATIENT 2019; 11:591-598. [PMID: 29968179 DOI: 10.1007/s40271-018-0321-9] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The growing measurement of patient-reported outcomes (PROs) and adoption of electronic health records (EHRs) presents an unprecedented opportunity to improve health care for patients and populations. The integration of PROs into EHRs can promote patient-centered care and advance quality improvement initiatives, research, and population health. Despite these potential benefits, there are few best practices to help organizations achieve integration. To integrate PROs into EHRs, organizations should evaluate the advantages and disadvantages of various approaches within three themes: Planning, Selection, and Engagement. Planning considerations for integration include what strategy will be used, how the integrated system will be governed, ethical and legal issues, and how data from multiple EHRs can be pooled across organizations. Selection considerations involve identifying which patient population to target for PRO data collection on the basis of the intended use of the data in the health care system, and then choosing specific outcomes and their measures. Engagement considerations include how, where, and with what frequency patients will respond to PRO measures, how to display PRO data in EHRs, how clinical teams will act upon PRO data, and how to train, support and incent clinical teams and patients to incorporate PRO data into care. There is no most effective model that will work in all contexts. Organizations wishing to integrate PROs and EHRs should assemble the multidisciplinary expertise needed to evaluate the advantages and disadvantages of the various approaches for their particular context. We specifically recommend that organizations think carefully about stakeholder participation; design their system with data sharing in mind; develop a framework to aid in PRO selection; create guidelines to support PRO interpretation and action for patients and clinicians; and ensure patients have access to their own PRO data.
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Mulder FJ, Mosmuller DGM, de Vet RHCW, Don Griot JPW. Aesthetics Assessment and Patient Reported Outcome of Nasolabial Aesthetics in 18-Year-Old Patients With Unilateral Cleft Lip. Cleft Palate Craniofac J 2019; 56:1058-1064. [PMID: 30808197 PMCID: PMC6696741 DOI: 10.1177/1055665619832439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: To determine if there is a correlation between objective nasolabial aesthetics assessment using the Cleft Aesthetic Rating Scale (CARS) and patient satisfaction. Design: Retrospective analysis of a generic satisfaction questionnaire and independent assessment by three cleft surgeons of the nasolabial area of these patients on 2D frontal photographs, using the CARS. Setting: The Vrije Universiteit Medical Center and The Academic Center for Dentistry Amsterdam. Patients: Thirty-nine 18-year old patients with a repaired complete or incomplete unilateral cleft lip, with or without a cleft palate, and a completed satisfaction questionnaire. Exclusion criteria were an incomplete questionnaire; a history of facial trauma; and congenital syndromes affecting facial appearance. Main Outcome Measures: The correlation between surgeon evaluation (on a 5-point Likert scale) and patient satisfaction (not, moderately or very satisfied) on nasolabial appearance was assessed using Spearman rho (ρ). Results: There was a negligible correlation between surgeon evaluation and patient satisfaction on nose assessment (ρ = 0.20) and a moderate correlation on lip assessment (ρ = 0.32). Conclusions: Most literature supports this discrepancy between different objective aesthetics evaluation methods and subjective patient-reported outcome measures, suggesting there are factors playing a role in patient satisfaction that are impossible to objectify with assessment methods. Therefore, a strong emphasis should remain on clear communication between the physician and patient regarding their expectations, perception, and satisfaction of surgery results.
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Affiliation(s)
- Frans J Mulder
- 1 Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Center, Amsterdam, the Netherlands
| | - David G M Mosmuller
- 1 Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Center, Amsterdam, the Netherlands
| | - Riekie H C W de Vet
- 2 Department of Epidemiology and Biostatistics and the Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands
| | - J P W Don Griot
- 1 Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Center, Amsterdam, the Netherlands
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A systematic review of randomised controlled trials evaluating the use of patient-reported outcome measures (PROMs). Qual Life Res 2018; 28:567-592. [PMID: 30284183 DOI: 10.1007/s11136-018-2016-z] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) could play an important role in identifying patients' needs and goals in clinical encounters, improving communication and decision-making with clinicians, while making care more patient-centred. Comprehensive evidence that PROMS are an effective intervention is lacking in single randomised controlled trials (RCTs). METHODS A systematic search was performed using controlled vocabulary related to the terms: clinical care setting and patient-reported outcome. English language studies were included if they were a RCT with a PROM as an intervention in a patient population. Included studies were analysed and their methodologic quality was appraised using the Cochrane Risk of Bias tool. The protocol was registered with PROSPERO (CRD42016034182). RESULTS Of 4302 articles initially identified, 115 underwent full-text review resulting in 22 studies reporting on 25 comparisons. The majority of included studies were conducted in USA (11), among cancer patients (11), with adult participants only (20). Statistically significant and robust improvements were reported in the pre-specified outcomes of the process of care (2) and health care (3). Additionally, five, eight and three statistically significant but possibly non-robust findings were reported in the process of care, health and patient satisfaction outcomes, respectively. CONCLUSIONS Overall, studies that compared PROM to standard care either reported a positive effect or were not powered to find pre-specified differences. There is justification for the use of a PROM as part of standard care, but further adequately powered studies on their use in different contexts are necessary for a more comprehensive evidence base.
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Celestin MD, Ferguson T, Ledford EC, Tseng TS, Carton T, Moody-Thomas S. Differences in Treating Tobacco Use Across National, State, and Public Hospital System Surveys. Prev Chronic Dis 2018; 15:E103. [PMID: 30124428 PMCID: PMC6110402 DOI: 10.5888/pcd15.170575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The Louisiana Tobacco Control Initiative (TCI), a multidisciplinary program specializing in helping tobacco users quit, assisted health care providers in Louisiana’s public hospitals with integrating evidence-based treatment of tobacco use into clinical practice. Our study compared smoking behavior, provider adherence to the 5 A’s tobacco cessation intervention (ask, advise, assess, assist, and arrange), cessation assistance awareness, quit attempts, and treatment preference among respondents to a TCI survey with a sample of respondents from the National Adult Tobacco Survey (NATS) and a sample from the Louisiana Adult Tobacco Survey (LATS). In 2010, more TCI respondents were asked if they smoked, advised to quit, helped to set a quit date, counseled, and arranged to be contacted for follow-up than respondents to NATS or LATS. Fewer TCI respondents received self-help material or were prescribed medication to assist in quitting than NATS and LATS respondents. In 2010 and 2013, TCI participants reported more quit attempts when 4 or more of the 5 A’s were received. Thus, public health systems can promote treatment of tobacco use.
