1
|
Nowojewski A, Bark E, Shih VH, Dearden R. Patient adherence and response time in electronic patient-reported outcomes: insights from three longitudinal clinical trials. Qual Life Res 2024; 33:1691-1706. [PMID: 38598132 DOI: 10.1007/s11136-024-03644-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/11/2024]
Abstract
PURPOSE Patient-reported outcome measures (PROMs) are used to collect data on disease symptoms in support of clinical trial endpoints. Clinical studies can last a year or more, and the patients' adherence and response time to daily at-home questionnaires may vary significantly over time. The aim of this study was to understand patterns and changes in patients' completion of daily PROMs during longitudinal clinical studies. METHODS Data were collected from 1342 patients randomized into three respiratory clinical trials (NCT03401229, NCT03347279, and NCT03406078). PROMs were completed by patients using electronic handheld devices that collected the starting and completion times. A Bayesian generalized linear mixed-effects model was used to identify unbiased coefficients associated with PROM adherence and response time using patient, site, and calendar features as covariates. RESULTS Adherence decreased over time after randomization, and the rate of decrease was higher in younger patients. The 14-day pre-randomization adherence was correlated with adherence throughout the study. Patients were also more adherent during working days compared to non-working days. Oldest patients took twice as long to complete PROMs throughout the study; however, the response time for all patients decreased during the first month of the study regardless of age. Response time increased 7 days before and after the date of a scheduled clinic visit and when a patient-reported higher symptom burden. CONCLUSION Detailed analyses of adherence and response time for daily PROMs in clinical trials can provide significant insights about trends of patient behavior in longitudinal clinical studies with high baseline adherence.
Collapse
Affiliation(s)
- Andrzej Nowojewski
- Imaging & Data Analytics, Clinical Pharmacology & Safety Sciences, AstraZeneca, R&D BioPharmaceuticals, Cambridge, UK.
| | - Erik Bark
- BioPharmaceuticals Medical, AstraZeneca, Gothenburg, Sweden
| | - Vivian H Shih
- BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD, USA
| | - Richard Dearden
- Imaging & Data Analytics, Clinical Pharmacology & Safety Sciences, AstraZeneca, R&D BioPharmaceuticals, Cambridge, UK
| |
Collapse
|
2
|
Srinivasan R, Rodgers-Melnick SN, Rivard RL, Kaiser C, Vincent D, Adan F, Dusek JA. Implementing paper-based patient-reported outcome collection within outpatient integrative health and medicine. PLoS One 2024; 19:e0303985. [PMID: 38809886 DOI: 10.1371/journal.pone.0303985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 05/04/2024] [Indexed: 05/31/2024] Open
Abstract
OBJECTIVE To investigate the feasibility of pre- and post-encounter patient-reported outcome (PRO) measure collection within an outpatient integrative health and medicine (IHM) clinic and to characterize factors associated with successful completion. METHODS We conducted a retrospective review of 27,464 outpatient IHM encounters including 9,520 chiropractic; 8,237 acupuncture; 5,847 massage; 2,345 IHM consultation; and 1,515 osteopathic manipulation treatment encounters at four clinics offering IHM over 18 months. Patients were asked to complete paper questionnaires rating pain, anxiety, and stress from 0-10 immediately pre- and post-encounter. Generalized linear mixed effect regression models were used to examine the relationship between demographic, clinical, and operational covariates and completing (1) pre-encounter and (2) paired (i.e., pre and post) PROs. RESULTS Patients (N = 5587, mean age 49 years, 74% white, 77% female) generally presented for musculoskeletal conditions (81.7%), with a chief complaint of pain (55.1%). 21,852 (79.6%) encounters were among patients who completed pre-encounter PROs; 11,709/21,852 (53.6%) completed subsequent post-encounter PROs. Odds of PRO completion were more impacted by provider, operational, and clinical-level factors than patient factors. Covariates associated with increased odds of pre-encounter PRO completion included being female, having additional IHM encounters, and having a pain or anxiety complaint. Covariates associated with increased odds of paired PRO completion included being aged 31-40 vs. 51-60 years and having additional IHM encounters. CONCLUSION Implementing a paper-based PRO collection system in outpatient IHM is feasible; however, collecting post-encounter PROs was challenging. Future endeavors should leverage the electronic health record and patient portals to optimize PRO collection and engage patients and clinical providers.
Collapse
Affiliation(s)
- Roshini Srinivasan
- Connor Whole Health, University Hospitals of Cleveland, Cleveland, OH, United States of America
- Duke University School of Medicine, Durham, NC, United States of America
| | - Samuel N Rodgers-Melnick
- Connor Whole Health, University Hospitals of Cleveland, Cleveland, OH, United States of America
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, United States of America
| | - Rachael L Rivard
- Connor Whole Health, University Hospitals of Cleveland, Cleveland, OH, United States of America
- Center for Evaluation Survey and Research, HealthPartners Institute, Minneapolis, MN, United States of America
| | - Christine Kaiser
- Connor Whole Health, University Hospitals of Cleveland, Cleveland, OH, United States of America
| | - David Vincent
- Connor Whole Health, University Hospitals of Cleveland, Cleveland, OH, United States of America
| | - Francoise Adan
- Connor Whole Health, University Hospitals of Cleveland, Cleveland, OH, United States of America
- Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, United States of America
| | - Jeffery A Dusek
- Susan Samueli Integrative Health Institute, University of California Irvine, Irvine, CA, United States of America
- Department of Medicine, University of California Irvine, Irvine, CA, United States of America
| |
Collapse
|
3
|
Lowe N, Permyakova N, Dutton R. A clinical audit of patient outcomes in real-world acupuncture practice. Acupunct Med 2024:9645284241248471. [PMID: 38711226 DOI: 10.1177/09645284241248471] [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: 05/08/2024]
Abstract
INTRODUCTION Clinical auditing represents a valuable and cost-effective method for the collection of patient outcomes and is increasingly being used to inform clinical guidelines. The aim of this clinical audit was to assess patient outcomes across a small subset of acupuncture practitioners and private practices in the United Kingdom. METHODS The Measure Yourself Medical Outcomes Profile (MYMOP) questionnaire and the Patient Global Impression of Change (PGIC) scale were used as outcome measures. Additional questions assessed adverse events and patient experience with care. Clinical data were collected utilising an electronic patient-reported outcome measures (ePROMs) system. RESULTS Baseline data were collected for a total of 233 health complaints (from 232 patients), of which 45.9% were musculoskeletal and 26.2% were psychological. Follow-up outcomes data were available for 144 health complaints (61.8% completion rate). For PGIC responses, >90% of health complaints were reported as at least 'minimally improved'. This was reduced to >51% when controlling for missing data. There was a gradual improvement in both mean MYMOP scores (24.5%-43.0%) and PGIC responses of 'very much improved' (12.3%-56.3%) over a 6-month period. A clinically significant improvement (>1 point change, p ⩽ 0.001) was seen in mean MYMOP scores compared to baseline from 4 to 8 weeks and symptom 1 MYMOP scores from 1 to 4 weeks. A moderately strong, negative correlation was seen between outcome measures (r = -0.507, p < 0.001). CONCLUSIONS The majority of patients reported clinically meaningful improvements for their main health complaints/symptoms, which appeared to be sustained in the medium to long-term.
Collapse
|
4
|
Chevalier LL, Blackmon JE, Bober SL, Roman A, Chang G, Recklitis CJ. Evaluating sensitive symptoms in young adult cancer survivors: acceptability of suicidal ideation and sexual health items across administration modes. J Cancer Surviv 2024; 18:450-456. [PMID: 35904728 DOI: 10.1007/s11764-022-01237-5] [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: 05/05/2022] [Accepted: 07/15/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE Patient-reported outcomes (PROs) are essential for assessing potential late effects experienced by young adult cancer survivors (YACS), but stigma and social desirability bias may limit their effectiveness for assessing sensitive topics (e.g., suicidal ideation, sexual health). This study compared two methods of item administration to determine the optimal method for obtaining sensitive information in YACS. METHODS Two hundred forty-four YACS (ages 18-40) were randomized to complete measures of suicidal ideation and sexual health (i.e., sensitive items) by paper survey or by telephone automated computer assisted structured interview (TACASI). Participants also provided information on acceptability of administration mode and sensitive items. RESULTS The proportion of participants reporting symptoms did not significantly vary between paper and TACASI administration: respectively, 10% vs. 12% reported suicidal ideation and 55% vs. 58% reported sexual health concerns. The majority (≥ 78%) of participants reported feeling comfortable answering sensitive items on paper and TACASI and there were no significant differences in acceptability based on administration mode. Although participants endorsing sensitive symptoms were significantly more likely to feel upset answering sensitive items, the majority (93%) of participants experiencing symptoms still felt they were important to ask. CONCLUSIONS Despite their potentially sensitive nature, questions about suicidal ideation and sexual health were highly acceptable to YACS across administration modes. Moreover, YACS almost universally endorse the importance of providers asking about these topics. IMPLICATIONS FOR CANCER SURVIVORS Findings should bolster provider confidence that screening for suicidal ideation and sexual health concerns can and should be integrated into clinical care for YACS using paper or technology-assisted methods.
Collapse
Affiliation(s)
- Lydia L Chevalier
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
| | - Jaime E Blackmon
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Sharon L Bober
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
| | - Anthony Roman
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
- University of Massachusetts, Boston, MA, USA
| | - Grace Chang
- Harvard Medical School, Boston, MA, USA
- VA Boston Healthcare System, Brockton, MA, USA
| | - Christopher J Recklitis
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.
- Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
5
|
Hoppe JE, Sjoberg J, Hong G, Poch K, Zemanick ET, Thee S, Edmondson C, Patel D, Sathe M, Borowitz D, Putman MS, Lechtzin N, Riekert KA, Basile M, Goss CH, Jarosz ME, Rosenfeld M. Remote endpoints for clinical trials in cystic fibrosis: Report from the U.S. CF foundation remote endpoints task force. J Cyst Fibros 2024:S1569-1993(24)00023-7. [PMID: 38429150 DOI: 10.1016/j.jcf.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/18/2024] [Accepted: 02/19/2024] [Indexed: 03/03/2024]
Abstract
The COVID-19 pandemic necessitated a rapid shift in clinical research to perform virtual visits and remote endpoint assessments, providing a key opportunity to optimize the use of remote endpoints for clinical trials in cystic fibrosis. The use of remote endpoints could allow more diverse participation in clinical trials while minimizing participant burden but must be robustly evaluated to ensure adequate performance and feasibility. In response, the Cystic Fibrosis Foundation convened the Remote Endpoint Task Force (Supplemental Table 1), a multidisciplinary group of CF researchers with remote endpoint expertise and community members tasked to better understand the current and future use of remote endpoints for clinical research. Here, we describe the current use of remote endpoints in CF clinical research, address key unanswered questions regarding their use and feasibility, and discuss the next steps to determine clinical trial readiness.
Collapse
Affiliation(s)
- Jordana E Hoppe
- Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora CO, USA.
| | | | - Gina Hong
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia Pennsylvania, USA
| | - Katie Poch
- Department of Medicine, National Jewish Health, Denver CO, USA
| | - Edith T Zemanick
- Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora CO, USA
| | - Stephanie Thee
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine and Cystic Fibrosis Center, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Claire Edmondson
- Department of Paediatric Respiratory Medicine, Great Ormond Street Hospital, London WC1N3JH, USA
| | - Dhiren Patel
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, St. Louis MO, USA
| | - Meghana Sathe
- Pediatric Gastroenterology and Nutrition, University of Texas Southwestern/Children's Health, Dallas Texas, USA
| | - Drucy Borowitz
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo New York, USA
| | - Melissa S Putman
- Division of Pediatric Endocrinology, Boston Children's Hospital, Boston MA, USA
| | - Noah Lechtzin
- Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore Maryland, USA
| | - Kristin A Riekert
- Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore Maryland, USA
| | - Melissa Basile
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset NY, USA
| | - Christopher H Goss
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington Medical Center, Seattle Washington, USA; Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Research Institute, Seattle Washington, USA
| | | | - Margaret Rosenfeld
- Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Research Institute, Seattle Washington, USA
| |
Collapse
|
6
|
Niiberg-Pikksööt T, Laas K, Aluoja A, Braschinsky M. Implementing a digital solution for patients with migraine-Developing a methodology for comparing digitally delivered treatment with conventional treatment: A study protocol. PLOS DIGITAL HEALTH 2024; 3:e0000295. [PMID: 38421955 PMCID: PMC10903846 DOI: 10.1371/journal.pdig.0000295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 01/18/2024] [Indexed: 03/02/2024]
Abstract
Migraine is one of the most frequent and expensive neurological disease in the world. Non-pharmacological and digitally administered treatment options have long been used in the treatment of chronic pain and mental illness. Digital solutions increase the patients' possibilities of receiving evidence-based treatment even when conventional treatment options are limited. The main goal of the study is to assess the efficacy of interdisciplinary digital interventions compared to conventional treatment. The maximum number of participants in this multi-centre, open-label, prospective, randomized study is 600, divided into eight treatment groups. The participants will take part in either a conventional or a digital intervention, performing various tests and interdisciplinary tasks. The primary outcome is expected to be a reduction in the number of headache days. We also undertake to measure various other headache-related burdens as a secondary outcome. The sample size, digital interventions not conducted via video calls, the lack of human connection, limited intervention program, and the conducting of studies only in digitally sophisticated countries are all significant limitations. However, we believe that digitally mediated treatment options are at least as effective as traditional treatment options while also allowing for a significantly higher patient throughput. The future of chronic disease treatment is remote monitoring and high-quality digitally mediated interventions.The study is approved by the Ethics Committee of the University of Tartu for Human Research (Permission No. 315T-17, 10.08.2020) and is registered at ClinicalTrials.gov: NTC05458817 (14.07.2022).
