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Kamran R, Jackman L, Laws A, Stepney M, Harrison C, Jain A, Rodrigues J. Patient and healthcare professional perspectives on the Practical Guide to Implementing PROMs in Gender-Affirming Care (PG-PROM-GAC): analysis of open-ended responses from patients and healthcare professionals. BMJ Open Qual 2024; 13:e002721. [PMID: 38569665 PMCID: PMC11002366 DOI: 10.1136/bmjoq-2023-002721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/12/2024] [Indexed: 04/05/2024] Open
Abstract
IMPORTANCE Several international calls have been made for evidence-based patient-reported outcome measure (PROM) implementation for gender-affirming care. The Practical Guide to Implementing PROMs in Gender-Affirming Care (PG-PROM-GAC) is a resource which can help guide PROM implementation efforts, developed using a three-phase participatory research approach with transgender and gender-diverse (TGD) patients and gender-affirming healthcare professionals. However, thoughts and perspectives from TGD patients and gender-affirming healthcare professionals on the PG-PROM-GAC need to be investigated. OBJECTIVE Investigate patient and healthcare professional perspectives on the PG-PROM-GAC through analysis of open-ended survey results. DESIGN Qualitative study analysing open-ended responses from TGD patients and gender-affirming healthcare professionals. SETTING Participants were recruited from a UK National Health System (NHS) gender clinic. PARTICIPANTS Patients receiving care at an NHS gender clinic and healthcare professionals working at an NHS gender clinic were eligible for participation. Eligible participants were invited to participate in this study via email. INTERVENTION Participants were sent an open-ended survey to collect responses on the PG-PROM-GAC. MAIN OUTCOMES AND MEASURES Data were thematically analysed by two independent researchers and interpreted following guidance from established methods in implementation science. RESULTS A total of 64 TGD patients and 9 gender-affirming healthcare professionals responded to the open-ended survey (mean (SD) age: 35 (16) and 48 (8), respectively). Four main themes emerged from the data: overall opinions and support for the PG-PROM-GAC, presentation of the PG-PROM-GAC, impact of gender clinic resources on PROM implementation and impact of PROM selection on implementation. Data were used to iterate the PG-PROM-GAC in response to participant feedback. CONCLUSIONS AND RELEVANCE The PG-PROM-GAC is an acceptable and feasible resource that can be used by clinicians, researchers and policymakers to guide PROM implementation for gender-affirming care settings, helping to align gender-affirming care with patient needs.
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Affiliation(s)
- Rakhshan Kamran
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Liam Jackman
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anna Laws
- Northern Region Gender Dysphoria Service, Cumbria Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Conrad Harrison
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Abhilash Jain
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Jeremy Rodrigues
- Department of Plastic Surgery, Buckinghamshire Healthcare NHS Trust, Amersham, UK
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
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Dhiman K, Hall M, Crump T, Hoens AM, Lacaille D, Rankin JA, Then KL, Hazlewood G, Barnabe C, Katz S, Sutherland J, Dempsey E, Barber CEH. Content validity testing of the INTERMED Self-Assessment in a sample of adults with rheumatoid arthritis and rheumatology healthcare providers. Health Expect 2024; 27:e13978. [PMID: 38366795 PMCID: PMC10873686 DOI: 10.1111/hex.13978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Care complexity can occur when patients experience health challenges simultaneously with social barriers including food and/or housing insecurity, lack of transportation or other factors that impact care and patient outcomes. People with rheumatoid arthritis (RA) may experience care complexity due to the chronicity of their condition and other biopsychosocial factors. There are few standardised instruments that measure care complexity and none that measure care complexity specifically in people with RA. OBJECTIVES We assessed the content validity of the INTERMEDS Self-Assessment (IMSA) instrument that measures care complexity with a sample of adults with RA and rheumatology healthcare providers (HCPs). Cognitive debriefing interviews utilising a reparative framework were conducted. METHODS Patient participants were recruited through two existing studies where participants agreed to be contacted about future studies. Study information was also shared through email blasts, posters and brochures at rheumatology clinic sites and trusted arthritis websites. Various rheumatology HCPs were recruited through email blasts, and divisional emails and announcements. Interviews were conducted with nine patients living with RA and five rheumatology HCPs. RESULTS Three main reparative themes were identified: (1) Lack of item clarity and standardisation including problems with item phrasing, inconsistency of the items and/or answer sets and noninclusive language; (2) item barrelling, where items asked about more than one issue, but only allowed a single answer choice; and (3) timeframes presented in the item or answer choices were either too long or too short, and did not fit the lived experiences of patients. Items predicting future healthcare needs were difficult to answer due to the episodic and fluctuating nature of RA. CONCLUSIONS Despite international use of the IMSA to measure care complexity, patients with RA and rheumatology HCPs in our setting perceived that it did not have content validity for use in RA and that revision for use in this population under a reparative framework was unfeasible. Future instrument development requires an iterative cognitive debriefing and repair process with the population of interest in the early stages to ensure content validity and comprehension. PATIENT OR PUBLIC CONTRIBUTION Patient and public contributions included both patient partners on the study team and people with RA who participated in the study. Patient partners were involved in study design, analysis and interpretation of the findings and manuscript preparation. Data analysis was structured according to emergent themes of the data that were grounded in patient perspectives and experiences.