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Affiliation(s)
- Michael D Celestin
- Department of Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health - New Orleans, New Orleans, Louisiana.,2020 Gravier St, 3rd Floor, New Orleans, LA 70112.
| | - Tekeda Ferguson
- Department of Epidemiology, School of Public Health, Louisiana State University Health - New Orleans, New Orleans, Louisiana
| | | | - Tung-Sung Tseng
- Department of Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health - New Orleans, New Orleans, Louisiana
| | - Thomas Carton
- Louisiana Public Health Institute, New Orleans, Louisiana
| | - Sarah Moody-Thomas
- Department of Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health - New Orleans, New Orleans, Louisiana
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Inacio MCS, Cashman K, Pratt NL, Gillam MH, Caughey G, Graves SE, Roughead EE. Prevalence and changes in analgesic medication utilisation 1 year prior to total joint replacement in an older cohort of patients. Osteoarthritis Cartilage 2018; 26:356-362. [PMID: 29258881 DOI: 10.1016/j.joca.2017.11.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 10/24/2017] [Accepted: 11/01/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To evaluate the prevalence and change in analgesic medications use prior to joint replacement in older patients between 2001 and 2012. METHODS A population based epidemiological study was conducted. Opioids, non-steroidal anti-inflammatories (NSAIDs), paracetamol, corticosteroid injections, medications for neuropathic pain, hypnotics, and muscle relaxants supplied 1 year prior to total knee replacement (TKR, n = 15,517) and hip replacement (THR, n = 10,018) were assessed. Patient characteristics and surgical indication adjusted prevalence ratios (PRs) and 95% confidence intervals (CI) are provided. RESULTS From 2001 to 2012, in the TKR cohort (median age 78.9) the prevalence of opioid use prior to surgery increased from 37% to 49% (PR = 1.01, 95% CI 1.00-1.01, P = 0.01), while in the THR cohort (median age 81.1) it increased from 44% to 54% (PR = 1.01, 95% CI 1.01-1.02, P < 0.001). Paracetamol use increased from 52% to 61% (PR = 1.0, 95% CI 1.0-1.0, P = 0.913) in the TKR cohort and from 55% to 67% (PR = 1.01, 95% CI 1.00-1.01, P = 0.005) in the THR cohort. Neuropathic pain medication use increased from 5% to 11% in the TKR cohort (PR = 1.04, 95% CI 1.02-1.06, P < 0.0001) and from 6% to 12% in the THR cohort (PR = 1.06, 95% CI 1.04-1.09, P < 0.0001). NSAID use decreased from 76% to 50% in the TKR cohort (PR = 0.96, 95% CI 0.95-0.96, P < 0.0001), and from 81% to 47% in THR cohort (PR = 0.95, 95% CI 0.94-0.95, P < 0.0001). Corticosteroid injections prevalence also decreased (TKR: 21-18%, PR = 0.97, 95% CI 0.96-0.97, P < 0.001, THR: 18-17%, PR = 0.97, 95% CI 0.96-0.98, P < 0.001). CONCLUSION Pain medication utilization prior to joint replacement surgery changed significantly in this national older cohort of patients during the 2000s.
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Affiliation(s)
- M C S Inacio
- Medicine and Device Surveillance Centre of Research Excellence, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - K Cashman
- Medicine and Device Surveillance Centre of Research Excellence, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - N L Pratt
- Medicine and Device Surveillance Centre of Research Excellence, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - M H Gillam
- Medicine and Device Surveillance Centre of Research Excellence, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - G Caughey
- Medicine and Device Surveillance Centre of Research Excellence, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia.
| | - S E Graves
- Australian Orthopaedic Association, National Total Joint Replacement Registry, Adelaide, Australia
| | - E E Roughead
- Medicine and Device Surveillance Centre of Research Excellence, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
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Abstract
Comparative effectiveness research (CER) has become increasing central to clinical research in medicine. CER seeks to conduct clinical trials that compare different commonly used interventions in real-world settings (pragmatic clinical trials) and use a multitude of sources of evidence (including registries and cohort studies) to inform clinical decision making. CER also ensures that stakeholders (patients, families, care providers, insurers) have a voice in the research process by integrating formal stakeholder engagement as part of the research. This innovative approach to clinical research has distinct benefits and pitfalls. This review first defines what CER is and then describes some of its benefits and then pitfalls. The focus is on the role of CER in pediatrics.
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Wiering B, de Boer D, Delnoij D. Patient involvement in the development of patient-reported outcome measures: The developers' perspective. BMC Health Serv Res 2017; 17:635. [PMID: 28886742 PMCID: PMC5591531 DOI: 10.1186/s12913-017-2582-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 08/30/2017] [Indexed: 01/02/2023] Open
Abstract
Background Patient-reported outcome measures (PROMs) are increasingly used in health care. To capture the patient’s perspective, patient involvement in PROM development is needed. As earlier research showed varying degrees of patient involvement in PROM development, this study aimed to investigate why PROM developers do or do not involve patients, how patients can be successfully involved and what the negative aspects and benefits of patient involvement are. Methods PROM developers who, according to an earlier scoping review, involved patients in at least two phases of PROM development or did not involve patients at all, were contacted for a telephone interview. The interviews were recorded, transcribed and analysed using a general inductive approach. Results From the PROM developers who involved patients, 21 developers were interviewed and three answered questions via e-mail. Most developers considered patient involvement necessary to create a valid questionnaire and relied on guidelines, personal experience and practical considerations for choosing a qualitative method. Negative aspects of patient involvement were mainly time investment and budget impact. One developer who did not involve patients was interviewed. Two developers sent back answers via e-mail. These developers did not involve patients because of limited resources or because no benefits were expected. Conclusion Although PROM developers agree that patient involvement is necessary, a lack of resources can be a stumbling block. Most developers rely on guidelines, personal experience or practical considerations for choosing a qualitative method. Although this may be a good place to start, to optimize patient involvement developers should explicitly think about which methods would suit their study.