Collapse
Affiliation(s)
- Triinu Niiberg-Pikksööt
- Neurosciences, Institute of Clinical Medicine, Faculty of Medicine, University of Tartu, Tartu, Estonia
- Headache Clinic, Department of Neurology, Tartu University Hospital, Tartu, Estonia
- Migrevention OÜ, Tallinn, Estonia
| | - Kariina Laas
- Institute of Psychology, University of Tartu, Tartu, Estonia
| | - Anu Aluoja
- Department of Psychiatry, Institute of Clinical Medicine, Faculty of Medicine, University of Tartu, Tartu, Estonia
- Psychiatry Clinic, Tartu University Hospital, Tartu, Estonia
| | - Mark Braschinsky
- Headache Clinic, Department of Neurology, Tartu University Hospital, Tartu, Estonia
- Migrevention OÜ, Tallinn, Estonia
- Neurology Clinic, University of Tartu, Tartu, Estonia
| |
Collapse
|
7
|
Shah R, Badawy SM. Health-related quality of life with standard and curative therapies in thalassemia: A narrative literature review. Ann N Y Acad Sci 2024; 1532:50-62. [PMID: 38270933 PMCID: PMC10923063 DOI: 10.1111/nyas.15100] [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] [Indexed: 01/26/2024]
Abstract
Health-related quality of life (HRQOL) is a patient-reported outcome that assesses the impact of a disease or illness on different domains of a patient's life. Different general and disease-specific measures can be used to evaluate HRQOL. This article aimed to summarize the evidence for HRQOL among patients with transfusion-dependent (TDT) and non-transfusion-dependent thalassemia (NTDT). We included HRQOL data related to standard therapy with blood transfusions, iron chelation, and/or luspatercept in TDT and NTDT, as well as curative therapies for TDT, including hematopoietic stem cell transplant (HSCT) and gene therapy. Patients with thalassemia had worse HRQOL scores compared to the general population, and chronic pain was seen to increase in frequency and severity over time with age. NTDT patients reported worse physical health and functioning, mental health, general health, and vitality than TDT patients. However, TDT patients reported worse pain, change in health, and social support than NTDT. Most therapies improved overall HRQOL among thalassemia patients. Deferasirox, an oral iron chelator, was associated with more HRQOL benefits compared to deferoxamine, an intravenous iron chelator. Luspatercept showed clinically meaningful improvement in physical functioning among TDT and NTDT. Furthermore, HSCT and gene therapy were associated with better physical, emotional, and mental domains scores.
Collapse
Affiliation(s)
- Richa Shah
- Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sherif M. Badawy
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Hematology, Oncology, and Stem Cell Transplant, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA
| |
Collapse
|
8
|
Haenel E, Elash CA, Garner K, Turner M, Kern S. Flexible approaches to eCOA administration in clinical trials: The site perspective. Contemp Clin Trials Commun 2024; 37:101241. [PMID: 38174210 PMCID: PMC10758701 DOI: 10.1016/j.conctc.2023.101241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/23/2023] [Accepted: 12/02/2023] [Indexed: 01/05/2024] Open
Abstract
The Critical Path Institute convened the Support Flexible Approaches to PRO Data Collection project as part of the eCOA: Getting Better Together Initiative which was instigated to identify and address common challenges and drive positive change with eCOA implementation in clinical trials. The project aimed to identify clinical trial stakeholders' concerns related to electronic PRO (ePRO) implementation and propose areas of improvement via simplification and flexibility. One workstream focused on patient-/site-centric approaches for simplification and surveyed representatives of clinical sites and site monitors for their perspectives. A semi-structured questionnaire was developed and distributed via snowball sampling to site professionals and clinical research associates (CRAs) that had ePRO experience who had been identified via representative groups or sponsor-led site networks. Responses were received from various site roles across a range of global regions; the largest contribution was from the United States. Topics raised included helpdesk capabilities, technical concerns, device types, and user interfaces among others and are discussed further in this paper. The feedback derived from the questionnaire provided the basis for concrete ideas that sponsors should consider incorporating into protocol design for participant visits, technology use, devices, and methods of back-up data collection.
Collapse
Affiliation(s)
| | | | | | | | | | - Electronic Clinical Outcome Assessment (eCOA) Consortium and the Patient-Reported Outcome (PRO) Consortium
- Kayentis SAS, Meylan, France
- YPrime, Malvern, PA, USA
- Signant Health, Blue Bell, PA, USA
- GlaxoSmithKline, Collegeville, PA, USA
- Critical Path Institute, Tucson, AZ, USA
| |
Collapse
|
9
|
Miller MD, Redfern RE, Anderson MB, Abshagen S, Van Andel D, Lonner JH. Completion of Patient-Reported Outcome Measures Improved With Use of a Mobile Application in Arthroplasty Patients: Results From a Randomized Controlled Trial. J Arthroplasty 2024:S0883-5403(24)00007-X. [PMID: 38211730 DOI: 10.1016/j.arth.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 12/17/2023] [Accepted: 01/02/2024] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND The collection of patient-reported outcome measures (PROMs) has historically been reported as costly and time-consuming, with low compliance rates that may impact reimbursement. Little research has reported the effects of mobile applications to support PROMs collection following arthroplasty. METHODS Secondary analysis of data from a multicenter randomized controlled trial was performed. Patients undergoing knee and hip arthroplasty were randomized to utilize a smartphone-based care management platform (app) for self-directed rehabilitation and completed joint-specific PROMs (Hip Dysfunction and Osteoarthritis Outcome Score, Joint Replacement or Knee Injury and Osteoarthritis Score, Joint Replacement) via the application at prescribed intervals or on paper during clinic visits. Control patients received practice standard of care, and completed PROMs via emailed hyperlink or during clinic visits following lower limb arthroplasty. Overall, 455 patients underwent knee arthroplasty procedures (245 control, 210 app group) and 380 underwent total hip arthroplasty (206 control, 174 app group). Compliance with expected PROMs completion was calculated through one year postoperatively. RESULTS Compliance was higher in the app group preoperatively in both knee (98.1 versus 86.9%, P < .0001) and hip cohorts (96.0 versus 88.4%, P = .008), and postoperatively, including at one year (knees, 72.2 versus 53.7%, P < .0001; hips, 71.1 versus 49.2%, P < .0001). On log-binomial regressions, intervention arm was the strongest predictor of completion of all PROMs, where app users undergoing knee (Relative Risk 2.039, 95% confidence interval (CI) 1.595 to 2.607, P < .000) and hip arthroplasty (2.268 95% CI 1.742 to 2.953, P < .0001) were more likely to be compliant at all timepoints. The majority of patients in the app group, including those over 65 years of age, completed PROMs using the application as opposed to paper methods. CONCLUSIONS A smartphone mobile application that engages patients during recovery after knee and hip joint arthroplasty improved compliance with completion of preoperative and postoperative PROMs compared to other electronic and paper methods.
Collapse
Affiliation(s)
- Matthew D Miller
- Department of Orthopaedic Surgery, Stanford Medicine, Stanford, California
| | | | | | | | | | - Jess H Lonner
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
| |
Collapse
|
10
|
Salmani H, Nasiri S, Ahmadi M. The advantages, disadvantages, threats, and opportunities of electronic patient-reported outcome systems in cancer: A systematic review. Digit Health 2024; 10:20552076241257146. [PMID: 38812853 PMCID: PMC11135117 DOI: 10.1177/20552076241257146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 05/07/2024] [Indexed: 05/31/2024] Open
Abstract
Objective Electronic patient-reported outcome (ePRO) systems hold promise for revolutionizing communication between cancer patients and healthcare providers across various care settings. This systematic review explores the multifaceted landscape of ePROs in cancer care, encompassing their advantages, disadvantages, potential risks, and opportunities for improvement. Methods In our systematic review, we conducted a rigorous search in Scopus, Web of Science, and PubMed, employing comprehensive medical subject heading terms for ePRO and cancer, with no date limitations up to 2024. Studies were critically appraised and thematically analyzed based on inclusion and exclusion criteria, including considerations of advantages, disadvantages, opportunities, and threats. Findings Analyzing 85 articles revealed 69 themes categorized into four key areas. Advantages (n = 14) were dominated by themes like "improved quality of life and care." Disadvantages (n = 26) included "limited access and technical issues." Security concerns and lack of technical skills were prominent threats (n = 10). Opportunities (n = 19) highlighted advancements in symptom management and potential solutions for technical challenges. Conclusion This review emphasizes the crucial role of continuous exploration, integration, and innovation in ePRO systems for optimizing patient outcomes in cancer care. Beyond traditional clinical settings, ePROs hold promise for applications in survivorship, palliative care, and remote monitoring. By addressing existing limitations and capitalizing on opportunities, ePROs can empower patients, enhance communication, and ultimately improve care delivery across the entire cancer care spectrum.
Collapse
Affiliation(s)
- Hosna Salmani
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Somayeh Nasiri
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Ahmadi
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
11
|
Gounder MM, Atkinson TM, Bell T, Daskalopoulou C, Griffiths P, Martindale M, Smith LM, Lim A. GOunder/Desmoid Tumor Research Foundation DEsmoid Symptom/Impact Scale (GODDESS ©): psychometric properties and clinically meaningful thresholds as assessed in the Phase 3 DeFi randomized controlled clinical trial. Qual Life Res 2023; 32:2861-2873. [PMID: 37347393 PMCID: PMC10474203 DOI: 10.1007/s11136-023-03445-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2023] [Indexed: 06/23/2023]
Abstract
PURPOSE The GODDESS© tool was developed to assess Desmoid Tumor/Aggressive Fibromatosis (DT/AF) symptom severity and impact on patients' lives. This study evaluated GODDESS©'s cross-sectional and longitudinal measurement properties. METHODS The Phase 3, randomized placebo-controlled, DeFi study (NCT03785964) of nirogacestat in DT/AF was used to assess GODDESS©'s reliability, construct validity, responsiveness, and estimate of meaningful change thresholds (MCTs). Other patient-reported outcome (PRO) measures included Patient Global Impression of Severity (PGIS) in DT/AF symptoms, EORTC QLQ-C30, Brief Pain Inventory Short Form, and PROMIS Physical Function short-form 10a v2.0 plus 3 items. RESULTS DeFi participants (N = 142) had a median age of 34 years (range: 18-76) and were mostly female (64.8%), with extra-abdominal (76.8%) or intra-abdominal tumors (23.2%). The GODDESS© symptom/impact scales showed internal consistency at baseline, cycles 4 and 7 (Cronbach's α > 0.70) and test-retest reliability (intra-class correlation coefficient > 0.85). GODDESS© scales correlated moderately to highly with PRO measures capturing similar content and differentiated among PGIS and Eastern Cooperative Oncology Group groups. GODDESS© scales detected improvement over time. For the total symptom score, a 1.30-point decrease was estimated as the within-person MCT and a 1.00-point decrease as the between-group MCT. For the physical functioning impact score, estimated within- and between-group MCTs were 0.60-point and 0.50-point decreases, respectively. Few participants exhibited symptom worsening. CONCLUSION GODDESS© was found to be reliable, valid, responsive, and interpretable as a clinical trial endpoint in the pooled sample of DT/AF patients. Estimated MCTs can be used to define responders and assess group-level differences in future, unblinded, efficacy analyses. TRIAL REGISTRATION NUMBER AND REGISTRATION DATE NCT03785964; December 24, 2018.
Collapse
Affiliation(s)
| | | | - Timothy Bell
- SpringWorks Therapeutics, Inc., Stamford, CT, USA.
| | | | | | | | - L Mary Smith
- SpringWorks Therapeutics, Inc., Stamford, CT, USA
| | - Allison Lim
- SpringWorks Therapeutics, Inc., Stamford, CT, USA
| |
Collapse
|
12
|
Salm H, Hentschel L, Eichler M, Pink D, Fuhrmann S, Kramer M, Reichardt P, Schuler MK. Evaluation of electronic patient-reported outcome assessment in inpatient cancer care: a feasibility study. Support Care Cancer 2023; 31:575. [PMID: 37707633 PMCID: PMC10501936 DOI: 10.1007/s00520-023-08014-9] [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: 12/18/2022] [Accepted: 08/23/2023] [Indexed: 09/15/2023]
Abstract
PURPOSE Patient-reported outcome (PRO) measures are increasingly important in evaluating medical care. The increased integration of technology within the healthcare systems allows for collection of PROs electronically. The objectives of this study were to Ashley et al. J Med Internet Res (2013) implement an electronic assessment of PROs in inpatient cancer care and test its feasibility for patients and Dawson et al. BMJ (2010) determine the equivalence of the paper and electronic assessment. METHODS We analyzed two arms from a study that was originally designed to be an interventional, three-arm, and multicenter inpatient trial. A self-administered questionnaire based on validated PRO-measures was applied and completed at admission, 1 week after, and at discharge. For this analysis - focusing on feasibility of the electronic assessment - the following groups will be considered: Group A (intervention arm) received a tablet version, while group B (control arm) completed the questionnaire on paper. A feasibility questionnaire, that was adapted from Ashley et al. J Med Internet Res (2013), was administered to group A. RESULTS We analyzed 103 patients that were recruited in oncology wards. ePRO was feasible to most patients, with 84% preferring the electronic over paper-based assessment. The feasibility questionnaire contained questions that were answered on a scale ranging from "1" (illustrating non achievement) to "5" (illustrating achieving goal). The majority (mean 4.24, SD .99) reported no difficulties handling the electronic tool and found it relatively easy finding time for filling out the questionnaire (mean 4.15, SD 1.05). There were no significant differences between the paper and the electronic assessment regarding the PROs. CONCLUSION Results indicate that electronic PRO assessment in inpatient cancer care is feasible.
Collapse
Affiliation(s)
- Hanna Salm
- Department of Internal Medicine C, University Hospital Greifswald, Greifswald, Germany.
- Sarcoma Center Berlin-Brandenburg, Helios Hospital Bad Saarow, Bad Saarow, Germany.
| | | | - Martin Eichler
- National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
| | - Daniel Pink
- Department of Internal Medicine C, University Hospital Greifswald, Greifswald, Germany
- Sarcoma Center Berlin-Brandenburg, Helios Hospital Bad Saarow, Bad Saarow, Germany
| | - Stephan Fuhrmann
- Clinic for Hematology and Oncology, Helios Hospital Emil von Behring Berlin, Berlin, Germany
| | | | - Peter Reichardt
- Clinic for Oncology and Palliative Medicine, Helios Hospital Berlin Buch, Berlin, Germany
| | - Markus K Schuler
- Division of Hematology, Oncology and Stem Cell Transplantation, Medical Clinic I, Department of Medicine I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
- Onkologischer Schwerpunkt am Oskar-Helene-Heim, Berlin, Germany
| |
Collapse
|
13
|
Bächinger D, Neudert M, Dazert S, Röösli C, Huber A, Mlynski R, Weiss NM. [Health-related quality of life in chronic otitis media-measurement methods and their application in surgical therapy]. HNO 2023; 71:556-565. [PMID: 37422596 DOI: 10.1007/s00106-023-01324-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Chronic otitis media (COM) can lead to significant impairment of health-related quality of life (HRQoL) due to symptoms such as otorrhea, pain, hearing loss, tinnitus, or dizziness. A systematic assessment of HRQoL in COM is becoming increasingly important as it complements (semi-)objective outcome parameters in clinical practice and research. HRQoL is measured by means of patient-reported outcome measures (PROMs). There are two disease-specific validated PROMs available for COM in German-the Chronic Otitis Media Outcome Test (COMOT-15) and the Zurich Chronic Middle Ear Inventory (ZCMEI-21)-which have become increasingly popular in recent years. OBJECTIVE The purpose of this narrative review is to present the current state of research on measuring HRQoL in COM before and after surgical procedures. RESULTS AND CONCLUSION Hearing is the most important factor influencing HRQoL in COM. Surgical procedures usually result in a clinically relevant improvement in HRQoL in COM with or without cholesteatoma. However, if cholesteatoma is present, its extent does not correlate with HRQoL. While HRQoL plays a secondary role in establishment of the indication for surgical therapy in COM with cholesteatoma, it plays an important role in terms of relative surgical indications, e.g., a symptomatic open mastoid cavity after resection of the posterior canal wall. We encourage the regular use of disease-specific PROMs preoperatively as well as during follow-up to assess HRQoL in COM in individual patients, in research, and in the context of quality monitoring.