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Affiliation(s)
- Kiran Dhiman
- Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Marc Hall
- Faculty of NursingUniversity of CalgaryCalgaryAlbertaCanada
| | - Trafford Crump
- Department of Community Health Sciences, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Department of Surgery, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Alison M. Hoens
- Arthritis Research CanadaVancouverBritish ColumbiaCanada
- Department of Physical TherapyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Arthritis Patient Advisory Board, Arthritis Research CanadaVancouverBritish ColumbiaCanada
| | - Diane Lacaille
- Arthritis Research CanadaVancouverBritish ColumbiaCanada
- Department of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | | | - Karen L. Then
- Faculty of NursingUniversity of CalgaryCalgaryAlbertaCanada
| | - Glen Hazlewood
- Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Department of Community Health Sciences, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Arthritis Research CanadaVancouverBritish ColumbiaCanada
- McCaig Institute for Bone and Joint HealthCalgaryAlbertaCanada
| | - Cheryl Barnabe
- Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Department of Community Health Sciences, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Arthritis Research CanadaVancouverBritish ColumbiaCanada
- McCaig Institute for Bone and Joint HealthCalgaryAlbertaCanada
| | - Steven Katz
- Department of MedicineUniversity of AlbertaEdmontonAlbertaCanada
| | - Jason Sutherland
- Centre for Health Services and Policy ResearchUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Erika Dempsey
- Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Claire E. H. Barber
- Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Department of Community Health Sciences, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Arthritis Research CanadaVancouverBritish ColumbiaCanada
- McCaig Institute for Bone and Joint HealthCalgaryAlbertaCanada
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Kasturi S, Price LL, LeClair A, Patel N, Shetty S, Sheira D, Weber S, Curtis D, Nowell WB, Salmon J, Terrin N, McAlindon TE, Mandl LA. Clinical integration of patient-reported outcome measures to enhance the care of patients with SLE: a multi-centre prospective cohort study. Rheumatology (Oxford) 2022; 61:4763-4774. [PMID: 35357445 PMCID: PMC9707322 DOI: 10.1093/rheumatology/keac200] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/17/2022] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To assess the feasibility and impact of integrating electronic patient-reported outcome measures (PROMs) into the routine outpatient care of patients with SLE. METHODS We conducted a prospective cohort study, utilizing a mixed-methods sequential explanatory design, of SLE outpatients receiving rheumatology care at two academic medical centres. Participants completed electronic PROMs at enrolment and then prior to their next two routine rheumatology visits. PROM score reports were shared with patients and rheumatologists before visits. Patients and rheumatologists completed post-visit surveys evaluating the utility of PROMs in the clinical encounters. Focus groups of patients and interviews with treating rheumatologists were conducted to further explore their experience utilizing PROMs. RESULTS A total of 105 SLE patients and 17 rheumatologists participated in the study. Patients completed PROMs in 159 of 184 encounters (86%), with 93% of surveys completed remotely. Patients reported that PROMs were 'quite a bit' or 'very' useful (55% of encounters) and beneficial to communication (55% of encounters). In contrast, physicians found PROMs useful (20%) and beneficial to communication (17%) less frequently. There was no significant change in visit length, health-related quality of life or disease activity after implementation of PROMs; however, patient satisfaction improved slightly. Qualitative analyses revealed that patients felt PROMs provided utility primarily by facilitating communication, particularly when physicians discussed the surveys. CONCLUSION The remote capture and integration of electronic PROMs into clinical care was feasible in a diverse cohort of SLE outpatients. PROMs were useful to patients and enhanced their clinical experience primarily by facilitating communication.