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Affiliation(s)
- Bianca Wiering
- Tranzo (Scientific Centre for Transformation in Care and Welfare), Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands.
| | - Dolf de Boer
- NIVEL (Netherlands institute for health services research), Utrecht, the Netherlands
| | - Diana Delnoij
- Tranzo (Scientific Centre for Transformation in Care and Welfare), Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands
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Ahmed S, Ware P, Gardner W, Witter J, Bingham CO, Kairy D, Bartlett SJ. Montreal Accord on Patient-Reported Outcomes (PROs) use series – Paper 8: patient-reported outcomes in electronic health records can inform clinical and policy decisions. J Clin Epidemiol 2017; 89:160-167. [DOI: 10.1016/j.jclinepi.2017.04.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 03/28/2017] [Accepted: 04/10/2017] [Indexed: 12/22/2022]
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Basch E, Dueck AC, Rogak LJ, Minasian LM, Kelly WK, O'Mara AM, Denicoff AM, Seisler D, Atherton PJ, Paskett E, Carey L, Dickler M, Heist RS, Himelstein A, Rugo HS, Sikov WM, Socinski MA, Venook AP, Weckstein DJ, Lake DE, Biggs DD, Freedman RA, Kuzma C, Kirshner JJ, Schrag D. Feasibility Assessment of Patient Reporting of Symptomatic Adverse Events in Multicenter Cancer Clinical Trials. JAMA Oncol 2017; 3:1043-1050. [PMID: 28208174 PMCID: PMC5553624 DOI: 10.1001/jamaoncol.2016.6749] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE In cancer clinical trials, symptomatic adverse events (AEs), such as nausea, are reported by investigators rather than by patients. There is increasing interest to collect symptomatic AE data via patient-reported outcome (PRO) questionnaires, but it is unclear whether it is feasible to implement this approach in multicenter trials. OBJECTIVE To examine whether patients are willing and able to report their symptomatic AEs in multicenter trials. DESIGN, SETTING, AND PARTICIPANTS A total of 361 consecutive patients enrolled in any 1 of 9 US multicenter cancer treatment trials were invited to self-report 13 common symptomatic AEs using a PRO adaptation of the National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE) via tablet computers at 5 successive clinic visits. Patient adherence was tracked with reasons for missed self-reports. Agreement with clinician AE reports was analyzed with weighted κ statistics. Patient and investigator perspectives were elicited by survey. The study was conducted from March 15, 2007, to August 11, 2011. Data analysis was performed from August 9, 2013, to March 21, 2014. RESULTS Of the 361 patients invited to participate, 285 individuals enrolled, with a median age of 57 years (range, 24-88), 202 (74.3%) female, 241 (85.5%) white, 73 (26.8%) with a high school education or less, and 176 (64.7%) who reported regular internet use (denominators varied owing to missing data). Across all patients and trials, there were 1280 visits during which patients had an opportunity to self-report (ie, patients were alive and enrolled in a treatment trial at the time of the visit). Self-reports were completed at 1202 visits (93.9% overall adherence). Adherence was highest at baseline and declined over time (visit 1, 100%; visit 2, 96%; visit 3, 95%; visit 4, 91%; and visit 5, 85%). Reasons for missing PROs included institutional errors in 27 of 48 (56.3%) of the cases (eg, staff forgetting to bring computers to patients at visits), patients feeling "too ill" in 8 (16.7%), patient refusal in 8 (16.7%), and internet connectivity problems in 5 (10.4%). Patient-investigator CTCAE agreement was moderate or worse for most symptoms (most κ < 0.05), with investigators reporting fewer AEs than patients across symptoms. Most patients believed that the system was easy to use (234 [93.2%]) and useful (230 [93.1%]), and investigators thought that the patient-reported AEs were useful (133 [94.3%]) and accurate (119 [83.2%]). CONCLUSIONS AND RELEVANCE Participants in multicenter cancer trials are willing and able to report their own symptomatic AEs at most clinic visits and report more AEs than investigators. This approach may improve the precision of AE reporting in cancer trials.
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Affiliation(s)
- Ethan Basch
- Department of Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Amylou C Dueck
- Alliance Statistics and Data Center, Division of Health Sciences Research, Mayo Clinic, Scottsdale, Arizona
| | - Lauren J Rogak
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lori M Minasian
- Division of Cancer Prevention, National Cancer Institute (NCI), Rockville, Maryland
| | - William Kevin Kelly
- Department of Medical Oncology and Urology, Division of Solid Tumor, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
- Clinical Research and Prostate Cancer Program, Sidney Kimmel Cancer Center, Philadelphia, Pennsylvania
| | - Ann M O'Mara
- Division of Cancer Treatment and Diagnosis, NCI, Rockville, Maryland
| | - Andrea M Denicoff
- Division of Cancer Treatment and Diagnosis, NCI, Rockville, Maryland
| | - Drew Seisler
- Alliance Statistics and Data Center, Division of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Pamela J Atherton
- Alliance Statistics and Data Center, Division of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Electra Paskett
- Division of Cancer Prevention and Control, Department of Internal Medicine, Division of Epidemiology, College of Public Health, The Ohio State University, Columbus
| | - Lisa Carey
- Department of Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill
| | - Maura Dickler
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Rebecca S Heist
- Department of Thoracic Oncology, Harvard Medical School, Massachusetts General Hospital, Boston
| | - Andrew Himelstein
- Delaware/Christiana Care NCI Community Oncology Research Program (NCORP), Helen F. Graham Cancer Center & Research Institute, Newark
| | - Hope S Rugo
- Department of Medicine, University of California at San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco
| | - William M Sikov
- Program in Women's Oncology, Department of Obstetrics & Gynecology, Women and Infants Hospital of Rhode Island, Providence
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Mark A Socinski
- Thoracic Oncology Program, Florida Hospital Cancer Institute, Orlando
| | - Alan P Venook
- Department of Medicine, University of California at San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco
| | | | - Diana E Lake
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David D Biggs
- Delaware/Christiana Care NCI Community Oncology Research Program (NCORP), Helen F. Graham Cancer Center & Research Institute, Newark
| | - Rachel A Freedman
- Department of Medical Oncology, Harvard Medical School, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Charles Kuzma
- Southeast Clinical Oncology Research Consortium, Winston-Salem, North Carolina
| | | | - Deborah Schrag
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
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Wiering B, de Boer D, Delnoij D. Asking what matters: The relevance and use of patient-reported outcome measures that were developed without patient involvement. Health Expect 2017; 20:1330-1341. [PMID: 28675514 PMCID: PMC5689236 DOI: 10.1111/hex.12573] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2017] [Indexed: 12/12/2022] Open
Abstract
Background Patient‐reported outcome measures (PROMs) are increasingly used to establish the value of health care. In order to reflect value, PROMs should measure outcomes that matter to patients. However, patients are not always involved in the development of PROMs. This study therefore aimed to investigate whether PROMs, which were developed without patient involvement, are relevant to patients and whether the level of importance allocated towards aspects of these PROMs varies between patient groups. Methods All patients from 20 Dutch hospitals undergoing hip or knee surgery in 2014 were invited to a PROMs survey. Participants were asked to rate the importance of each of the items in the HOOS‐Physical Function Short form or the KOOS‐Physical Function Short form, the EQ‐5D and the NRS pain. Results Most outcomes were considered important. However, 77.7% of hip surgery patients rated being able to run as unimportant. Being able to kneel (32.7%) or squat (39.6%) was not important to a considerable minority of knee surgery patients. Pain, especially during rest, was considered very important by both hip (68.2%) and knee (66.5%) surgery patients. Patients who were older, male, experienced overall bad health and psychological health considered many items from the PROMs less important than other patients. Discussion Patients differ in what they consider important. Health‐care professionals should explore patients’ preferences and discuss which treatment options best fit patients’ preferences. Additionally, if PROMs are used in performance measurement, further research is needed to look at whether and how variation in patient preferences can be taken into account.