Collapse
Affiliation(s)
- David Bächinger
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, St. Elisabeth-Hospital, Ruhr-Universität Bochum, Bochum, Deutschland
| | - Marcus Neudert
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum "Carl Gustav Carus", Dresden, Deutschland
| | - Stefan Dazert
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, St. Elisabeth-Hospital, Ruhr-Universität Bochum, Bochum, Deutschland
| | - Christof Röösli
- Klinik für Ohren‑, Nasen‑, Hals und Gesichtschirurgie, Universitätsspital Zürich, Zürich, Schweiz
- Universität Zürich, Zürich, Schweiz
| | - Alexander Huber
- Klinik für Ohren‑, Nasen‑, Hals und Gesichtschirurgie, Universitätsspital Zürich, Zürich, Schweiz
- Universität Zürich, Zürich, Schweiz
| | - Robert Mlynski
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie "Otto Körner", Universitätsmedizin Rostock, Rostock, Deutschland
| | - Nora M Weiss
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, St. Elisabeth-Hospital, Ruhr-Universität Bochum, Bochum, Deutschland.
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, St. Elisabeth Hospital, Klinikum der Ruhr-Universität Bochum, Bleichstraße 15, 44787, Bochum, Deutschland.
| |
Collapse
|
14
|
Cho Y, Lavoie Smith EM, Zahrieh D, Chow SL, Williams DA, Saint Arnault D, Jiang Y. Electronic Patient-Reported Outcome Data Collection Systems in Oncology Clinical Trials: A Survey of Clinical Research Professionals (an Alliance Study). JCO Clin Cancer Inform 2023; 7:e2300007. [PMID: 37677111 PMCID: PMC10545018 DOI: 10.1200/cci.23.00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 06/20/2023] [Accepted: 07/02/2023] [Indexed: 09/09/2023] Open
Abstract
PURPOSE To describe clinical research professionals (CRPs)' experiences with electronic patient-reported outcome (ePRO) data collection systems in oncology clinical trials and identify correlates of CRPs' attitude toward technology. METHODS An online survey was conducted among 210 CRPs from 125 National Cancer Institute-funded research sites. Measures included CRPs' demographic characteristics, working years, employment locations, and previous experiences with various types of ePROs. Their attitude toward technology was measured by the Technology Attitude Scale-Adapted. The Wilcoxon signed-rank test was used to compare two subdomains of attitude (perceived usefulness [PU] and perceived ease of use [PEU]). Multiple linear regression was used to explore correlates of (1) overall attitude, (2) PU, and (3) PEU. The significance level was 5%. RESULTS Participants' median age was 41 years (range, 21-67). Most were female (90%) and White (82%). More than half of the participants had previous experiences with web-based ePROs using patients' own devices (72%) or site-/sponsor-provided on-site devices (eg, kiosks or tablets; 64%). CRPs who were 60 years or older (β = -0.32, P < .05) or worked for 10-20 years (β = -0.11, P < .05) had relatively negative attitudes, controlling for other factors. Previous experiences with more ePRO types were associated with more positive attitudes (β = 0.08, P = .02). Similar correlates were found with PU but not with PEU. CONCLUSION This study revealed that CRPs had various experiences with ePRO systems and attitudes toward technology. Age, working years, and previous experiences with ePROs were correlates of overall attitude toward technology and PU. These findings suggest necessary targeted training to facilitate ePRO use in oncology clinical trials by improving CRPs' awareness and attitude toward technology.
Collapse
Affiliation(s)
- Youmin Cho
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX
| | | | - David Zahrieh
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN
| | - Selina L. Chow
- Alliance Protocol Operations Office, University of Chicago, Chicago, IL
| | | | | | - Yun Jiang
- School of Nursing, University of Michigan, Ann Arbor, MI
| |
Collapse
|
15
|
Hyland CJ, Pusic AL, Liu JB. Patient-Reported Outcomes and Surgical Quality. Clin Colon Rectal Surg 2023; 36:259-264. [PMID: 37223232 PMCID: PMC10202543 DOI: 10.1055/s-0043-1761594] [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: 05/25/2023]
Abstract
Delivering high-quality surgical care requires knowing how best to define and measure quality in surgery. Patient-reported outcomes (PROs) enable surgeons, health care systems, and payers to understand meaningful health outcomes from the patient's perspective and can be measured using patient-reported outcome measures (PROMs). As a result, there is much interest in using PROMs in routine surgical care, to guide quality improvement and to inform reimbursement pay structures. This chapter defines PROs and PROMs, differentiates PROMs from other quality measures such as patient-reported experience measures, describes PROMs in the context of routine clinical care, and provides an overview of interpreting PROM data. This chapter also describes how PROMs may be applied to quality improvement and value-based reimbursement in surgery.
Collapse
Affiliation(s)
- Colby J. Hyland
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Patient-Reported Outcomes, Value, and Experience (PROVE) Center, Brigham and Women's Hospital, Boston, Massachusetts
| | - Andrea L. Pusic
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Patient-Reported Outcomes, Value, and Experience (PROVE) Center, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jason B. Liu
- Patient-Reported Outcomes, Value, and Experience (PROVE) Center, Brigham and Women's Hospital, Boston, Massachusetts
- Section of Endocrine Surgery, Division of Surgical Oncology, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| |
Collapse
|
16
|
Wang Y, Van Dijk L, Mohamed ASR, Naser M, Fuller CD, Zhang X, Marai GE, Canahuate G. Improving Prediction of Late Symptoms using LSTM and Patient-reported Outcomes for Head and Neck Cancer Patients. IEEE INTERNATIONAL CONFERENCE ON HEALTHCARE INFORMATICS. IEEE INTERNATIONAL CONFERENCE ON HEALTHCARE INFORMATICS 2023; 2023:292-300. [PMID: 38343586 PMCID: PMC10853990 DOI: 10.1109/ichi57859.2023.00047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Patient-Reported Outcomes (PRO) are collected directly from the patients using symptom questionnaires. In the case of head and neck cancer patients, PRO surveys are recorded every week during treatment with each patient's visit to the clinic and at different follow-up times after the treatment has concluded. PRO surveys can be very informative regarding the patient's status and the effect of treatment on the patient's quality of life (QoL). Processing PRO data is challenging for several reasons. First, missing data is frequent as patients might skip a question or a questionnaire altogether. Second, PROs are patient-dependent, a rating of 5 for one patient might be a rating of 10 for another patient. Finally, most patients experience severe symptoms during treatment which usually subside over time. However, for some patients, late toxicities persist negatively affecting the patient's QoL. These long-term severe symptoms are hard to predict and are the focus of this study. In this work, we model PRO data collected from head and neck cancer patients treated at the MD Anderson Cancer Center using the MD Anderson Symptom Inventory (MDASI) questionnaire as time series. We impute missing values with a combination of K nearest neighbor (KNN) and Long Short-Term Memory (LSTM) neural networks, and finally, apply LSTM to predict late symptom severity 12 months after treatment. We compare performance against clinical and ARIMA models. We show that the LSTM model combined with KNN imputation is effective in predicting late-stage symptom ratings for occurrence and severity under the AUC and F1 score metrics.
Collapse
Affiliation(s)
- Yaohua Wang
- Electrical and Computer Engineering, The University of Iowa, Iowa City, United States
| | - Lisanne Van Dijk
- Radiation Oncology, UT M.D. Anderson Cancer Center, Houston, United States
| | | | - Mohamed Naser
- Radiation Oncology, UT M.D. Anderson Cancer Center, Houston, United States
| | | | - Xinhua Zhang
- Computer Science, University of Illinois at Chicago, Chicago, United States
| | - G Elisabeta Marai
- Computer Science, University of Illinois at Chicago, Chicago, United States
| | - Guadalupe Canahuate
- Electrical and Computer Engineering, The University of Iowa, Iowa City, United States
| |
Collapse
|
17
|
McLeod LD, Rockwood NJ. Comparability Among Modes of Data Collection for Patient-Reported Outcome Measures: Opening the Gates for Faithful Migration. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:620-622. [PMID: 36990208 DOI: 10.1016/j.jval.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 05/03/2023]
Affiliation(s)
- Lori D McLeod
- Patient-Centered Outcomes Assessment, RTI Health Solutions, Research Triangle Park, NC, USA.
| | - Nicholas J Rockwood
- Patient-Centered Outcomes Assessment, RTI Health Solutions, Research Triangle Park, NC, USA
| |
Collapse
|
18
|
Thomsen LH, Vexø LE, Schnack TH, Hansen KE, Forman A, Hartwell D, Nielsen HS, Hummelshoj L, Nyegaard M, Madsen ME. Danish translation, cross-cultural adaptation, and electronic migration of the World Endometriosis Research Foundation Endometriosis Phenome and Biobanking Harmonisation Project Endometriosis Patient Questionnaire. Front Glob Womens Health 2023; 4:1102006. [PMID: 36994241 PMCID: PMC10042231 DOI: 10.3389/fgwh.2023.1102006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/01/2023] [Indexed: 03/16/2023] Open
Abstract
ObjectivesThis study aims to translate and cross-culturally adapt the standard version of the World Endometriosis Research Foundation (WERF) EPHect Endometriosis Patient Questionnaire (EPQ) into Danish and to ensure equivalence of a Danish electronic version.MethodsThe translation, cultural adaption, and electronic migration followed recommendations from the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) and the Critical Path Institute. Ten women with endometriosis were enrolled for cognitive debriefing of the paper version (pEPQ) after translation and back translation. The questionnaire was then migrated into an electronic version (eEPQ) and subsequently tested for usability and measurement equivalence by five women with endometriosis.ResultsCross-cultural alterations were needed for medical terms, response options for ethnicity, the educational system, and measurement units. Thirteen questions were altered after back translation, while 21 underwent minor changes after cognitive debriefing. After testing the eEPQ, 13 questions were altered. Questions tested for measurement equivalence across the two modes of administration were found comparable. The median time-to-complete the pEPQ and eEPQ was 62 min (range: 29–110) and 63 min (range: 31–88), respectively. General comments included the questionnaire being relevant but long and repetitive.ConclusionsWe find the the Danish pEPQ and eEPQ similar and comparable to the original English instrument. However, attention must be drawn to questions regarding measurement units, ethnicity, and educational systems before cross-country comparison. The Danish pEPQ and eEPQ are suitable for obtaining subjective data on women with endometriosis.
Collapse
Affiliation(s)
- Line Holdgaard Thomsen
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Correspondence: Line Holdgaard Thomsen
| | - Laura Emilie Vexø
- Department of Gynecology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Obstetrics and Gynecology, Copenhagen University Hospital, Hvidovre, Denmark
| | | | | | - Axel Forman
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
| | - Dorthe Hartwell
- Department of Gynecology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henriette Svarre Nielsen
- Department of Obstetrics and Gynecology, Copenhagen University Hospital, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lone Hummelshoj
- World Endometriosis Research Foundation (WERF), London, United Kingdom
- Endometriosis.org, London, United Kingdom
| | - Mette Nyegaard
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Mette Elkjær Madsen
- Department of Gynecology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Obstetrics and Gynecology, Copenhagen University Hospital, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
19
|
Thompson V, Moshirfar M, Clinch T, Scoper S, Linn SH, McIntosh A, Li Y, Eaton M, Ferriere M, Stasi K. Topical Ocular TRPV1 Antagonist SAF312 (Libvatrep) for Postoperative Pain After Photorefractive Keratectomy. Transl Vis Sci Technol 2023; 12:7. [PMID: 36917119 PMCID: PMC10020951 DOI: 10.1167/tvst.12.3.7] [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: 03/16/2023] Open
Abstract
Purpose Evaluation of safety and efficacy of topical ocular SAF312 (Libvatrep) in post-photorefractive keratectomy (PRK) pain. Methods In this placebo (vehicle)-controlled, participant- and investigator-masked study, 40 participants were randomized (1:1) to two treatment sequences in a bilateral PRK crossover design (SAF312 2.5% followed by vehicle [or vice versa], one eye drop, four times daily for 72 hours after PRK). Primary endpoints were visual analog scale (VAS) pain scores at 6 hours after first drop of study drug and average VAS scores over 0 to 12 hours postoperatively. Secondary endpoints included postoperative oral rescue medication (ORM) use and adverse events (AEs). Results All 40 participants completed the study. Both primary endpoints were met; mean difference in VAS pain scores between SAF312- and vehicle-treated eyes was -11.13 (P = 0.005, -25%) at 6 hours postoperatively and -8.56 (P = 0.017, -22%) over 0 to 12 hours. Mean VAS pain scores with SAF312 were consistently lower than with vehicle from 1 hour postoperatively up to 30 hours (P ≤ 0.10 observed in 8/11 time points). Less ORM was taken with SAF312 up to 0 to 72 hours postoperatively, with a trend of fewer participants taking ORM at 0 to 24 hours postoperatively with SAF312 versus vehicle. No serious AEs were reported. All ocular AEs were mild and transient, and none were drug related. SAF312-treated eyes showed no delay in wound healing and had a lower grade 4 conjunctival hyperemia 24 hours postoperatively versus vehicle-treated eyes. Conclusions SAF312 was well tolerated and effective in reducing ocular pain post-PRK. Translational Relevance Topical SAF312 presents a new therapeutic option for patients undergoing PRK.
Collapse
Affiliation(s)
- Vance Thompson
- Vance Thompson Vision, Sioux Falls, SD, USA.,University of South Dakota, Sanford School of Medicine, Sioux Falls, SD, USA
| | - Majid Moshirfar
- Hoopes, Durrie, Rivera Research, Hoopes Vision, Draper, UT, USA
| | | | | | - Steven H Linn
- Hoopes, Durrie, Rivera Research, Hoopes Vision, Draper, UT, USA
| | | | - Yifang Li
- Novartis Pharmaceuticals Corp., East Hanover, NJ, USA
| | - Matt Eaton
- Novartis Institute of Biomedical Research, Cambridge, MA, USA
| | | | - Kalliopi Stasi
- Novartis Institute of Biomedical Research, Cambridge, MA, USA
| |
Collapse
|
20
|
Ng VL, Dunphy C, Shemesh E, Lobritto S, Eisenberg E, Pomponi C, Szolna J, Wilkerson D, Gupta N, Romero R, Perito ER, DiPaola F, Gonzalez-Peralta RP, Hsu E, Saarela K, Mohammad S, Superina R, Logan S, Miller DW, Krise-Confair C, Swami N, Mazariegos G. Feasibility of using a patient-reported outcome measure into clinical practice following pediatric liver transplantation: The Starzl Network experience. Pediatr Transplant 2023; 27:e14409. [PMID: 36272132 DOI: 10.1111/petr.14409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 09/19/2022] [Accepted: 09/23/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) are not routinely used in clinical care by pediatric liver transplant (LT) teams. The Starzl Network for Excellence in Pediatric Transplantation (SNEPT) assessed feasibility of using a disease-specific Quality of Life (QoL) questionnaire in the ambulatory setting at 10 SNEPT sites. METHODS A mixed methods feasibility project assessing administration processes, barriers, and user experiences with the Pediatric Liver Transplant Quality of Life (PeLTQL) tool. Iterative processes sought stakeholder feedback across four phases (Pilot, Extended Pilot, Development of a Mobile App PeLTQL version, and Pilot App use). RESULTS A total of 149 patient-parent dyads completed the PeLTQL during LT clinic follow-up. Clinicians, parents, and patients evaluated and reported on feasibility of operationalization. Only two of 10 SNEPT sites continued PeLTQL administration after the initial two pilot phases. Reasons include limited clinical time and available personnel aggravated by the COVID-19 pandemic. In response, a mobile application version of the PeLTQL was initiated. Providing PeLTQL responses electronically was "very easy" or "easy" as reported by 96% (22/23) parents. CONCLUSIONS Administration of a PROM into post-pediatric LT clinical care was feasible, but ongoing utilization stalled. Use of a mobile app towards facilitating completion of the PeLTQL outside of clinic hours may address the time and work-flow barriers identified.