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Affiliation(s)
- Shanthini Kasturi
- Division of Rheumatology/Department of Medicine, Tufts Medical Center
| | - Lori Lyn Price
- Tufts Clinical and Translational Science Institute, Tufts University
- Institute for Clinical Research and Health Policy Studies
| | - Amy LeClair
- Department of Medicine, Tufts Medical Center, Boston, MA
| | - Neena Patel
- Division of Rheumatology/Department of Medicine, Tufts Medical Center
| | - Shreya Shetty
- Division of Rheumatology/Department of Medicine, Tufts Medical Center
| | - Dina Sheira
- Division of Rheumatology/Department of Medicine, Hospital for Special Surgery, New York
| | - Serena Weber
- Division of Rheumatology/Department of Medicine, Tufts Medical Center
| | | | | | - Jane Salmon
- Division of Rheumatology/Department of Medicine, Hospital for Special Surgery, New York
- Division of Rheumatology/Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Norma Terrin
- Tufts Clinical and Translational Science Institute, Tufts University
| | | | - Lisa A Mandl
- Division of Rheumatology/Department of Medicine, Hospital for Special Surgery, New York
- Division of Rheumatology/Department of Medicine, Weill Cornell Medicine, New York, NY, USA
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Mou D, Mjaset C, Sokas CM, Virji A, Bokhour B, Heng M, Sisodia RC, Pusic AL, Rosenthal MB. Impetus of US hospital leaders to invest in patient-reported outcome measures (PROMs): a qualitative study. BMJ Open 2022; 12:e061761. [PMID: 35793919 PMCID: PMC9260769 DOI: 10.1136/bmjopen-2022-061761] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Though hospital leaders across the USA have invested significant resources in collection of patient-reported outcome measures (PROMs), there are very limited data on the impetus for hospital leadership to establish PROM programmes. In this qualitative study, we identify the drivers and motivators of PROM collection among hospital leaders in the USA. DESIGN Exploratory qualitative study. SETTING Thirty-seven hospital leaders representing seven different institutions with successful PROMs programs across twenty US states. METHODS Semistructured interviews conducted with hospital leaders. Transcripts were analysed using thematic analysis. RESULTS Leaders strongly believe that collecting PROMs is the 'right thing to do' and that the culture of the institution plays an important role in enabling PROMs. The study participants often believe that their institutions deliver superior care and that PROMs can be used to demonstrate the value of their services to payors and patients. Direct financial incentives are relatively weak motivators for collection of PROMs. Most hospital leaders have reservations about using PROMs in their current state as a meaningful performance metric. CONCLUSION These findings suggest that hospital leaders feel a strong moral imperative to collect PROMs, which is also supported by the culture of their institution. Although PROMs are used in negotiations with payors, direct financial return on investment is not a strong driver for the collection of PROMs. Understanding why leaders of major healthcare institutions invest in PROMs is critical to understanding the role that PROMs play in the US healthcare system.
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Affiliation(s)
- Danny Mou
- Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Physician Organization, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Christer Mjaset
- Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- Commonwealth Fund, New York, New York, USA
| | - Claire M Sokas
- Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Azan Virji
- Harvard Medical School, Boston, Massachusetts, USA
| | - Barbara Bokhour
- Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Marilyn Heng
- Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rachel C Sisodia
- Physician Organization, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Andrea L Pusic
- Division of Plastic and Reconstructive Surgery, Patient Reported Outcome Value and Experience (PROVE) Center, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Meredith B Rosenthal
- Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA
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Kwan YH, Fong W, Woon TH, Phang JK, Png K, Lau JQ, Leung YY, Tan CS, Østbye T, Thumboo J. Development of an Item Bank for a health-related quality of life Measure in Spondyloarthritis. J Rheumatol 2022; 49:1006-1011. [PMID: 35649556 DOI: 10.3899/jrheum.210980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Health-related quality of life (HRQOL) is an important aspect in the management of chronic diseases such as spondyloarthritis (SpA). A promising approach to reduce respondent burden when measuring HRQOL is the use of shorter patient-reported outcome measures (PROMs) delivered using computer-adaptive tests (CATs). However, the lack of an item bank which covers the entire continuum of the HRQOL domain impedes the development of CAT to measure HRQOL among patients with SpA. We aim to develop an item bank for a HRQOL measure among patients with SpA based on the items from existing validated PROMs. METHODS This study is guided by the preferred reporting items for systematic review and metaanalysis (PRISMA) and Patient Reported Outcomes Measurement Information System (PROMIS) Cooperative Group guidelines. Relevant articles were retrieved from PubMed®, Embase®, and PsycINFO® (Ovid) databases. Items from existing PROMs were "binned" and "winnowed" according to the facets of HRQOL in the World Health Organisation (WHO) QOL framework. RESULTS We identified 147 relevant articles. 1039 items from 31 PROMs of which permission has been obtained for inclusion into the item bank underwent binning and winnowing. This resulted in 968 items covering 23 domains of HRQOL in the WHO framework, with the number of items within each domain ranging from 1 to 453. CONCLUSION We created an item bank to measure HRQOL among patients with SpA using items from validated PROMs. This set can provide the foundation for the development of CATs to measure HRQOL among patients with SpA.