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Affiliation(s)
- Bianca Wiering
- Tranzo (Scientific Centre for Transformation in Care and Welfare), Tilburg University, Tilburg, The Netherlands
| | - Dolf de Boer
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Diana Delnoij
- Tranzo (Scientific Centre for Transformation in Care and Welfare), Tilburg University, Tilburg, The Netherlands
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Affiliation(s)
- Jennifer F Waljee
- Department of Surgery, Center for Health Outcomes and Policy, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Justin B Dimick
- Department of Surgery, Center for Health Outcomes and Policy, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
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Hong YD, Goto D, Mullins CD. Querying stakeholders to inform comparative effectiveness research. J Comp Eff Res 2017; 6:10.2217/cer-2016-0082. [PMID: 28485177 PMCID: PMC5680160 DOI: 10.2217/cer-2016-0082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Despite the growing recognition of the value of stakeholder engagement in research, there is limited guidance on effectively eliciting stakeholder views during the comparative effectiveness research (CER) process. This article outlines the potential role of each stakeholder (patient, provider, policymaker and payer) throughout the CER process and provides examples of practical questions that researchers can ask the four primary stakeholder groups at each step of the CER process. This guide aims to assist in the development of meaningful stakeholder-researcher shared decision-making to incorporate stakeholder views in the design, conduct and dissemination of patient-centered CER.
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Affiliation(s)
- Yoon Duk Hong
- Pharmaceutical Health Services Research Department, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Daisuke Goto
- Pharmaceutical Health Services Research Department, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - C. Daniel Mullins
- Pharmaceutical Health Services Research Department, University of Maryland School of Pharmacy, Baltimore, MD, USA
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Fernandez B, Dore L, Velanovich V. Patient-Centered Outcomes in Surgical Research and Practice. J Gastrointest Surg 2017; 21:892-895. [PMID: 28108932 DOI: 10.1007/s11605-016-3342-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 12/14/2016] [Indexed: 01/31/2023]
Affiliation(s)
- Blake Fernandez
- Division of General Surgery, The University of South Florida, 5 Tampa General Circle, Suite 740, Tampa, FL, 33606, USA
| | - Livingstone Dore
- Division of General Surgery, The University of South Florida, 5 Tampa General Circle, Suite 740, Tampa, FL, 33606, USA
| | - Vic Velanovich
- Division of General Surgery, The University of South Florida, 5 Tampa General Circle, Suite 740, Tampa, FL, 33606, USA.
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Bheemanna NK, Channaiah SRD, Gowda PKV, Shanmugham VH, Chanappa NM. Fears and Perceptions Associated with Regional Anesthesia: A Study from a Tertiary Care Hospital in South India. Anesth Essays Res 2017; 11:483-488. [PMID: 28663646 PMCID: PMC5490094 DOI: 10.4103/aer.aer_51_17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIMS To assess the patients' fears and their perception about regional anesthesia and to study the correlation between fears and perception and demographic profile. DESIGN A prospective cross-sectional survey on 150 patients scheduled for surgery under regional anesthesia (RA). MATERIALS AND METHODS The structured questionnaires composed of patients' demographic data and questions regarding patients' fears about RA. Questionnaires along with consent forms were sequentially distributed to patients. American Society of Anesthesiologists physical status Classes I and II patients aged between 18 and 80 years scheduled for surgery under RA at the preanesthesia clinics were included in the study. STATISTICAL ANALYSIS Statistical analysis was done by calculating percentages using Chi-square test. RESULTS One hundred and fifty participants were studied, and their responses were analyzed. Overall, 75.3% (n = 113) patients had preoperative fear. Fear of pain during surgery, i.e., 49.3% (n = 56) and fear of needles 48.7% (n = 55) were the most common fears that were observed in the study population. Patients had less fear regarding nausea, vomiting, and headache. Patients' demographic details did not have a significant correlation with their fears except for gender, with women being more afraid (86.3% vs. 67.7% of men, P = 0.01). Six patients (4%) revealed dissatisfaction and 10 patients were neutral with RA. Ten patients (6.7%) opted for GA in the future and one patient opted for RA with sedation. CONCLUSION There is a significant prevalence of fear for RA and its procedures which can affect the patients' decision and postoperative anxiety. The study replicated the high prevalence of anxiety and fear and has clinical implication of improving the education and specifically targeting the fears and anxiety to help the patients' better cope during and after the surgical procedure.
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Affiliation(s)
| | | | - Pavithra K V Gowda
- Department of Anaesthesiology, M.S. Ramaiah Medical College, Bengaluru, Karnataka, India
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Abstract
OBJECTIVES The patient centered medical home is now widely supported as a strategy for delivering high quality primary care. The objective of this study was to examine whether children's primary care experiences nationally have become more aligned with the medical home model over time, and how this may have varied for vulnerable children. METHODS This study analyzed data on 289,672 children, aged 0-17 years, of families responding to one of three iterations of National Survey of Children's Health from 2003, 2007 and 2011-2012. Each year, we assessed indicators of four medical home features (access, continuity, comprehensiveness, and family-centeredness) and a total medical home score for children nationally and for those with a set of social and demographic risk factors. RESULTS Indicators of access and continuity, and total medical home scores fluctuated but improved overall from 2003 to 2012 (7.1, 6.7 and 1.4 % point increases, respectively), while indicators of comprehensiveness and family-centered care measures declined (2.4 and 1.8 % point decreases, respectively). Children with the highest levels of social and demographic risk experienced larger fluctuations in these measures over time. CONCLUSIONS FOR PRACTICE There were improvements in the extent to which children's primary care experiences aligned with a medical home model, though not linearly or for all component features. Children with more risk factors experienced more volatile changes, suggesting a particular need to attend to the primary care experiences of the most vulnerable children.