Collapse
Affiliation(s)
- Vicky Lee Ng
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Claire Dunphy
- Icahn School of Medicine at Mount Sinai, Mount Sinai Kravis Children's Hospital, New York, New York, USA
| | - Eyal Shemesh
- Icahn School of Medicine at Mount Sinai, Mount Sinai Kravis Children's Hospital, New York, New York, USA
| | - Steven Lobritto
- Columbia University Medical Center, Morgan Stanley Children's Hospital of New York, New York, New York, USA
| | - Elizabeth Eisenberg
- Patient and Family Voice, Starzl Network for Excellence in Pediatric Transplantation, Pittsburgh, Pennsylvania, USA
| | - Claudia Pomponi
- Icahn School of Medicine at Mount Sinai, Mount Sinai Kravis Children's Hospital, New York, New York, USA
| | - Jonathan Szolna
- Children's Hospital of Pittsburgh, UPMC, Pittsburgh, Pennsylvania, USA
| | - Dawn Wilkerson
- Children's Hospital of Pittsburgh, UPMC, Pittsburgh, Pennsylvania, USA
| | - Nitika Gupta
- Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia, USA
| | - Rene Romero
- Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia, USA
| | - Emily R Perito
- Benioff Children's Hospital, University of California San Francisco, San Francisco, California, USA
| | - Frank DiPaola
- Division of Pediatric Gastroenterology, Department of Pediatrics, University of Virginia, Charlottesville, Virginia, USA
| | | | - Evelyn Hsu
- Division of Gastroenterology and Hepatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Katelyn Saarela
- Division of Gastroenterology and Hepatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Saeed Mohammad
- Feinberg School of Medicine, The Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois, USA.,Vanderbilt Unversity Medical Center, Nashville, Tennessee, USA
| | - Riccardo Superina
- Feinberg School of Medicine, The Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois, USA
| | - Sherrie Logan
- Patient and Family Voice, Starzl Network for Excellence in Pediatric Transplantation, Pittsburgh, Pennsylvania, USA
| | - Daniel W Miller
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | | | - George Mazariegos
- Children's Hospital of Pittsburgh, UPMC, Pittsburgh, Pennsylvania, USA
| | | |
Collapse
|
21
|
Morris AC, Ibrahim Z, Heslin M, Moghraby OS, Stringaris A, Grant IM, Zalewski L, Pritchard M, Stewart R, Hotopf M, Pickles A, Dobson RJB, Simonoff E, Downs J. Assessing the feasibility of a web-based outcome measurement system in child and adolescent mental health services - myHealthE a randomised controlled feasibility pilot study. Child Adolesc Ment Health 2023; 28:128-147. [PMID: 35684987 PMCID: PMC10083915 DOI: 10.1111/camh.12571] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Interest in internet-based patient reported outcome measure (PROM) collection is increasing. The NHS myHealthE (MHE) web-based monitoring system was developed to address the limitations of paper-based PROM completion. MHE provides a simple and secure way for families accessing Child and Adolescent Mental Health Services to report clinical information and track their child's progress. This study aimed to assess whether MHE improves the completion of the Strengths and Difficulties Questionnaire (SDQ) compared with paper collection. Secondary objectives were to explore caregiver satisfaction and application acceptability. METHODS A 12-week single-blinded randomised controlled feasibility pilot trial of MHE was conducted with 196 families accessing neurodevelopmental services in south London to examine whether electronic questionnaires are completed more readily than paper-based questionnaires over a 3-month period. Follow up process evaluation phone calls with a subset (n = 8) of caregivers explored system satisfaction and usability. RESULTS MHE group assignment was significantly associated with an increased probability of completing an SDQ-P in the study period (adjusted hazard ratio (HR) 12.1, 95% CI 4.7-31.0; p = <.001). Of those caregivers' who received the MHE invitation (n = 68) 69.1% completed an SDQ using the platform compared to 8.8% in the control group (n = 68). The system was well received by caregivers, who cited numerous benefits of using MHE, for example, real-time feedback and ease of completion. CONCLUSIONS MHE holds promise for improving PROM completion rates. Research is needed to refine MHE, evaluate large-scale MHE implementation, cost effectiveness and explore factors associated with differences in electronic questionnaire uptake.
Collapse
Affiliation(s)
- Anna C. Morris
- South London and Maudsley NHS Foundation TrustLondonUK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Zina Ibrahim
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
- NIHR South London and Maudsley Biomedical Research CentreLondonUK
| | - Margaret Heslin
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | | | - Argyris Stringaris
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
- Emotion & Development Branch, National Institute of Mental HealthNational Institutes of HealthBethesdaMDUSA
| | - Ian M. Grant
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Lukasz Zalewski
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Megan Pritchard
- NIHR South London and Maudsley Biomedical Research CentreLondonUK
| | - Robert Stewart
- South London and Maudsley NHS Foundation TrustLondonUK
- NIHR South London and Maudsley Biomedical Research CentreLondonUK
| | - Matthew Hotopf
- South London and Maudsley NHS Foundation TrustLondonUK
- NIHR South London and Maudsley Biomedical Research CentreLondonUK
| | - Andrew Pickles
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
- NIHR South London and Maudsley Biomedical Research CentreLondonUK
| | - Richard J. B. Dobson
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
- NIHR South London and Maudsley Biomedical Research CentreLondonUK
| | - Emily Simonoff
- South London and Maudsley NHS Foundation TrustLondonUK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
- NIHR South London and Maudsley Biomedical Research CentreLondonUK
| | - Johnny Downs
- South London and Maudsley NHS Foundation TrustLondonUK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
- NIHR South London and Maudsley Biomedical Research CentreLondonUK
| |
Collapse
|
22
|
Kasoju N, Remya NS, Sasi R, Sujesh S, Soman B, Kesavadas C, Muraleedharan CV, Varma PRH, Behari S. Digital health: trends, opportunities and challenges in medical devices, pharma and bio-technology. CSI TRANSACTIONS ON ICT 2023; 11:11-30. [PMCID: PMC10089382 DOI: 10.1007/s40012-023-00380-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 03/27/2023] [Indexed: 04/12/2024]
Abstract
Digital health interventions refer to the use of digital technology and connected devices to improve health outcomes and healthcare delivery. This includes telemedicine, electronic health records, wearable devices, mobile health applications, and other forms of digital health technology. To this end, several research and developmental activities in various fields are gaining momentum. For instance, in the medical devices sector, several smart biomedical materials and medical devices that are digitally enabled are rapidly being developed and introduced into clinical settings. In the pharma and allied sectors, digital health-focused technologies are widely being used through various stages of drug development, viz. computer-aided drug design, computational modeling for predictive toxicology, and big data analytics for clinical trial management. In the biotechnology and bioengineering fields, investigations are rapidly growing focus on digital health, such as omics biology, synthetic biology, systems biology, big data and personalized medicine. Though digital health-focused innovations are expanding the horizons of health in diverse ways, here the development in the fields of medical devices, pharmaceutical technologies and biotech sectors, with emphasis on trends, opportunities and challenges are reviewed. A perspective on the use of digital health in the Indian context is also included.
Collapse
Affiliation(s)
- Naresh Kasoju
- Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, 695011 Kerala India
| | - N. S. Remya
- Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, 695011 Kerala India
| | - Renjith Sasi
- Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, 695011 Kerala India
| | - S. Sujesh
- Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, 695011 Kerala India
| | - Biju Soman
- Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, 695011 Kerala India
| | - C. Kesavadas
- Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, 695011 Kerala India
| | - C. V. Muraleedharan
- Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, 695011 Kerala India
| | - P. R. Harikrishna Varma
- Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, 695011 Kerala India
| | - Sanjay Behari
- Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, 695011 Kerala India
| |
Collapse
|
23
|
Gander JC, Chrenka E, Cromwell L, Truitt AR, Sesay M, Segall M, Amouzou SA, Hudgins AF, Kodthala P, Roblin D, Deneal AN, Whiting T, Powers JD, Martinson BC. Systematic surveillance of patient-reported symptoms of viral respiratory tract infectious Syndromes in diverse populations. BMC Health Serv Res 2022; 22:1591. [PMID: 36581932 PMCID: PMC9797889 DOI: 10.1186/s12913-022-08991-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 12/20/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Patient reported outcome measures (PROM) can improve patient care and be crucial for symptom tracking especially during disease outbreaks. FLU-PRO Plus is a validated PROM used to track viral respiratory symptoms. Our study aimed to evaluate the feasibility of using FLU-PRO© Plus, to track symptoms across three healthcare systems. METHODS The prospective, longitudinal study recruited adults between February-May 2021 from HealthPartners Institute (HP), Kaiser Permanente Georgia (KPGA), and Kaiser Permanente Mid-Atlantic States (KPMAS). Adult members were eligible if they had a positive lab or diagnosis for either COVID-19 or influenza-like illness (ILI) or exhibited 2 + viral respiratory symptoms. Descriptive statistics were calculated to describe the patient characteristics for participants that were eligible for FLU-PRO Plus, successfully contacted, attempted to log in to the FLU-PRO Plus website, and participants who completed FLU-PRO Plus Day 1. Bivariable and multivariable logistic regression using PROC GLIMMIXX investigated the patient characteristics associated with (1) successful contact and (2) FLU-PRO Plus Day 1 completion. RESULTS We identified a total of 15,650 eligible participants during the enrollment period: 9,582 from HP, 1,740 from KPGA, and 4,328 from KPMAS. Among the total of 409 eligible adults who attempted to participate in FLU-PRO Plus, 317 completed FLU-PRO Plus Day 1. Among the 317 individuals that completed FLU-PRO Plus Day 1, 205 (67.5%) were diagnosed with COVID-19; 112 adults diagnosed with COVID-19 completed FLU-PRO Plus Day 14. Among adults successfully contacted, adults aged 35-64 (OR = 1.40, 95% CI 1.05, 1.87), females (OR = 1.77, 95% CI 1.38, 2.27), and adults diagnosed with COVID-19 (OR = 1.66, 95% CI 1.27, 2.17) had higher odds of completing FLU-PRO Plus Day 1; Asian adults (OR = 0.38, 95% CI 0.19, 0.76) and Black and African American adults (OR = 0.33, 95% CI 0.19, 0.76) had lower odds compared to White adults. CONCLUSION Our study reports on the feasibility of patients across three integrated healthcare systems utilizing FLU-PRO Plus to monitor their respiratory symptoms. Patient reported outcome measures (PROM) can improve patient care, quality of life, and reduce the strain of limited resources on healthcare systems. Future FLU-PRO Plus studies should develop an implementation strategy to fully integrate FLU-PRO Plus within clinical care and patient management.
Collapse
Affiliation(s)
- Jennifer C. Gander
- grid.280062.e0000 0000 9957 7758Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, GA USA
| | - Ella Chrenka
- grid.280625.b0000 0004 0461 4886HealthPartners Institute, Bloomington, MN USA
| | - Lee Cromwell
- grid.280062.e0000 0000 9957 7758Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, GA USA
| | - Anjali R. Truitt
- grid.280625.b0000 0004 0461 4886HealthPartners Institute, Bloomington, MN USA
| | - Musu Sesay
- grid.280062.e0000 0000 9957 7758Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, GA USA
| | - Marni Segall
- grid.280062.e0000 0000 9957 7758Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, GA USA
| | - Sandra A. Amouzou
- grid.280062.e0000 0000 9957 7758Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, GA USA
| | - Alexander F. Hudgins
- grid.280062.e0000 0000 9957 7758Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, GA USA
| | - Prasanthi Kodthala
- grid.280625.b0000 0004 0461 4886HealthPartners Institute, Bloomington, MN USA
| | - Douglas Roblin
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD USA
| | - Adrienne N. Deneal
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD USA
| | - Thomas Whiting
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD USA
| | - John D. Powers
- grid.418021.e0000 0004 0535 8394Clinical Research Directorate, Frederick National Laboratory for Cancer Research, Frederick, MD USA
| | - Brian C. Martinson
- grid.280625.b0000 0004 0461 4886HealthPartners Institute, Bloomington, MN USA
| |
Collapse
|
24
|
Girgis A, Bamgboje-Ayodele A, Rincones O, Vinod SK, Avery S, Descallar J, Smith A‘B, Arnold B, Arnold A, Bray V, Durcinoska I, Rankin NM, Chang CF, Eifler B, Elliott S, Hardy C, Ivimey B, Jansens W, Kaadan N, Koh ES, Livio N, Lozenkovski S, McErlean G, Nasser E, Ryan N, Smeal T, Thomas T, Tran T, Wiltshire J, Delaney GP. Stepping into the real world: a mixed-methods evaluation of the implementation of electronic patient reported outcomes in routine lung cancer care. J Patient Rep Outcomes 2022; 6:70. [PMID: 35723827 PMCID: PMC9207870 DOI: 10.1186/s41687-022-00475-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 06/03/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
To realize the broader benefits of electronic patient-reported outcome measures (ePROMs) in routine care, we used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to inform the translation of a clinically effective ePROM system (hereafter referred to as the PRM system) into practice. The study aimed to evaluate the processes and success of implementing the PRM system in the routine care of patients diagnosed with lung cancer.
Method
A controlled before-and-after mixed-methods study was undertaken. Data sources included a self-report questionnaire and interviews with healthcare providers, electronic health record data for PRMs patients and historical controls, and field notes. Descriptive statistics, logistic regression modelling, negative binomial models, generalized estimating equations and repeated measures ANOVA were used to analyze quantitative data. Qualitative data was thematically analyzed.