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Affiliation(s)
- Yu Heng Kwan
- Source(s) of support in the form of grants or industrial support: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Programme in Health Systems & Services Research, Duke NUS Medical School, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Rheumatology and Immunology, Singapore General Hospital; Department of Pharmacy, National University of Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore. Corresponding author: Yu Heng Kwan (BSc (Pharm)(Hons), MD, PhD), Program in Health Services and Systems Research, 8 College Road Level 4, Singapore 169857.
| | - Warren Fong
- Source(s) of support in the form of grants or industrial support: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Programme in Health Systems & Services Research, Duke NUS Medical School, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Rheumatology and Immunology, Singapore General Hospital; Department of Pharmacy, National University of Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore. Corresponding author: Yu Heng Kwan (BSc (Pharm)(Hons), MD, PhD), Program in Health Services and Systems Research, 8 College Road Level 4, Singapore 169857.
| | - Ting Hui Woon
- Source(s) of support in the form of grants or industrial support: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Programme in Health Systems & Services Research, Duke NUS Medical School, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Rheumatology and Immunology, Singapore General Hospital; Department of Pharmacy, National University of Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore. Corresponding author: Yu Heng Kwan (BSc (Pharm)(Hons), MD, PhD), Program in Health Services and Systems Research, 8 College Road Level 4, Singapore 169857.
| | - Jie Kie Phang
- Source(s) of support in the form of grants or industrial support: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Programme in Health Systems & Services Research, Duke NUS Medical School, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Rheumatology and Immunology, Singapore General Hospital; Department of Pharmacy, National University of Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore. Corresponding author: Yu Heng Kwan (BSc (Pharm)(Hons), MD, PhD), Program in Health Services and Systems Research, 8 College Road Level 4, Singapore 169857.
| | - Kelly Png
- Source(s) of support in the form of grants or industrial support: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Programme in Health Systems & Services Research, Duke NUS Medical School, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Rheumatology and Immunology, Singapore General Hospital; Department of Pharmacy, National University of Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore. Corresponding author: Yu Heng Kwan (BSc (Pharm)(Hons), MD, PhD), Program in Health Services and Systems Research, 8 College Road Level 4, Singapore 169857.
| | - Jia Qi Lau
- Source(s) of support in the form of grants or industrial support: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Programme in Health Systems & Services Research, Duke NUS Medical School, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Rheumatology and Immunology, Singapore General Hospital; Department of Pharmacy, National University of Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore. Corresponding author: Yu Heng Kwan (BSc (Pharm)(Hons), MD, PhD), Program in Health Services and Systems Research, 8 College Road Level 4, Singapore 169857.
| | - Ying Ying Leung
- Source(s) of support in the form of grants or industrial support: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Programme in Health Systems & Services Research, Duke NUS Medical School, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Rheumatology and Immunology, Singapore General Hospital; Department of Pharmacy, National University of Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore. Corresponding author: Yu Heng Kwan (BSc (Pharm)(Hons), MD, PhD), Program in Health Services and Systems Research, 8 College Road Level 4, Singapore 169857.
| | - Chuen Seng Tan
- Source(s) of support in the form of grants or industrial support: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Programme in Health Systems & Services Research, Duke NUS Medical School, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Rheumatology and Immunology, Singapore General Hospital; Department of Pharmacy, National University of Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore. Corresponding author: Yu Heng Kwan (BSc (Pharm)(Hons), MD, PhD), Program in Health Services and Systems Research, 8 College Road Level 4, Singapore 169857.
| | - Truls Østbye
- Source(s) of support in the form of grants or industrial support: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Programme in Health Systems & Services Research, Duke NUS Medical School, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Rheumatology and Immunology, Singapore General Hospital; Department of Pharmacy, National University of Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore. Corresponding author: Yu Heng Kwan (BSc (Pharm)(Hons), MD, PhD), Program in Health Services and Systems Research, 8 College Road Level 4, Singapore 169857.
| | - Julian Thumboo
- Source(s) of support in the form of grants or industrial support: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Programme in Health Systems & Services Research, Duke NUS Medical School, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Rheumatology and Immunology, Singapore General Hospital; Department of Pharmacy, National University of Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore. Corresponding author: Yu Heng Kwan (BSc (Pharm)(Hons), MD, PhD), Program in Health Services and Systems Research, 8 College Road Level 4, Singapore 169857.
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