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Affiliation(s)
- Gregory D Stevens
- Departments of Family Medicine and Preventive Medicine, Keck School of Medicine, University of Southern California, Alhambra, CA, USA
| | - Alice Y Kim
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 1000 South Fremont Ave, Unit #80, Alhambra, CA, 91803, USA.
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Wards in Opinion of Patients - A Comparative Study on the Quality of Nursing Care. Arch Psychiatr Nurs 2016; 30:685-691. [PMID: 27888960 DOI: 10.1016/j.apnu.2016.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 03/22/2016] [Accepted: 03/27/2016] [Indexed: 11/21/2022]
Abstract
AIM The aim of this study was to evaluate the quality of nursing care in psychiatric wards and compare it between hospitals of different types. RESULTS Significant differences between hospitals were found in: personnel benevolence (p=0,006219) and response to patient needs (p=0,011446) as well as patients' sense of safety (p=0,020042). In both hospitals, patients were equally dissatisfied with the quality of information concerning treatment side effects (p=0,207804). In both hospitals patients were equally satisfied regarding the level of respect for their dignity and psychological support (p=0,176928). CONCLUSION General patient perception of nursing care in psychiatry wards seems to be positive. Some tasks carried out by nurses in psychiatric care still require improvement, especially regarding providing information to patients.
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Wong CKH, Lam CLK, Wan EYF, Chan AKC, Pak CH, Chan FWK, Wong WCW. Evaluation of patient-reported outcomes data in structured diabetes education intervention: 2-year follow-up data of patient empowerment programme. Endocrine 2016; 54:422-432. [PMID: 27623970 DOI: 10.1007/s12020-016-1015-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 06/03/2016] [Indexed: 12/16/2022]
Abstract
To examine the effects of a structured group-based education programme, patient empowerment programme (PEP), compared with usual care on 2-year changes in patient-reported outcomes (PRO) in patients with diabetes mellitus (DM). A prospective observational study of 715 patients (PEP/non-PEP: 390/325) was conducted to complete the baseline PRO survey and followed up for 2 years. Health-related quality of life (HRQOL) was measured using the short-form 12 at baseline and annually at two follow-up assessments, which yielded physical and mental component summary and SF-6D preference-based scores. Perceived control over diabetes and general health status were measured using the patient enablement instrument (PEI) and global rating scale (GRS) at follow-ups. When compared with non-PEP, PEP participants significantly reported improvement in health condition (GRS score > 0; 24.55 % vs 10.16 %; odds ratio = 2.502; P = 0.018) in 2 years and enabled the self-perceived control over diabetes (PEI score > 0; 72.20 % vs 38.40 %; odds ratio = 3.25; P < 0.001) in 1-year follow-up but no sustained effects in year 2 (52.65 % vs 39.04 %; odds ratio = 1.366; P = 0.265). There were no significant differences between PEP and non-PEP groups in the changes in quality of life scores (all P > 0.05) at 1 year. Although HRQOL scores deteriorated over 2-year period in both groups, PEP participants reported similar changes in HRQOL scores to that of non-PEP. PEP for DM patients preserved self-perceived disease control and health condition, whereas PEP participants perceived their HRQOL similar to that of non-PEP participants. Findings of PRO should be considered alongside clinical outcomes when evaluating the overall benefits of PEP.
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Affiliation(s)
- Carlos K H Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China
| | - Cindy L K Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China
| | - Eric Y F Wan
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China
| | - Anca K C Chan
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China
| | - C H Pak
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China
| | - Frank W K Chan
- Integrated Care Programs, Hospital Authority Head Office, Hong Kong Hospital Authority, Hong Kong, China
| | - William C W Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China.
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Wiklund I, Anatchkova M, Oko-Osi H, von Maltzahn R, Chau D, Malik FI, Patrick DL, Spertus J, Teerlink JR. Incorporating development of a patient-reported outcome instrument in a clinical drug development program: examples from a heart failure program. Health Qual Life Outcomes 2016; 14:131. [PMID: 27629389 PMCID: PMC5024511 DOI: 10.1186/s12955-016-0529-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 09/06/2016] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Patient-reported outcome (PRO) measures can be used to support label claims if they adhere to US Food & Drug Administration guidance. The process of developing a new PRO measure is expensive and time-consuming. We report the results of qualitative studies to develop new PRO measures for use in clinical trials of omecamtiv mecarbil (a selective, small molecule activator of cardiac myosin) for patients with heart failure (HF), as well as the lessons learned from the development process. METHODS Concept elicitation focus groups and individual interviews were conducted with patients with HF to identify concepts for the instrument. Cognitive interviews with HF patients were used to confirm that no essential concepts were missing and to assess patient comprehension of the instrument and items. RESULTS During concept elicitation, the most frequently reported HF symptoms were shortness of breath, tiredness, fluid retention, fatigue, dizziness/light-headedness, swelling, weight fluctuation, and trouble sleeping. Two measures were developed based on the concepts: the Heart Failure Symptom Diary (HF-SD) and the Heart Failure Impact Scale (HFIS). Findings from cognitive interviews suggested that the items in the HF-SD and HFIS were relevant and well understood by patients. Multiple iterations of concept elicitation and cognitive interviews were needed based on FDA request for a broader patient population in the qualitative study. Lessons learned from the omecamtiv mecarbil PRO/clinical development program are discussed, including challenges of qualitative studies, patient recruitment, expected and actual timelines, cost, and engagement with various stakeholders. CONCLUSION Development of a new PRO measure to support a label claim requires significant investment and early planning, as demonstrated by the omecamtiv mecarbil program.
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Affiliation(s)
- Ingela Wiklund
- Evidera, Metro Building 6th Floor, 1 Butterwick, London, W6 8DL, UK.