Results
A total of 48/79 eligible people diagnosed with lung cancer completed 90 assessments during the 5-month implementation period (RE-AIM reach). Every assessment breached the pre-defined threshold and care coordinators reviewed and actioned 95.6% of breaches, resulting in 146 referrals to allied health services, most frequently for social work (25.3%), dietetics (18.5%), physiotherapy (18.5%) and occupational therapy (17.1%). PRMs patients had significantly fewer visits to the cancer assessment unit for problematic symptoms (M = 0.23 vs. M = 0.43; p = 0.035), and were significantly more likely to be offered referrals (71% vs. 29%, p < 0.0001) than historical controls (RE-AIM effect). The levels of ‘organizational readiness for implementing change’ (ORIC) did not show much differences between baseline and follow-up, though this was already high at baseline; but significantly more staff reported improved confidence when asking patients to complete assessments (64.7% at baseline vs. 88.2% at follow-up, p = 0.0046), and when describing the assessment tool to patients (64.7% at baseline vs. 76.47% at follow-up, p = 0.0018) (RE-AIM adoption). A total of 78 staff received PRM system training, and 95.6% of the PRM system alerts were actioned (RE-AIM implementation); and all lung cancer care coordinators were engaged with the PRM system beyond the end of the study period (RE-AIM maintenance).
Conclusion
This study demonstrates the potential of the PRM system in enhancing the routine care of lung cancer patients, through leveraging the capabilities of automated web-based care options.
Plain English summary
Research has shown the clear benefits of using electronically collected patient-reported outcome measures (ePROMs) for cancer patients and health services. However, we need to better understand how to implement ePROMs as part of routine care. This study evaluated the processes and outcomes of implementing an ePROMs system in the routine care of patients diagnosed with lung cancer. Key findings included: (a) a majority of eligible patients completed the scheduled assessments; (b) patient concerns were identified in every assessment, and care coordinators reviewed and actioned almost all of these, including making significantly more referrals to allied health services; (c) patients completing assessments regularly were less likely to present to the cancer assessment unit with problematic symptoms, suggesting that ePROMs identified patient concerns early and this led to a timely response to concerns; (d) staff training and engagement was high, and staff reporting increased confidence when asking patients to complete assessments and when describing the assessment tool to patients at the end of the implementation period. This study shows that implementing ePROMs in routine care is feasible and can lead to improvements in patient care.
Collapse
|
25
|
Newton L, Knight-West O, Eremenco S, Hudgens S, Crescioni M, Symonds T, Reasner DS, Byrom B, O’Donohoe P, Vallow S. Comparability of a provisioned device versus bring your own device for completion of patient-reported outcome measures by participants with chronic obstructive pulmonary disease: qualitative interview findings. J Patient Rep Outcomes 2022; 6:86. [PMID: 35925498 PMCID: PMC9352826 DOI: 10.1186/s41687-022-00492-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background There is interest in participants using their own smartphones or tablets (“bring your own device”; BYOD) to complete patient-reported outcome (PRO) measures in clinical studies. Our study aimed to qualitatively evaluate participants’ experience using a provisioned device (PD) versus their own smartphone (BYOD) for this purpose. Methods Participants with chronic obstructive pulmonary disease (COPD) were recruited for this observational, cross-over study and completed PRO measures daily on one device type for 15 days, then switched to the other device type to complete the same measures for another 15 days. After each 15-day period, semi-structured interviews were conducted about their experience with the device. Results Of 64 participants enrolled, the final qualitative analysis populations comprised those who participated in an interview without protocol violations. Thus, the qualitative longitudinal population (LP) included n = 57 (89%), while the qualitative cross-sectional population (CSP) included n = 60 (94%). CSP participants found both device types easy to use. Twenty CSP participants (33%) reported missing data entry on at least one day when using PD, and 24 (40%) reported missing at least one day when using BYOD. In the LP, preference for one of the device types was somewhat evenly split; 45.6% (n = 26) preferred PD and 50.9% (n = 29) preferred BYOD. The most common reason for preferring PD was that it was “dedicated” to the study; the “convenience” of carrying a single device was the main reason for preferring BYOD. Conclusion The findings from the interviews demonstrated few differences in participants’ experience completing PRO measures on a PD versus BYOD. Our study supports the use of BYOD as a potential addition to PD for collecting PRO data and contributes evidence that BYOD may be employed to collect PRO data in demographically diverse patient populations.
Collapse
|
26
|
Franko OI, London DA, Kiefhaber TR, Stern PJ. Automated Reporting of Patient Outcomes in Hand Surgery: A Pilot Study. Hand (N Y) 2022; 17:1278-1285. [PMID: 34521230 PMCID: PMC9608284 DOI: 10.1177/15589447211043214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Obtaining patient-reported outcomes (PROs) is becoming a standard component of patient care. For nonacademic practices, this can be challenging. From this perspective, we designed a nearly autonomous patient outcomes reporting system. We then conducted a prospective, cohort pilot study to assess the efficacy of the system. METHODS We created an automated system to gather PROs. All operative patients for 4 surgeons in an upper-extremity private practice were asked to participate. These patients completed the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaires preoperatively and received follow-up e-mails requesting patients to complete additional QuickDASH questionnaires at 3, 6, and 12 weeks postoperatively and to complete a 13-week postoperative satisfaction survey. Response rates and satisfaction levels are reported with descriptive statistics. RESULTS Sixty-two percent of participants completed the 3-week assessment, 55% completed the 6-week assessment, and 43% completed the 12-week assessment. Overall, 35% of patients completed all questionnaires, and 73% completed at least 1 postoperative assessment. The collection of follow-up questionnaires required no additional time from the clinical staff, surgeon, or a research associate. CONCLUSIONS Automated e-mail assessments can collect reliable clinical data, with minimal surgeon or staff intervention required to administer and collect data, minimizing the financial cost. For nonacademic practices, without access to additional research resources, such a system is feasible. Further improvements in communication with patients could increase response rates.
Collapse
Affiliation(s)
| | - Daniel A. London
- The Mary S. Stern Hand Surgery Fellowship, Cincinnati, OH, USA
- University of Cincinnati, OH, USA
| | | | - Peter J. Stern
- University of Cincinnati, OH, USA
- TriHealth Hand Surgery Specialists, Cincinnati, OH, USA
| |
Collapse
|
27
|
Hughes SE, McMullan C, Rowe A, Retzer A, Malpass R, Bathurst C, Davies EH, Frost C, McNamara G, Harding R, Price G, Wilson R, Walker A, Newsome PN, Calvert M. Feasibility of a new electronic patient-reported outcome (ePRO) system for an advanced therapy clinical trial in immune-mediated inflammatory disease (PROmics): protocol for a qualitative feasibility study. BMJ Open 2022; 12:e063199. [PMID: 36691123 PMCID: PMC9453996 DOI: 10.1136/bmjopen-2022-063199] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 08/15/2022] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION The use of electronic patient-reported outcome (ePRO) systems to capture PRO data in clinical trials is increasing; however, their feasibility, acceptability and utility in clinical trials of advanced therapy medicinal products (ATMPs) are not yet well understood. This protocol describes a qualitative study that aims to evaluate the feasibility and acceptability of ePRO data capture using a trial-specific ePRO system (the PROmics system) within an advanced therapy trial involving patients with immune-mediated inflammatory disease (rheumatoid arthritis, lupus, primary sclerosing cholangitis (PSC) and Crohn's disease). METHODS AND ANALYSIS This protocol for a remote, qualitative, interview-based feasibility study is embedded within the POLARISE trial, a single-arm, phase II, multisite ATMP basket trial in the UK. 10-15 patients enrolled in the POLARISE trial and 10-15 research team members at the trial sites will be recruited. Participants will take part in semistructured interviews which will be transcribed verbatim and analysed thematically according to the framework method. Data collection and analysis will occur concurrently and iteratively. Researcher triangulation will be used to achieve a consensus-based analysis, enhancing rigour and trustworthiness. ETHICS AND DISSEMINATION This study was approved by the London-West London and GTAC Research Ethics Committee (Ref: 21/LO/0475). Informed consent will be obtained from all participants prior to data collection. The study findings will be published in peer-review journals and disseminated via conference presentations and other media. Our patient and public involvement and engagement group and ATMP stakeholder networks will be consulted to maximise dissemination and impact. TRIAL REGISTRATION NUMBER ISRCTN80103507.
Collapse
Affiliation(s)
- Sarah E Hughes
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Centre (ARC) West Midlands, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- National Institute of Health and Care Research (NIHR) Oxford-Birmingham Blood and Transplant Research Unit (BTRU) in Precision Therapeutics, University of Birmingham, Birmingham, UK
| | - Christel McMullan
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute of Health and Care Research (NIHR) Oxford-Birmingham Blood and Transplant Research Unit (BTRU) in Precision Therapeutics, University of Birmingham, Birmingham, UK
- National Institute fo Health and Care Research (NIHR) Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK
- Centre for Trauma Research, University of Birmingham, Birmingham, UK
| | - Anna Rowe
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Ameeta Retzer
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- National Institute fo Health and Care Research (NIHR) Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK
| | - Rebecca Malpass
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Camilla Bathurst
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | | | | | | | - Rosie Harding
- Birmingham Law School, University of Birmingham, Birmingham, UK
| | - Gary Price
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Roger Wilson
- National Cancer Research Institute (NCRI) Consumer Forum, Sarcoma Patients Euronet, Church Stretton, UK
| | - Anita Walker
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Philip N Newsome
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
- Midlands Health Data Research UK, University of Birmingham and Institute of Applied Health Research, Birmingham, UK
| | - Melanie Calvert
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Centre (ARC) West Midlands, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- National Institute of Health and Care Research (NIHR) Oxford-Birmingham Blood and Transplant Research Unit (BTRU) in Precision Therapeutics, University of Birmingham, Birmingham, UK
- National Institute fo Health and Care Research (NIHR) Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- Midlands Health Data Research UK, University of Birmingham and Institute of Applied Health Research, Birmingham, UK
- DEMAND Hub, University of Birmingham, Birmingham, UK
| |
Collapse
|
28
|
Nguyen MP, Rivard RL, Blaschke B, Vang S, Schroder LK, Cole PA, Cunningham BP. Capturing patient-reported outcomes: paper versus electronic survey administration. OTA Int 2022; 5:e212. [PMID: 36349121 PMCID: PMC9580259 DOI: 10.1097/oi9.0000000000000212] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 04/25/2022] [Indexed: 11/26/2022]
Abstract
Objective: To compare the capture rates and costs of paper patient-reported outcomes (pPRO) administered in-clinic and electronic PROs (ePRO) collected through emails and texts. Design: Retrospective review. Setting: Level 1 trauma center. Patients/Participants: The pPRO program enrolled 2164 patients for postsurgical follow-up in 4 fracture types: ankle, distal radius, proximal humerus, and implant removal from 2012 to 2017. The ePRO program enrolled 3096 patients in 13 fracture types from 2018 to 2020. Among the patients enrolled in the ePRO program, 1296 patients were matched to the 4 original fracture types and time points. Main Outcome Measures: PRO capture rates in 4 fracture types by matched time point and estimated cost of each program per enrolled patient. Results: At first follow-up, pPRO provided a higher capture rate than ePRO for 3 of 4 fracture types except for implant removal (P < 0.05). However, at 6-month and 1-year follow-ups, ePRO demonstrated statistically significant higher capture rates when compared with pPRO for all applicable modules (P < 0.05). The average cost for the pPRO program was $171 per patient versus $56 per patient in the ePRO program. Patients were 1.19 times more likely to complete ePRO compared with pPRO (P = 0.007) after controlling for age, sex, fracture type, and time point. Conclusion: The electronic PRO service has improved long-term capture rates compared with paper PROs, while minimizing cost. A combined program that includes both in-clinic and out of clinic effort may be the ideal model for collection of PROs. Level of Evidence: Level 3.
Collapse
Affiliation(s)
- Mai P. Nguyen
- Department of Orthopaedic Surgery, Regions Hospital, St. Paul, MN
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN; and
| | | | - Breanna Blaschke
- Department of Orthopaedic Surgery, Methodist Hospital, St. Louis Park, MN
| | - Sandy Vang
- Department of Orthopaedic Surgery, Regions Hospital, St. Paul, MN
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN; and
| | - Lisa K. Schroder
- Department of Orthopaedic Surgery, Regions Hospital, St. Paul, MN
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN; and
| | - Peter A. Cole
- Department of Orthopaedic Surgery, Regions Hospital, St. Paul, MN
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN; and
| | | |
Collapse
|
29
|
Campbell C, Feehan M, Kanitscheider C, Makena PS, Cai J, Baxter SA. Designing Studies to Inform Tobacco Harm Reduction: Learnings From an Oral Nicotine Pouch Actual Use Pilot Study. JMIR Form Res 2022; 6:e37573. [PMID: 35984682 PMCID: PMC9440415 DOI: 10.2196/37573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 06/28/2022] [Accepted: 07/19/2022] [Indexed: 12/01/2022] Open
Abstract
Background Introduction of new tobacco products in the United States, including those that may be lower on the risk continuum than traditional combustible cigarettes, requires premarket authorization by the US Food and Drug Administration and information on the potential impact of the products on consumer behaviors. Efficient recruitment and data capture processes are needed to collect relevant information in a near-to-real-world environment. Objective The aim of this pilot study was to develop and test a protocol for an actual use study of a new tobacco product. The product included in this study was a commercially available oral nicotine pouch. Through the process of study design and execution, learnings were garnered to inform the design, execution, analysis, and report writing of future full-scale actual use studies with tobacco products. Methods A small sample (n=100) of healthy adult daily smokers of 7 or more cigarettes per day were recruited to participate in an 8-week prospective observational study conducted at 4 geographically dispersed sites in the United States. A smartphone-based customized electronic diary (eDiary) was employed to capture daily tobacco product use, including 1 week of baseline smoking and 6 weeks during which participants were provided with oral nicotine pouches for use as desired. Results Online screening procedures with follow-up telephone interviews and on-site enrollment were successfully implemented. Of 100 participants, 97 completed the study, with more than half (59/99, 60%) identifying as dual- or poly-users of cigarettes and other types of tobacco products at baseline. There was more than 90% (91-93/99, 92%-94%) compliance with daily eDiary reporting, and the majority (92/99, 93%) of participants expressed satisfaction with the study processes. Product use data from the eDiary indicated that after an initial period of trial use, pouches per day increased among those continuing to use the products, while per day average cigarette consumption decreased for 82% (79/97) of all study participants. At the end of the week 6, 16% (15/97) of participants had reduced their cigarette consumption by more than half. Conclusions The design of this study, including recruiting, enrollment, eDiary use, and oversight, was successfully implemented through the application of a detailed protocol, a user-friendly eDiary, electronically administered questionnaires, and remote monitoring procedures. High-resolution information was obtained on prospective changes in tobacco product use patterns in the context of availability of a new tobacco product. Future, larger actual use studies will provide important evidence supporting the role that alternatives to combustible cigarettes may play in smoking reduction and/or cessation and lowering the population health burden of tobacco and nicotine-containing products.
Collapse
Affiliation(s)
| | - Michael Feehan
- Cerner Enviza, an Oracle company, Kansas City, MO, United States
- Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, United States
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, United States
| | | | | | - Jenny Cai
- Cerner Enviza, an Oracle company, Kansas City, MO, United States
| | | |
Collapse
|
30
|
Griffiths P, Williams A, Brohan E. How do the number of missing daily diary days impact the psychometric properties and meaningful change thresholds arising from a weekly average summary score? Qual Life Res 2022; 31:3433-3445. [PMID: 35930136 PMCID: PMC9362484 DOI: 10.1007/s11136-022-03198-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE Quality of life research often collects daily information and averages this over a week, producing a summary score. When data are missing, arbitrary rules (such as requiring at least 4/7 observations) are used to determine whether a patient's summary score is created or set to missing. This simulation work aimed to assess the impact of missing data on the estimates produced by summary scores, the psychometric properties of the resulting summary score estimates and the impact on interpretation thresholds. METHODS Complete longitudinal data were simulated for 1000 samples of 400 patients with different day-to-day variability. Data were deleted from these samples in line with missingness mechanisms to create scenarios with up to six days of missing data. Summary scores were created for complete and missing data scenarios. Summary score estimates, psychometric properties and meaningful change estimates were assessed for missing data scenarios compared to complete data. RESULTS In most cases, the 4/7 day rule was supported, but this depended on daily variability. Fewer days of data were sometimes acceptable, but this was also dependent on the proportion of patients with missing data. Tables and figures allow researchers to assess the potential impact of missing data in their own studies. CONCLUSIONS This work suggests that the missing data rule used to create summary scores impacts on the estimate, measurement properties and interpretation thresholds. Although a general rule of 4/7 days is supported, the way the summary score is derived does not have a uniform impact across psychometric analyses. Recommendations are to use the 4/7 rule, but plan for sensitivity analyses with other missing data rules.
Collapse
Affiliation(s)
- Pip Griffiths
- Patient Centric Services, IQVIA France, Tour D2, 17 bis Passerelle des Reflets, 92400, Courbevoie, France.
| | - Abi Williams
- Patient Centric Services, IQVIA UK, 3 Forbury Place, 23 Forbury Rd, Reading, RG1 3JH, UK
| | - Elaine Brohan
- Formerly of Patient Centered Outcomes, Adelphi Values, Bollington, UK
| |
Collapse
|
31
|
Mowlem FD, Tenaerts P, Gwaltney C, Oakley-Girvan I. Regulatory Acceptance of Patient-Reported Outcome (PRO) Data from Bring-Your-Own-Device (BYOD) Solutions to Support Medical Product Labeling Claims : Let's Share the Success Stories to Move the Industry Forward. Ther Innov Regul Sci 2022; 56:531-535. [PMID: 35534774 PMCID: PMC9084261 DOI: 10.1007/s43441-022-00412-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 04/18/2022] [Indexed: 11/29/2022]
Abstract
Bring-your-own-device (BYOD) methods for collecting patient-reported outcome (PRO) data in clinical trials can decrease patient burden and improve data quality. However, adoption of BYOD in clinical trials is limited by the absence of publicly available case studies where BYOD PRO data supported regulatory medical product approvals. Anecdotally, we are aware of multiple examples where efficacy and safety label claims were based on BYOD PRO data; however—except for one—these examples have not been made public. The absence of these case studies can lead sponsors to be hesitant to use BYOD for capturing primary and secondary PRO-based endpoints in their trials. This commentary outlines the context of the issue faced and concludes with a call for sponsor transparency with regard to BYOD use through publicizing where approved labeling claims were based on BYOD data. We suggest how this data could be systematically captured going forward. Sharing this information will benefit the clinical trials enterprise by increasing confidence in the utilization of BYOD and provide opportunities to enhance patient-centricity.
Collapse
|
32
|
Arbuckle R, Marshall C, Grant L, Burrows K, Albrecht HH, Shea T. Development and content validity testing of patient-reported outcome (PRO) items to assess chest congestion associated with the common cold for use in children and adolescents. J Patient Rep Outcomes 2022; 6:56. [PMID: 35633410 PMCID: PMC9148330 DOI: 10.1186/s41687-022-00465-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 05/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This article describes qualitative interviews conducted with children (aged 6-11), adolescents (aged 12-17), and adults with the common cold as well as parents/caregivers of the 6-8-year-old children. The aim was to support the refinement and content validity testing of patient-reported outcome (PRO) items assessing chest congestion that could be used as pediatric clinical trial endpoints. Feasibility and acceptability of administering the PRO items electronically on a hand-held touch-screen device were also evaluated. The sample included children aged 6-8 years (n = 14), 9-11 years (n = 13), adolescents aged 12-17 years (n = 12), and adults (n = 10), all of who had current (n = 38) or recent (n = 11) cold. Both concept elicitation (CE) and cognitive debriefing (CD) interviews were conducted with all of these participants, conducted over in two rounds. Ten parents/caregivers of participants aged 6-8 years were also interviewed (separately from their child) regarding how they thought their children would understand the items. The CE interviews explored the qualitative experience of having chest congestion and related symptoms of the common cold. Following their CE interview, participants completed draft items on an electronic patient-reported outcome (ePRO) device twice daily for 2-5 days prior to their CD interview. During the CD interview participants were asked about relevance, understanding and interpretation of the draft PRO items. Qualitative analysis of the interview data and descriptive analyses of the ePRO data were conducted following both rounds of interviews, with modifications to the items implemented following Round 1 and tested in Round 2. RESULTS Eight symptoms were reported by children during concept elicitation. Findings from the child, adolescent, and adult/parent interviews supported revisions to the items and enabled the selection of the best performing items. The results provided evidence that the final items were well understood by participants and relevant to their experiences of chest congestion as part of a common cold. Findings also provide support for using the same items across age groups. CONCLUSIONS The results of the CE and CD interviews provide evidence supporting the content validity of new PRO items assessing the experience of chest congestion symptoms associated with common cold experienced by children, adolescents, and adults.
Collapse
Affiliation(s)
- Rob Arbuckle
- Adelphi Values Patient-Centered Outcomes, Bollington, UK.
| | - Chris Marshall
- Adelphi Values Patient-Centered Outcomes (at the time research was conducted), Bollington, UK
| | - Laura Grant
- Adelphi Values Patient-Centered Outcomes, Bollington, UK
| | - Kate Burrows
- Adelphi Values Patient-Centered Outcomes (at the time research was conducted), Bollington, UK
| | - Helmut H Albrecht
- Herbert Wertheim College of Medicine, Cellular Biology and Pharmacology, Florida International University, Miami, FL, USA
| | - Tim Shea
- RB Health (US), LLC, Parsippany, New Jersey, USA
| |
Collapse
|
33
|
Chakraborty S, Mallick I, Bhattacharyya T, Singh MA, Achari RB, Chatterjee S. Development and user experience testing of an electronic system for routine collection and use of electronic patient-reported outcome measures. HEALTH AND TECHNOLOGY 2022. [DOI: 10.1007/s12553-022-00647-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
34
|
Clinical trial considerations in sickle cell disease: patient-reported outcomes, data elements, and the stakeholder engagement framework. Hematology 2021; 2021:196-205. [DOI: 10.1182/hematology.2021000252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Patients with sickle cell disease (SCD) have significant impairment in their quality of life across the life span as a consequence of serious disease burden with several SCD-related complications. A number of disease-modifying therapies are currently available, yet long-term clinical benefits in real-world settings remain unclear. Over the past few years, a number of important initiatives have been launched to optimize clinical trials in SCD in different ways, including: (1) established panels through a partnership between the American Society of Hematology (ASH) and the US Food and Drug Administration; (2) the ASH Research Collaborative SCD Clinical Trials Network; (3) the PhenX Toolkit (consensus measures for Phenotypes and eXposures) in SCD; and (4) the Cure Sickle Cell Initiative, led by the National Heart, Lung, and Blood Institute. Electronic patient-reported outcomes assessment is highly recommended, and patient-reported outcomes (PROs) should be evaluated in all SCD trials and reported using Standard Protocol Items Recommendations for Interventional Trials guidelines. Patient-centered outcomes research (PCOR) approaches and meaningful stakeholder engagement throughout the process have the potential to optimize the execution and success of clinical trials in SCD with considerable financial value. This article reviews several clinical trial considerations in SCD related to study design and outcomes assessment as informed by recent initiatives as well as patient-centered research approaches and stakeholder engagement. A proposed hematology stakeholder-engagement framework for clinical trials is also discussed.
Collapse
|
35
|
Ben-Ali W, Lamarche Y, Carrier M, Demers P, Bouchard D, El-Hamamsy I, Cartier R, Pellerin M, Perrault LP. Use of Mobile-Based Application for Collection of Patient-Reported Outcomes in Cardiac Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2021; 16:536-544. [PMID: 34882492 DOI: 10.1177/15569845211045677] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Application-based (app) technology has been studied for patient engagement and collecting patient-reported outcomes (PROs) in several surgical specialties with limited research in cardiac surgery. The aim of study was to determine the effectiveness of app-based technology for collecting PROs, improving the patient experience, and reducing health services utilization in a cardiac surgery center. METHODS Patients accessed an interactive app via smartphones. Patients were guided from 4 weeks preoperative to 4 weeks postoperative via reminders, tasks, PRO surveys, and evidence-based education. In the postoperative period, patients were engaged with daily health surveys to track warning signs and recovery milestones. Based on the patient's signs and symptoms, the app escalated lower risk issues to self-care education or higher risk issues to the care team (e.g., phone call to a nurse). RESULTS Sixty-six percent of patients (730 of 1,108) activated their app account. Two hundred seventy-seven patients completed an end-of-program feedback survey, with 94% of patients recommending the app and 98% of patients finding the app was helpful in recovery. Patients also reported using the app to avoid unnecessary health services utilization, with 45% of patients using the app to avoid at least 1 phone call and 28% of patients using the app to avoid at least 1 hospital visit. CONCLUSIONS App-based technology for patient engagement is an effective modality to enhance the patient experience, better understand the trajectory of recovery, and reduce unnecessary health services utilization in cardiac surgery.
Collapse
Affiliation(s)
- Walid Ben-Ali
- Department of Cardiac Surgery, 25465Montreal Heart Institute, Canada
| | - Yoan Lamarche
- Department of Cardiac Surgery, 25465Montreal Heart Institute, Canada
| | - Michel Carrier
- Department of Cardiac Surgery, 25465Montreal Heart Institute, Canada
| | - Philippe Demers
- Department of Cardiac Surgery, 25465Montreal Heart Institute, Canada
| | - Denis Bouchard
- Department of Cardiac Surgery, 25465Montreal Heart Institute, Canada
| | - Ismail El-Hamamsy
- Department of Cardiac Surgery, 25465Montreal Heart Institute, Canada
| | - Raymond Cartier
- Department of Cardiac Surgery, 25465Montreal Heart Institute, Canada
| | - Michel Pellerin
- Department of Cardiac Surgery, 25465Montreal Heart Institute, Canada
| | - Louis P Perrault
- Department of Cardiac Surgery, 25465Montreal Heart Institute, Canada
| |
Collapse
|
36
|
Petracca F, Tempre R, Cucciniello M, Ciani O, Pompeo E, Sannino L, Lovato V, Castaman G, Ghirardini A, Tarricone R. An Electronic Patient-Reported Outcome Mobile App for Data Collection in Type A Hemophilia: Design and Usability Study. JMIR Form Res 2021; 5:e25071. [PMID: 34855619 PMCID: PMC8686465 DOI: 10.2196/25071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 02/28/2021] [Accepted: 09/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background There is currently limited evidence on the level and intensity of physical activity in individuals with hemophilia A. Mobile technologies can offer a rigorous and reliable alternative to support data collection processes but they are often associated with poor user retention. The lack of longitudinal continuity in their use can be partly attributed to the insufficient consideration of stakeholder inputs in the development process of mobile apps. Several user-centered models have been proposed to guarantee that a thorough knowledge of the end user needs is considered in the development process of mobile apps. Objective The aim of this study is to design and validate an electronic patient-reported outcome mobile app that requires sustained active input by individuals during POWER, an observational study that aims at evaluating the relationship between physical activity levels and bleeding in patients with hemophilia A. Methods We adopted a user-centered design and engaged several stakeholders in the development and usability testing of this mobile app. During the concept generation and ideation phase, we organized a need-assessment focus group (FG) with patient representatives to elicit specific design requirements for the end users. We then conducted 2 exploratory FGs to seek additional inputs for the app’s improvement and 2 confirmatory FGs to validate the app and test its usability in the field through the mobile health app usability questionnaire. Results The findings from the thematic analysis of the need-assessment FG revealed that there was a demand for sense making, for simplification of app functionalities, for maximizing integration, and for minimizing the feeling of external control. Participants involved in the later stages of the design refinement contributed to improving the design further by upgrading the app’s layout and making the experience with the app more efficient through functions such as chatbots and visual feedback on the number of hours a wearable device had been worn, to ensure that the observed data were actually registered. The end users rated the app highly during the quantitative assessment, with an average mobile health app usability questionnaire score of 5.32 (SD 0.66; range 4.44-6.23) and 6.20 (SD 0.43; range 5.72-6.88) out of 7 in the 2 iterative usability testing cycles. Conclusions The results of the usability test indicated a high, growing satisfaction with the electronic patient-reported outcome app. The adoption of a thorough user-centered design process using several types of FGs helped maximize the likelihood of sustained retention of the app’s users and made it fit for data collection of relevant outcomes in the observational POWER study. The continuous use of the app and the actual level of engagement will be evaluated during the ongoing trial. Trial Registration ClinicalTrials.gov NCT04165135; https://clinicaltrials.gov/ct2/show/NCT04165135
Collapse
Affiliation(s)
- Francesco Petracca
- Centre for Research in Health and Social Care Management (CERGAS), Government, Health and Non Profit Division, SDA Bocconi, Milan, Italy
| | | | - Maria Cucciniello
- Centre for Research in Health and Social Care Management (CERGAS), Government, Health and Non Profit Division, SDA Bocconi, Milan, Italy.,University of Edinburgh Business School, Edinburgh, United Kingdom
| | - Oriana Ciani
- Centre for Research in Health and Social Care Management (CERGAS), Government, Health and Non Profit Division, SDA Bocconi, Milan, Italy.,Institute of Health Research, University of Exeter Medical School, Exeter, United Kingdom
| | | | | | | | - Giancarlo Castaman
- SODc Malattie Emorragiche e della Coagulazione, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | | | - Rosanna Tarricone
- Centre for Research in Health and Social Care Management (CERGAS), Government, Health and Non Profit Division, SDA Bocconi, Milan, Italy.,Department of Social and Political Sciences, Bocconi University, Milan, Italy
| |
Collapse
|
37
|
McCutchan R, Bosch P. [Telemedical care and IT-based systems in rheumatology]. Z Rheumatol 2021; 80:936-942. [PMID: 34618209 PMCID: PMC8495670 DOI: 10.1007/s00393-021-01098-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic and also the ever-increasing demands on the healthcare system, have led to a focus on the further development of telemedical services in rheumatology. OBJECTIVE What is the evidence for telemedical services in rheumatology? MATERIAL AND METHODS Narrative review of existing literature on telemedicine in rheumatology. RESULTS Electronic patient reported outcomes (ePROs) can be determined by patients from their home and sent electronically to the rheumatologist. In future, ePROs may help with the decision whether a patient needs to attend the clinic for a visit or the visit can be rescheduled due to remission and well-being. Telemedicine has already been used for well-controlled patients with rheumatic diseases with good results in terms of safety and disease activity compared to conventional face-to-face visits. Telemedicine represents an interesting tool for appointment prioritization and triaging, while automated algorithm-based applications are currently too imprecise for routine clinical use. The role of smartphone applications in the care of patients with rheumatic diseases is still unclear. DISCUSSION Telemedicine represents an interesting option for certain patient populations with rheumatic diseases. Apart from research on the effectiveness and safety of telemedical interventions, decision makers need to set clear rules on how telemedicine should be used to provide the best possible care for the individual patient.