| | | | | | | | | | | | | | | | - John R Teerlink
- San Francisco Veterans Affairs Medical Center and University of California San Francisco School of Medicine, San Francisco, CA, USA
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Xu Y, Deforest M, Grabell J, Hopman W, James P. Relative contributions of bleeding scores and iron status on health-related quality of life in von Willebrand disease: a cross-sectional study. Haemophilia 2016; 23:115-121. [DOI: 10.1111/hae.13062] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Y. Xu
- School of Medicine; Queen's University; Kingston Canada
| | - M. Deforest
- NCIC Clinical Trials Group; Queen's University; Kingston Canada
| | - J. Grabell
- Department of Pathology and Molecular Medicine; Queen's University; Kingston Canada
| | - W. Hopman
- Clinical Research Centre, Kingston General Hospital; Queen's University; Kingston Canada
- Department of Public Health Sciences; Queen's University; Kingston Canada
| | - P. James
- Department of Pathology and Molecular Medicine; Queen's University; Kingston Canada
- Department of Medicine; Queen's University; Kingston Canada
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Bingham CO, Bartlett SJ, Merkel PA, Mielenz TJ, Pilkonis PA, Edmundson L, Moore E, Sabharwal RK. Using patient-reported outcomes and PROMIS in research and clinical applications: experiences from the PCORI pilot projects. Qual Life Res 2016; 25:2109-16. [PMID: 26914103 PMCID: PMC4946989 DOI: 10.1007/s11136-016-1246-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2016] [Indexed: 01/22/2023]
Abstract
PURPOSE The field of patient-centered outcomes research (PCOR) continues to develop. Patient-reported outcomes and, in particular the Patient-Reported Outcomes Measurement Information System (PROMIS) contribute complementary data to clinician-derived outcomes traditionally used in health decision-making. However, there has been little work to understand how PROMIS measures may inform or be integrated into PCOR or clinical applications. METHODS Lead investigators from four pilot projects funded by the Patient-Centered Outcomes Research Institute (PCORI) collaborated to discuss lessons learned about the use of PROMIS in PCOR studies via virtual and in-person meetings. In addition, a qualitative data collection tool was used to assess the pilot projects' experiences. RESULTS Lessons learned from the pilot projects centered on practical elements of research design, such as choosing the right outcomes to study, considering the advantages and limitations of the PROMIS short forms and computer adaptive technology versions, planning ahead for a feasible data collection process, maintaining the focus on patients by ensuring that the research is truly patient-centered, and helping patients and providers make the most of PROMIS in care. CONCLUSION The PCORI pilot projects demonstrated that PROMIS can be successfully used to conduct research that will help patients make decisions about their care. Interest in PCOR continues to grow and the lessons learned from these projects about the use of PROMIS will be helpful to investigators. Given the numerous benefits of PROMIS, implementing this tool in research and care will hopefully lead to significant progress in measuring health outcomes that are meaningful and relevant to all stakeholders.
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Affiliation(s)
- Clifton O Bingham
- Division of Rheumatology, Johns Hopkins University, 5200 Eastern Avenue, MFL Center Tower Room 404, Baltimore, MD, 21224, USA.
| | - Susan J Bartlett
- Divisions of Clinical Epidemiology, Rheumatology and Respiratory Epidemiology and Clinical Trials Unit, McGill University/Royal Victoria Hospital, 687 Av des Pins Ouest, Ross Pavillion R4.31, Montreal, QC, H3A 1A1, Canada
| | - Peter A Merkel
- Division of Rheumatology and Department of Biostatistics and Clinical Epidemiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Thelma J Mielenz
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St., New York, NY, 10032, USA
| | - Paul A Pilkonis
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara St., Pittsburgh, PA, 15213, USA
| | - Lauren Edmundson
- Swedish Medical Center, 5300 Tallman Ave NW, Seattle, WA, 98107, USA
| | - Emily Moore
- University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA
| | - Rajeev K Sabharwal
- AcademyHealth, 1150 17th Street NW, Suite 600, Washington, DC, 20036, USA
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Alves PCG, Sales CMD, Ashworth M. "It is not just about the alcohol": service users' views about individualised and standardised clinical assessment in a therapeutic community for alcohol dependence. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2016; 11:25. [PMID: 27430578 PMCID: PMC4949765 DOI: 10.1186/s13011-016-0070-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 07/11/2016] [Indexed: 01/24/2023]
Abstract
Background The involvement of service users in health care provision in general, and specifically in substance use disorder treatment, is of growing importance. This paper explores the views of patients in a therapeutic community for alcohol dependence about clinical assessment, including general aspects about the evaluation process, and the specific characteristics of four measures: two individualised and two standardised. Methods A focus group was conducted and data were analysed using a framework synthesis approach. Results Service users welcomed the experience of clinical assessment, particularly when conducted by therapists. The duration of the evaluation process was seen as satisfactory and most of its contents were regarded as relevant for their population. Regarding the evaluation measures, patients diverged in their preferences for delivery formats (self-report vs. interview). Service users enjoyed the freedom given by individualised measures to discuss topics of their own choosing. However, they felt that part of the standardised questions were difficult to answer, inadequate (e.g. quantification of health status in 0–20 points) and sensitive (e.g. suicide-related issues), particularly for pre-treatment assessments. Conclusions Patients perceived clinical assessment as helpful for their therapeutic journey, including the opportunity to reflect about their problems, either related or unrelated to alcohol use. Our study suggests that patients prefer to have evaluation protocols administered by therapists, and that measures should ideally be flexible in their formats to accommodate for patient preferences and needs during the evaluation.
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Affiliation(s)
- Paula Cristina Gomes Alves
- Instituto Universitário de Lisboa (ISCTE-IUL), Cis-IUL, Avenida das Forças Armadas, Edifício I, 2w17, 1649-026, Lisboa, Portugal. .,Centro de Psicologia da Universidade do Porto, Instituto Universitário de Lisboa (ISCTE-IUL), Cis-IUL; Faculdade de Psicologia e de Ciências da Educação, Rua Alfredo Allen, 4200-135, Porto, Portugal.
| | - Célia Maria Dias Sales
- Centro de Psicologia da Universidade do Porto, Instituto Universitário de Lisboa (ISCTE-IUL), Cis-IUL; Faculdade de Psicologia e de Ciências da Educação, Rua Alfredo Allen, 4200-135, Porto, Portugal
| | - Mark Ashworth
- Division of Health and Social Care Research; Faculty of Life Sciences & Medicine, King's College London, 3rd Floor Addison House, Guy's Campus, SE1 1UL, London, UK
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Fagan MB, Morrison CR, Wong C, Carnie MB, Gabbai-Saldate P. Implementing a pragmatic framework for authentic patient-researcher partnerships in clinical research. J Comp Eff Res 2016; 5:297-308. [PMID: 27144508 DOI: 10.2217/cer-2015-0023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In response to the creation of the Patient-Centered Outcomes Research Institute in 2010, researchers have begun to incorporate patient and family stakeholders into the research process as equal partners, bringing their unique perspectives and experiences to the table. Nonetheless, there is a dearth of literature around how best to engage patients and families and many barriers to doing so effectively. This paper outlines a pragmatic framework of collaborative engagement and partnership between research investigators and patient and family advisors from existing patient and family advisory councils (PFACs) at an academic medical center. This framework includes the role for each party throughout the clinical research process (launch, hypothesis, specific aims, measures/methods, results, interpretations/recommendation and dissemination).