Collapse
Affiliation(s)
- Rick McCutchan
- Universitätsklinik für Innere Medizin II, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Philipp Bosch
- Klinische Abteilung für Rheumatologie und Immunologie, Medizinische Universität Graz, Auenbruggerplatz 15, 8036, Graz, Österreich.
| |
Collapse
|
38
|
Uhrenholt L, Høstgaard S, Pedersen JF, Christensen R, Dreyer L, Leffers HCB, Taylor PC, Strand V, Jacobsen S, Voss A, Gregersen JW, Kristensen S. Patient-reported outcome measures in systemic lupus erythematosus by a web-based application: A randomized, crossover, agreement study. Lupus 2021; 30:2124-2134. [PMID: 34719299 DOI: 10.1177/09612033211051641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Patient-reported outcome measures (PROMs) are evaluated in randomized controlled trials (RCTs) in patients with systemic lupus erythematosus (SLE), but not widely used in clinical practice. However, interest in incorporating PROMs into the management of SLE is increasing as PROMs provide a unique insight into the patient's perception of lupus disease activity. The objective was to assess agreement in PROMs answered using a web app versus an outpatient touchscreen among patients with SLE. METHODS In a crossover RCT, SLE patients answered the following PROMs in a random order using the web app and the outpatient touchscreen: Systemic Lupus Erythematosus Activity Questionnaire (SLAQ) Global Health, SLAQ Symptom, SLAQ Total, SLAQ Worsening, Pain Visual Analog Scale (VAS), Fatigue VAS, Patient Global Health VAS, Health Assessment Questionnaire Disability Index (HAQ-DI), Patient Acceptable Symptom State (PASS), and an Anchoring Question. Equivalence between the two device types was demonstrated if the 95% confidence interval (95% CI) of the difference in PROM scores was within the prespecified equivalence margin. Agreement between the two device types was assessed using mixed linear models. RESULTS Thirty-four patients with SLE were included. Equivalence was demonstrated between the two device types for SLAQ Global Health with a difference of -0.21 (95% CI: -0.65 to 0.23). Moreover, equivalence was also found for HAQ-DI, Pain VAS, and Fatigue VAS whereas only comparability within the limits of the Minimal Clinically Important Difference (MCID) was demonstrated for VAS Patient Global Health. Statistical comparability was demonstrated for SLAQ Total, SLAQ Worsening, PASS, and Anchoring Question (no predefined MCID/equivalence margins available). However, a statistically significant difference between device types was observed for the SLAQ Symptom of -0.56 (95% CI: -1.10 to -0.01). The difference was, however, very small when considering the scale range of 0-24; thus, it was not judged to be of clinical relevance. Preference for the web app was very high (91.2%). CONCLUSION For the first time ever, equivalence and comparability between two electronic device types for various PROMs were demonstrated among patients with SLE. Implementation of the device is expected to improve the management of SLE.
Collapse
Affiliation(s)
- Line Uhrenholt
- Department of Rheumatology, 53141Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, 1004Aalborg University, Aalborg, Denmark.,Section for Biostatistics and Evidence-Based Research, 542252the Parker Institute, Copenhagen, Denmark.,DANBIO, 70590Rigshospitalet Glostrup, Glostrup, Denmark
| | - Simone Høstgaard
- Department of Clinical Medicine, 1004Aalborg University, Aalborg, Denmark
| | - Julie F Pedersen
- Department of Clinical Medicine, 1004Aalborg University, Aalborg, Denmark
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, 542252the Parker Institute, Copenhagen, Denmark.,Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, 11286Odense University Hospital, Odense, Denmark
| | - Lene Dreyer
- Department of Rheumatology, 53141Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, 1004Aalborg University, Aalborg, Denmark
| | - Henrik C B Leffers
- Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, 53146Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Peter C Taylor
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, 6396University of Oxford, Oxford, UK
| | - Vibeke Strand
- Division of Immunology/Rheumatology, 6429Stanford University School of Medicine, Palo Alto, California, USA
| | - Søren Jacobsen
- Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Diseases, 53146Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health Science, 4321University of Copenhagen, Copenhagen, Denmark
| | - Anne Voss
- Department of Rheumatology, 11286Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Jon W Gregersen
- Department of Nephrology, 53141Aalborg University Hospital, Aalborg, Denmark
| | - Salome Kristensen
- Department of Rheumatology, 53141Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, 1004Aalborg University, Aalborg, Denmark
| |
Collapse
|
39
|
Hussain SA, Sezgin E, Krivchenia K, Luna J, Rust S, Huang Y. A natural language processing pipeline to synthesize patient-generated notes toward improving remote care and chronic disease management: a cystic fibrosis case study. JAMIA Open 2021; 4:ooab084. [PMID: 34604710 PMCID: PMC8480545 DOI: 10.1093/jamiaopen/ooab084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/08/2021] [Accepted: 09/14/2021] [Indexed: 11/12/2022] Open
Abstract
Objectives Patient-generated health data (PGHD) are important for tracking and monitoring out of clinic health events and supporting shared clinical decisions. Unstructured text as PGHD (eg, medical diary notes and transcriptions) may encapsulate rich information through narratives which can be critical to better understand a patient’s condition. We propose a natural language processing (NLP) supported data synthesis pipeline for unstructured PGHD, focusing on children with special healthcare needs (CSHCN), and demonstrate it with a case study on cystic fibrosis (CF). Materials and Methods The proposed unstructured data synthesis and information extraction pipeline extract a broad range of health information by combining rule-based approaches with pretrained deep-learning models. Particularly, we build upon the scispaCy biomedical model suite, leveraging its named entity recognition capabilities to identify and link clinically relevant entities to established ontologies such as Systematized Nomenclature of Medicine (SNOMED) and RXNORM. We then use scispaCy’s syntax (grammar) parsing tools to retrieve phrases associated with the entities in medication, dose, therapies, symptoms, bowel movements, and nutrition ontological categories. The pipeline is illustrated and tested with simulated CF patient notes. Results The proposed hybrid deep-learning rule-based approach can operate over a variety of natural language note types and allow customization for a given patient or cohort. Viable information was successfully extracted from simulated CF notes. This hybrid pipeline is robust to misspellings and varied word representations and can be tailored to accommodate the needs of a specific patient, cohort, or clinician. Discussion The NLP pipeline can extract predefined or ontology-based entities from free-text PGHD, aiming to facilitate remote care and improve chronic disease management. Our implementation makes use of open source models, allowing for this solution to be easily replicated and integrated in different health systems. Outside of the clinic, the use of the NLP pipeline may increase the amount of clinical data recorded by families of CSHCN and ease the process to identify health events from the notes. Similarly, care coordinators, nurses and clinicians would be able to track adherence with medications, identify symptoms, and effectively intervene to improve clinical care. Furthermore, visualization tools can be applied to digest the structured data produced by the pipeline in support of the decision-making process for a patient, caregiver, or provider. Conclusion Our study demonstrated that an NLP pipeline can be used to create an automated analysis and reporting mechanism for unstructured PGHD. Further studies are suggested with real-world data to assess pipeline performance and further implications.
Collapse
Affiliation(s)
- Syed-Amad Hussain
- IT Research and Innovation, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Emre Sezgin
- IT Research and Innovation, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Katelyn Krivchenia
- Department of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - John Luna
- IT Research and Innovation, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Steve Rust
- IT Research and Innovation, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Yungui Huang
- IT Research and Innovation, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
| |
Collapse
|
40
|
Knapp A, Harst L, Hager S, Schmitt J, Scheibe M. Use of Patient-reported Outcome Measures and Patient-reported Experience Measures within Evaluation Studies of Telemedicine Applications: Systematic Review. J Med Internet Res 2021; 23:e30042. [PMID: 34523604 PMCID: PMC8663685 DOI: 10.2196/30042] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/06/2021] [Accepted: 09/12/2021] [Indexed: 01/08/2023] Open
Abstract
Background With the rise of digital health technologies and telemedicine, the need for evidence-based evaluation is growing. Patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) are recommended as an essential part of the evaluation of telemedicine. For the first time, a systematic review has been conducted to investigate the use of PROMs and PREMs in the evaluation studies of telemedicine covering all application types and medical purposes. Objective This study investigates the following research questions: in which scenarios are PROMs and PREMs collected for evaluation purposes, which PROM and PREM outcome domains have been covered and how often, which outcome measurement instruments have been used and how often, does the selection and quantity of PROMs and PREMs differ between study types and application types, and has the use of PROMs and PREMs changed over time. Methods We conducted a systematic literature search of the MEDLINE and Embase databases and included studies published from inception until April 2, 2020. We included studies evaluating telemedicine with patients as the main users; these studies reported PROMs and PREMs within randomized controlled trials, controlled trials, noncontrolled trials, and feasibility trials in English and German. Results Of the identified 2671 studies, 303 (11.34%) were included; of the 303 studies, 67 (22.1%) were feasibility studies, 70 (23.1%) were noncontrolled trials, 20 (6.6%) were controlled trials, and 146 (48.2%) were randomized controlled trials. Health-related quality of life (n=310; mean 1.02, SD 1.05), emotional function (n=244; mean 0.81, SD 1.18), and adherence (n=103; mean 0.34, SD 0.53) were the most frequently assessed outcome domains. Self-developed PROMs were used in 21.4% (65/303) of the studies, and self-developed PREMs were used in 22.3% (68/303). PROMs (n=884) were assessed more frequently than PREMs (n=234). As the evidence level of the studies increased, the number of PROMs also increased (τ=−0.45), and the number of PREMs decreased (τ=0.35). Since 2000, not only has the number of studies using PROMs and PREMs increased, but the level of evidence and the number of outcome measurement instruments used have also increased, with the number of PREMs permanently remaining at a lower level. Conclusions There have been increasingly more studies, particularly high-evidence studies, which use PROMs and PREMs to evaluate telemedicine. PROMs have been used more frequently than PREMs. With the increasing maturity stage of telemedicine applications and higher evidence level, the use of PROMs increased in line with the recommendations of evaluation guidelines. Health-related quality of life and emotional function were measured in almost all the studies. Simultaneously, health literacy as a precondition for using the application adequately, alongside proper training and guidance, has rarely been reported. Further efforts should be pursued to standardize PROM and PREM collection in evaluation studies of telemedicine.
Collapse
Affiliation(s)
- Andreas Knapp
- Center for Evidence-based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Fetscherstrasse 74, Dresden, DE
| | - Lorenz Harst
- Center for Evidence-based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Fetscherstrasse 74, Dresden, DE
| | - Stefan Hager
- Comprehensive Pain Center, University Hospital Carl Gustav Carus Dresden, Dresden, Germany, Dresden, DE
| | - Jochen Schmitt
- Center for Evidence-based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Fetscherstrasse 74, Dresden, DE
| | - Madlen Scheibe
- Center for Evidence-based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Fetscherstrasse 74, Dresden, DE
| |
Collapse
|
41
|
Spratt DE, Shore N, Sartor O, Rathkopf D, Olivier K. Treating the patient and not just the cancer: therapeutic burden in prostate cancer. Prostate Cancer Prostatic Dis 2021; 24:647-661. [PMID: 33603236 PMCID: PMC8384628 DOI: 10.1038/s41391-021-00328-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 01/12/2021] [Accepted: 01/20/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Prostate cancer (PC) is a leading cause of death in older men. Androgen deprivation therapy (ADT) is considered the standard-of-care for men with locally advanced disease. However, continuous androgen ablation is associated with acute and long-term adverse effects and most patients will eventually develop castration-resistant PC (CRPC). The recent approval of three, second-generation androgen receptor inhibitors (ARIs), apalutamide, enzalutamide, and darolutamide, has transformed the treatment landscape of PC. Treatment with these second-generation ARIs have produced positive trends in metastasis-free survival, progression-free survival, and overall survival. For patients with non-metastatic CRPC, who are mainly asymptomatic from their disease, maintaining quality of life is a major objective when prescribing therapy. Polypharmacy for age-related comorbidities also is common in this population and may increase the potential for drug-drug interactions (DDIs). METHOD This review summarizes the multiple factors that may contribute to the therapeutic burden of patients with CRPC, including the interplay between age, comorbidities, concomitant medications, the use of ARIs, and financial distress. CONCLUSIONS As the treatment landscape in PC continues to rapidly evolve, consideration must be given to the balance between therapeutic benefits and potential treatment-emergent adverse events that may be further complicated by DDIs with concomitant medications. Patient-centered communication is a crucial aspect of alleviating this burden, and healthcare professionals (HCPs) may benefit from training in effective patient communication. HCPs should closely and frequently monitor patient treatment responses, in order to better understand symptom onset and exacerbation. Patients also should be encouraged to participate in exercise programs, and health information and support groups, which may assist them in preventing or mitigating certain determinants of the therapeutic burden associated with PC and its management.
Collapse
Affiliation(s)
| | - Neal Shore
- Carolina Urologic Research Center, Atlantic Urology Clinics, Myrtle Beach, SC, USA
| | - Oliver Sartor
- Tulane University School of Medicine, New Orleans, LA, USA
| | - Dana Rathkopf
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kara Olivier
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| |
Collapse
|
42
|
Chhatwal J, Sapru A, Sundaram B, Shenoy B, Chand R, Yi K, Suroju S, Scott DA, Lockhart S. A phase 4 study of the safety of the 13-valent pneumococcal conjugate vaccine in children 6 to 17 years of age in India. Vaccine 2021; 39:5313-5317. [PMID: 34366142 DOI: 10.1016/j.vaccine.2021.07.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 06/23/2021] [Accepted: 07/20/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The 13-valent pneumococcal conjugate vaccine (PCV13) was recently approved in India for the prevention of pneumococcal disease in children aged 6 to 17 years based on global data as well as immunogenicity and safety findings from a phase 3 study. The current phase 4 study in India further evaluated the safety profile of PCV13 in this age group to support the positive benefit-risk profile of PCV13. METHODS Healthy male and female children aged 6 to 17 years in India were administered a single intramuscular injection of PCV13. Through 7 days after PCV13 administration, local reactions and systemic events were recorded daily by caregivers in an electronic diary. Adverse events (AEs) were collected from the provision of informed consent through 28-42 days postvaccination. RESULTS One hundred subjects enrolled in and completed the study. After PCV13 vaccination, 73.9% and 57.8% of subjects reported local reactions and systemic events, respectively. The majority of reactogenicity events were mild to moderate in severity, with injection site pain and fatigue the most frequently reported local reaction and systemic event, respectively. Six subjects reported 7 AEs, all of which were considered unrelated to PCV13. One subject reported a serious AE (acute hepatitis), which was considered unrelated to PCV13 and ultimately resolved. No subjects withdrew because of AEs, and there were no deaths. CONCLUSION PCV13 vaccination was well tolerated with an acceptable safety profile in healthy subjects aged 6 to 17 years in India. This work further supports the safety profile of PCV13 for prevention of pneumococcal disease in this age group in India.