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Affiliation(s)
- Maureen B Fagan
- Center for Patients & Families, Brigham & Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Constance Rc Morrison
- Center for Patients & Families, Brigham & Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Celene Wong
- Center for Patients & Families, Brigham & Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Martha B Carnie
- Center for Patients & Families, Brigham & Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Paulette Gabbai-Saldate
- Department of Medicine, University of California-San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
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Bucciardini R, Pugliese K, Francisci D, Costantini A, Schiaroli E, Cognigni M, Tontini C, Lucattini S, Fucili L, Di Gregorio M, Mirra M, Fragola V, Pompili S, Murri R, Vella S. Validation of a self-reported HIV symptoms list: the ISS-HIV symptoms scale. AIDS Res Ther 2016; 13:18. [PMID: 27064450 PMCID: PMC4826516 DOI: 10.1186/s12981-016-0102-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 03/30/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND To describe the development and the psychometric properties of the Istituto Superiore di Sanità-HIV symptoms scale (lSS-HIV symptoms scale). METHODS The ISS-HIV symptom scale was developed by an Italian working team including researchers, physicians and people living with HIV. The development process went through the following steps: (1) review of HIV/AIDS literature; (2) focus group; (3) pre-test analysis; (4) scale validation. RESULTS The 22 symptoms of HIV-ISS symptoms scale were clustered in five factors: pain/general discomfort (7 items); depression/anxiety (4 items); emotional reaction/psychological distress (5 items); gastrointestinal discomfort (4 items); sexual discomfort (2 items). The internal consistence reliability was for all factors within the minimum accepted standard of 0.70. CONCLUSIONS The results of this study provide a preliminary evidence of the reliability and validity of the ISS-HIV symptoms scale. In the new era where HIV infection has been transformed into a chronic diseases and patients are experiencing a complex range of symptoms, the ISS-HIV symptoms scale may represent an useful tool for a comprehensive symptom assessment with the advantage of being easy to fill out by patients and potentially attractive to physicians mainly because it is easy to understand and requires short time to interpret the results.
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Affiliation(s)
| | | | | | | | | | - Miriam Cognigni
- />Azienda Ospedaliera Universitaria Ospedali Riuniti, Ancona, Italy
| | - Chiara Tontini
- />Azienda Ospedaliera Universitaria Ospedali Riuniti, Ancona, Italy
| | | | | | | | | | | | | | - Rita Murri
- />Institute of Infectious Diseases, Catholic University of Rome, Rome, Italy
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Inacio MCS, Pratt NL, Roughead EE, Paxton EW, Graves SE. Opioid use after total hip arthroplasty surgery is associated with revision surgery. BMC Musculoskelet Disord 2016; 17:122. [PMID: 26965992 PMCID: PMC4785728 DOI: 10.1186/s12891-016-0970-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 03/01/2016] [Indexed: 12/16/2022] Open
Abstract
Background Pain is an indication for total hip arthroplasty (THA) and it should be resolved post-surgery. Because patients’ pain is typically treated pharmacologically we tested whether opioid use can be used as a surrogate for patient-reported pain and as an indicator for early surgical failure. Specifically, we evaluated whether the amount of opioids taken within the year after THA was associated with one and five years risk of revision surgery. Methods A cohort of 9943 THAs (01/2001-12/2012) was evaluated. Post-operative opioid use was the exposure of interest and cumulative daily oral morphine equivalent (OME) amounts were calculated. Total OMEs/90-day periods were categorised into quartiles. Revisions within one and five years were the outcomes of interest. Results Of the THAs, 2.0 % (N = 200) were revised within one year and 4.2 % (N = 413) within five years. After adjustments for gender, age, surgical indication, co-morbidities, and other analgesics, revision was associated with amount of OMEs in the second quarter after THA (days 91–180 after discharge). Patients on medium-high amounts of OME (400-1119 mg) had higher risk of one (hazard ratio (HR) = 2.22, 95 % CI 1.08-4.56) and five year (HR = 1.66, 95 % CI 1.08-2.56) revision than a patient not taking opioids. During the same period, patients taking the highest amounts of OMEs (≥1120 mg) had a 2.64 (95 % CI 1.03-6.74) times higher risk of one year and a 2.11 (95 % CI 1.13-3.96) times higher risk of five year revision. Conclusions Opioid use 91–180 days post-surgery is associated with higher risk of revision surgery and therefore is an early and useful indicator for surgical failure.
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Affiliation(s)
- Maria C S Inacio
- Medicine and Device Surveillance Centre of Research Excellence, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide, 5001, South Australia, Australia.
| | - Nicole L Pratt
- Medicine and Device Surveillance Centre of Research Excellence, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide, 5001, South Australia, Australia.,Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide, 5001, South Australia, Australia
| | - Elizabeth E Roughead
- Medicine and Device Surveillance Centre of Research Excellence, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide, 5001, South Australia, Australia.,Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide, 5001, South Australia, Australia
| | - Elizabeth W Paxton
- Surgical Outcomes and Analysis, SCPMG Clinical Analysis, Kaiser Permanente, 8954 Rio San Diego Drive, Suite 406, San Diego, CA, 92108, USA
| | - Stephen E Graves
- Australian Orthopaedic Association National Total Joint Replacement Registry, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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Wiering B, de Boer D, Delnoij D. Patient involvement in the development of patient-reported outcome measures: a scoping review. Health Expect 2016; 20:11-23. [PMID: 26889874 PMCID: PMC5217930 DOI: 10.1111/hex.12442] [Citation(s) in RCA: 192] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2015] [Indexed: 02/06/2023] Open
Abstract
Background Patient‐reported outcome measures (PROMs) measure patients’ perspectives on health outcomes and are increasingly used in health care. To capture the patient's perspective, it is essential that patients are involved in PROM development Objective This article reviews in what ways and to what extent patients are involved in PROM development and whether patient involvement has increased over time. Search strategy Literature was searched in PubMed, EMBASE, MEDLINE and the Cochrane Methodology Register. Inclusion criteria Studies were included if they described a new PROM development. Data extraction Basic information and information regarding patient involvement in development phases was recorded. Main results A total of 189 studies, describing the development of 193 PROMs, were included. Most PROMs were meant for chronic disease patients (n = 59) and measured quality of life (n = 28). In 25.9% of the PROM development studies, no patients were involved. Patients were mostly involved during item development (58.5%), closely followed by testing for comprehensibility (50.8%), while patient involvement in determining which outcome to measure was minimal (10.9%). Some patient involvement took place in the development of most PROMs, but in only 6.7% patients were involved in all aspects of the development. Patient involvement did not increase with time. Conclusions Although patient involvement in PROM development is essential to develop valid patient‐centred PROMs, patients are not always involved. When patients are involved, their level of involvement varies considerably. These variations suggest that further attention to building and/or disseminating consensus on requirements for patient involvement in PROM development is necessary.
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Affiliation(s)
- Bianca Wiering
- Tranzo (Scientific Centre for Transformation in Care and Welfare), Tilburg University, Tilburg, The Netherlands
| | - Dolf de Boer
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Diana Delnoij
- Tranzo (Scientific Centre for Transformation in Care and Welfare), Tilburg University, Tilburg, The Netherlands
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Di Maio M, Basch E, Bryce J, Perrone F. Patient-reported outcomes in the evaluation of toxicity of anticancer treatments. Nat Rev Clin Oncol 2016; 13:319-25. [DOI: 10.1038/nrclinonc.2015.222] [Citation(s) in RCA: 142] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Smith TG, Castro KM, Troeschel AN, Arora NK, Lipscomb J, Jones SM, Treiman KA, Hobbs C, McCabe RM, Clauser SB. The rationale for patient-reported outcomes surveillance in cancer and a reproducible method for achieving it. Cancer 2015; 122:344-51. [DOI: 10.1002/cncr.29767] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 07/27/2015] [Accepted: 07/29/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Tenbroeck G. Smith
- Behavioral Research Center, Intramural Research Department; American Cancer Society; Atlanta Georgia
| | - Kathleen M. Castro
- Division of Cancer Control and Population Sciences; National Cancer Institute; Bethesda Maryland
| | - Alyssa N. Troeschel
- Behavioral Research Center, Intramural Research Department; American Cancer Society; Atlanta Georgia
| | | | - Joseph Lipscomb
- Health Policy and Management, Rollins School of Public Health; Emory University; Atlanta Georgia
- Population Sciences, Winship Cancer Institute; Emory University; Atlanta Georgia
| | | | | | - Connie Hobbs
- RTI International, Research Triangle Park; North Carolina
| | - Ryan M. McCabe
- National Cancer Data Base; American College of Surgeons; Chicago Illinois
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Alshehri AA, Alomar YM, Mohammed GA, Al-Fozan MS, Al-Harbi MS, Alrobai KA, Zahoor H. A survey on postanesthetic patient satisfaction in a university hospital. Saudi J Anaesth 2015; 9:303-5. [PMID: 26240551 PMCID: PMC4478825 DOI: 10.4103/1658-354x.158499] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background and Objectives: Patient satisfaction after anesthesia is an important outcome of hospital care. The aim is to evaluate the postoperative patient satisfaction during the patient stay at King Khalid University Hospital in Riyadh, Saudi Arabia. Patients and Methods: Three hundred and fifty-three patients who underwent surgery under general/regional anesthesia were surveyed. They were interviewed face to face on the first postoperative day. We recorded pain and pain controls in addition to some common complication of anesthesia like nausea and vomiting (postoperative nausea and vomiting) as a parameter to assess the rate of patient's satisfaction. Results: The overall level of satisfaction was high (95.2%); 17 (4.8%) patients were dissatisfied with their anesthetic care. There was a strong relation between patient dissatisfaction and: (i) Patients with poor postoperative pain control 13 (12.4%), (ii) patients with moderate nausea 8 (11.1%) and (iii) patients with static and dynamic severe pain 6 (21.4). Several factors were associated with dissatisfaction can be prevented, or better treated. Conclusion: We concluded that the patient satisfaction was high. Postoperative visit should be routinely performed in order to assess the quality and severity of postoperative pain, nausea and vomiting and the other side-effects postoperatively.
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Affiliation(s)
- Adel Ali Alshehri
- Department of Anesthesia, King Khalid University Hospital, King Saud University, Riyadh, KSA
| | - Yasser Mohammed Alomar
- Department of Anesthesia, King Khalid University Hospital, King Saud University, Riyadh, KSA
| | | | - Mazen Saud Al-Fozan
- Department of Anesthesia, King Khalid University Hospital, King Saud University, Riyadh, KSA
| | - Mohammed Saleh Al-Harbi
- Department of Anesthesia, King Khalid University Hospital, King Saud University, Riyadh, KSA
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Basch E, Spertus J, Dudley RA, Wu A, Chuahan C, Cohen P, Smith ML, Black N, Crawford A, Christensen K, Blake K, Goertz C. Methods for Developing Patient-Reported Outcome-Based Performance Measures (PRO-PMs). VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2015; 18:493-504. [PMID: 26091604 DOI: 10.1016/j.jval.2015.02.018] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 02/03/2015] [Accepted: 02/15/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To recommend methods for assessing quality of care via patient-reported outcome-based performance measures (PRO-PMs) of symptoms, functional status, and quality of life. METHODS A Technical Expert Panel was assembled by the American Medical Association-convened Physician Consortium for Performance Improvement. An environmental scan and structured literature review were conducted to identify quality programs that integrate PRO-PMs. Key methodological considerations in the design, implementation, and analysis of these PRO-PM data were systematically identified. Recommended methods for addressing each identified consideration were developed on the basis of published patient-reported outcome (PRO) standards and refined through public comment. Literature review focused on programs using PROs to assess performance and on PRO guidance documents. RESULTS Thirteen PRO programs and 10 guidance documents were identified. Nine best practices were developed, including the following: provide a rationale for measuring the outcome and for using a PRO-PM; describe the context of use; select a measure that is meaningful to patients with adequate psychometric properties; provide evidence of the measure's sensitivity to differences in care; address missing data and risk adjustment; and provide a framework for implementation, interpretation, dissemination, and continuous refinement. CONCLUSION Methods for integrating PROs into performance measurement are available.
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Affiliation(s)
- Ethan Basch
- University of North Carolina, Chapel Hill, NC, USA.
| | | | - R Adams Dudley
- University of California, San Francisco, San Francisco, CA, USA
| | - Albert Wu
- Johns Hopkins School of Public Health, Baltimore, MD, USA
| | | | - Perry Cohen
- Parkinson Pipeline Project, Washington, DC (Patient Representative), USA
| | - Mary Lou Smith
- Research Advocacy Network, Plano, TX (Patient Representative), USA
| | - Nick Black
- London School of Hygiene and Tropical Medicine, London, England
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Positive perceptions on safety and satisfaction during a patient-centered timeout before peripheral nerve blockade. J Clin Anesth 2015; 27:214-20. [DOI: 10.1016/j.jclinane.2014.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Revised: 09/29/2014] [Accepted: 10/02/2014] [Indexed: 11/20/2022]
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