Collapse
Affiliation(s)
- Jugesh Chhatwal
- Department of Paediatric Medicine, Christian Medical College, Ludhiana, Punjab, India
| | - Amita Sapru
- Department of Paediatrics, KEM Hospital Research Centre, Pune, Maharashtra, India
| | | | - Bhaskar Shenoy
- Department of Paediatrics, Manipal Hospital, Bengaluru, Karnataka, India
| | - Rohit Chand
- Global Site and Study Operations, Pfizer Ltd, Mumbai, India
| | - Kevin Yi
- Medical Development - Vaccines, Pfizer Inc, Collegeville, PA, USA
| | - Suresh Suroju
- Vaccine Clinical Research and Development, Pfizer Ltd, Hurley, UK
| | - Daniel A Scott
- Vaccine Clinical Research and Development, Pfizer Inc, Collegeville, PA, USA
| | - Stephen Lockhart
- Vaccine Clinical Research and Development, Pfizer Ltd, Hurley, UK.
| |
Collapse
|
43
|
Veitch ZW, Shepshelovich D, Gallagher C, Wang L, Abdul Razak AR, Spreafico A, Bedard PL, Siu LL, Minasian L, Hansen AR. Underreporting of Symptomatic Adverse Events in Phase I Clinical Trials. J Natl Cancer Inst 2021; 113:980-988. [PMID: 33616650 DOI: 10.1093/jnci/djab015] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/04/2020] [Accepted: 01/04/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Clinician reporting of symptomatic adverse events (AEs) in phase I trials uses the Common Terminology Criteria for Adverse Events (CTCAE). The utility of the patient-reported outcomes (PROs) version of the CTCAE (PRO-CTCAE) in this setting is unknown. This prospective, observational study compared patient- and clinician-reported symptomatic AEs in phase I patients. METHODS Phase I study-eligible patients at Princess Margaret were surveyed with the PRO-CTCAE full-item library (78 symptomatic AEs) at baseline (BL), mid-cycle 1, and mid-cycle 2 (C2). Patient and trial characteristics, best response, and survival data were collected. Presence or absence of patient- (PRO-CTCAE) or clinician-reported symptomatic AEs were compared (kappa) at defined timepoints and overall (BL+ mid-cycle 1 + C2). RESULTS Of 292 patients approached from May 2017 to January 2019, a total of 265 (90.8%) were consented, with 243 (91.7%) evaluable and 552 PRO-CTCAE surveys (completion rate = 98.7%) included in analyses. Evaluation of overall patient-reported symptomatic AEs identified 50 PRO-CTCAE and 11 CTCAE items with 10% or greater reporting frequency. Nineteen CTCAE items were reported as 1% or less despite matched PRO-CTCAE items reporting as 10% or greater. Underreported categories included sexual health, bodily emissions, and cognition. Clinician- relative to patient-reporting frequency (ratio) demonstrated 9 symptomatic AEs with a 50-fold or more lower clinician reporting rate. Overall patient-clinician agreement for individual symptomatic AEs ranged from poor (κ = 0.00-0.19) to moderate (κ = 0.40-0.59), with discordance driven by lack of clinician reporting. Dyspnea (κ = 0.54) and peripheral neuropathy (κ = 0.63) at BL and limb edema (κ = 0.55) at C2 demonstrated the highest patient-clinician agreement. CONCLUSIONS Poor to moderate patient-clinician agreement for symptomatic AEs suggests clinician underreporting in phase I trials. Analyses of severity and interference PRO categories are ongoing.
Collapse
Affiliation(s)
- Zachary W Veitch
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Daniel Shepshelovich
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Internal Medicine, Sackler School of Medicine, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Christina Gallagher
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Lisa Wang
- Department of Biostatistics, University of Toronto, Toronto, ON, Canada
| | | | - Anna Spreafico
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Philippe L Bedard
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Lillian L Siu
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Lori Minasian
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Aaron R Hansen
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| |
Collapse
|
44
|
Wesley DB, Blumenthal J, Shah S, Littlejohn R, Pruitt Z, Dixit R, Hsiao CJ, Dymek C, Ratwani R. A novel application of SMART on FHIR architecture for interoperable and scalable integration of patient-reported outcome data with electronic health records. J Am Med Inform Assoc 2021; 28:2220-2225. [PMID: 34279660 DOI: 10.1093/jamia/ocab110] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/14/2021] [Accepted: 05/26/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Despite a proliferation of applications (apps) to conveniently collect patient-reported outcomes (PROs) from patients, PRO data are yet to be seamlessly integrated with electronic health records (EHRs) in a way that improves interoperability and scalability. We applied the newly created PRO standards from the Office of the National Coordinator for Health Information Technology to facilitate the collection and integration of standardized PRO data. A novel multitiered architecture was created to enable seamless integration of PRO data via Substitutable Medical Apps and Reusable Technologies on Fast Healthcare Interoperability Resources apps and scaled to different EHR platforms in multiple ambulatory settings. MATERIALS AND METHODS We used a standards-based approach to deploy 2 apps that source and surface PRO data in real-time for provider use within the EHR and which rely on PRO assessments from an external center to streamline app and EHR integration. RESULTS The apps were developed to enable patients to answer validated assessments (eg, a Patient-Reported Outcomes Measurement Information System including using a Computer Adaptive Test format). Both apps were developed to populate the EHR in real time using the Health Level Seven FHIR standard allowing providers to view patients' data during the clinical encounter. The process of implementing this architecture with 2 different apps across 18 ambulatory care sites and 3 different EHR platforms is described. CONCLUSION Our approach and solution proved feasible, secure, and time- and resource-efficient. We offer actionable guidance for this technology to be scaled and adapted to promote adoption in diverse ambulatory care settings and across different EHRs.
Collapse
Affiliation(s)
| | - Joseph Blumenthal
- MedStar Health Research Institute.,MedStar National Center for Human Factors in Healthcare
| | | | - Robin Littlejohn
- MedStar Health Research Institute.,MedStar National Center for Human Factors in Healthcare
| | - Zoe Pruitt
- MedStar Health Research Institute.,MedStar National Center for Human Factors in Healthcare
| | - Ram Dixit
- MedStar Health Research Institute.,MedStar National Center for Human Factors in Healthcare
| | | | | | - Raj Ratwani
- MedStar Health Research Institute.,MedStar National Center for Human Factors in Healthcare
| |
Collapse
|
45
|
Wang Y, Van Dijk L, Mohamed ASR, Fuller CD, Zhang X, Marai GE, Canahuate G. Predicting late symptoms of head and neck cancer treatment using LSTM and patient reported outcomes. PROCEEDINGS. INTERNATIONAL DATABASE ENGINEERING AND APPLICATIONS SYMPOSIUM 2021; 2021:273-279. [PMID: 35392138 PMCID: PMC8982996 DOI: 10.1145/3472163.3472177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Patient-Reported Outcome (PRO) surveys are used to monitor patients' symptoms during and after cancer treatment. Acute symptoms refer to those experienced during treatment and late symptoms refer to those experienced after treatment. While most patients experience severe symptoms during treatment, these usually subside in the late stage. However, for some patients, late toxicities persist negatively affecting the patient's quality of life (QoL). In the case of head and neck cancer patients, PRO surveys are recorded every week during the patient's visit to the clinic and at different follow-up times after the treatment has concluded. In this paper, we model the PRO data as a time-series and apply Long-Short Term Memory (LSTM) neural networks for predicting symptom severity in the late stage. The PRO data used in this project corresponds to MD Anderson Symptom Inventory (MDASI) questionnaires collected from head and neck cancer patients treated at the MD Anderson Cancer Center. We show that the LSTM model is effective in predicting symptom ratings under the RMSE and NRMSE metrics. Our experiments show that the LSTM model also outperforms other machine learning models and time-series prediction models for these data.
Collapse
Affiliation(s)
- Yaohua Wang
- Electrical and Computer Engineering University of Iowa
| | | | | | | | - Xinhua Zhang
- Computer Science University of Illinois at Chicago
| | | | | |
Collapse
|
46
|
He S, Wang J. Development and validation of a web-based version of the Child Oral Health Impact Profile - Preschool version. Int J Paediatr Dent 2021; 31:468-474. [PMID: 32767601 DOI: 10.1111/ipd.12695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/15/2020] [Accepted: 07/16/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND The Child Oral Health Impact Profile - Preschool version (COHIP-PS) is the first validated questionnaire designed to assess the oral health-related quality of life (OHRQoL) of preschool children with varying oral health-related conditions. AIM To cross-culturally adapt the original version of COHIP-PS into Chinese and to assess the psychometric properties of a web-based version of the COHIP-PS (eCOHIP-PS/C). DESIGN The eCOHIP-PS/C was first created using current guidelines. Then, the eCOHIP-PS/C was administered to caregivers having children 2-5 years old. The reliability of the eCOHIP-PS/C was estimated using Cronbach's alpha and the intraclass correlation coefficients (ICC). Cross-cultural validity and convergent validity were also investigated. RESULTS The study included 260 children (mean age 4.3 years). Cronbach's alpha of eCOHIP-PS/C was 0.903 and the ICC of the scale was 0.862. Confirmatory factor analysis (CFA) demonstrated that a four-component model was the best solution for the eCOHIP-PS/C. The fit indices were as follows: χ2 /df = 2.176, TLI = 0.942, CFI = 0.946, GFI = 0.927, and RMSEA = 0.075. In addition, a good relationship was found between the eCOHIP-PS/C and the global oral health question. CONCLUSION The eCOHIP-PS/C is a reliable and valid tool for assessing the OHRQoL among Chinese preschool children.
Collapse
Affiliation(s)
- Songlin He
- College of Stomatology, Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China.,Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Jinhua Wang
- College of Stomatology, Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China.,Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| |
Collapse
|
47
|
Uhrenholt L, Christensen R, Dreyer L, Schlemmer A, Hauge EM, Krogh NS, Abildtoft MK, Taylor PC, Kristensen S. Using a novel smartphone application for capturing of patient-reported outcome measures among patients with inflammatory arthritis:A randomized, crossover, agreement study. Scand J Rheumatol 2021; 51:25-33. [PMID: 34151710 DOI: 10.1080/03009742.2021.1907925] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objectives: In Denmark, patients with inflammatory arthritis (IA) have completed patient-reported outcome measures (PROMs) via touchscreens in the outpatient clinic since 2006. However, current technology makes it possible for patients to use their own smartphone via an application (app) developed for the Danish Rheumatology Database (DANBIO). This study aims to evaluate the agreement of PROMs between the DANBIO app and outpatient touchscreen in patients with IA.Method: Patients with IA (rheumatoid arthritis, psoriatic arthritis, and axial spondyloarthritis) were enrolled in a randomized, crossover, agreement study. Participants answered PROMs through the two device types in a randomized order. Differences in PROM scores with 95% confidence intervals (CIs) were evaluated for similarity according to prespecified equivalence margins.Results: The touchscreen invitation was accepted by 138 patients. Sixty patients (20 with each diagnosis) were included. The difference in Health Assessment Questionnaire Disability Index between the two device types was -0.007 (95% CI -0.043 to 0.030); thus, equivalence was demonstrated. In addition, all other PROMs obtained with the two device types were equivalent, except for the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), which was within the limits of minimally clinically important difference (MCID). In total, 78.3% preferred the DANBIO app.Conclusion: In patients with IA, equivalence was demonstrated between two device types for all PROMs except BASDAI; however, BASDAI was within the limits of the MCID. Implementation of the DANBIO app is expected to optimize outpatient visits, thereby improving healthcare for the individual patient and society.
Collapse
Affiliation(s)
- L Uhrenholt
- Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Musculoskeletal Statistics Unit, The Parker Institute, Frederiksberg Hospital, Copenhagen, Denmark.,The DANBIO Registry, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Glostrup, Denmark
| | - R Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Frederiksberg Hospital, Copenhagen, Denmark.,Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - L Dreyer
- Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - A Schlemmer
- Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark
| | - E-M Hauge
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | | | - P C Taylor
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - S Kristensen
- Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| |
Collapse
|
48
|
Aiyegbusi OL, Nair D, Peipert JD, Schick-Makaroff K, Mucsi I. A narrative review of current evidence supporting the implementation of electronic patient-reported outcome measures in the management of chronic diseases. Ther Adv Chronic Dis 2021; 12:20406223211015958. [PMID: 34104376 PMCID: PMC8150668 DOI: 10.1177/20406223211015958] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 04/20/2021] [Indexed: 12/14/2022] Open
Abstract
An application of telemedicine of growing interest and relevance is the use of personal computers and mobile devices to collect patient-reported outcomes (PROs). PROs are self-reports of patients' health status without interpretation by anyone else. The tools developed to assess PROs are known as patient-reported outcomes measures (PROMs). The technological innovations that have led to an increased ownership of electronic devices have also facilitated the development of electronic PROMs (ePROMs). ePROMs are a conduit for telemedicine in the care of patients with chronic diseases. Various studies have demonstrated that the use of ePROMs in routine clinical practice is both acceptable and feasible with patients increasingly expressing a preference for an electronic mode of administration. There is increasing evidence that the use of electronic patient-reported outcome (ePROMs) could have significant impacts on outcomes valued by patients, healthcare providers and researchers. Whilst the development and implementation of these systems may be initially costly and resource-intensive, patient preferences and existing evidence to support their implementation suggests the need for continued research prioritisation in this area. This narrative review summarises and discusses evidence of the impact of ePROMs on clinical parameters and outcomes relevant to chronic diseases. We also explore recently published literature regarding issues that may influence the robust implementation of ePROMs for routine clinical practice.
Collapse
Affiliation(s)
- Olalekan Lee Aiyegbusi
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK National Institute for Health Research (NIHR) Applied Research Centre, West Midlands, UK
| | - Devika Nair
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN, USA Vanderbilt O’Brien Center for Kidney Disease, Nashville, TN, USA
| | - John Devin Peipert
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Istvan Mucsi
- Multiorgan Transplant Program, University Health Network and Division of Nephrology, Department of Medicine, University of Toronto, ON, Canada
| |
Collapse
|
49
|
Yu JY, Goldberg T, Lao N, Feldman BM, Goh YI. Electronic forms for patient reported outcome measures (PROMs) are an effective, time-efficient, and cost-minimizing alternative to paper forms. Pediatr Rheumatol Online J 2021; 19:67. [PMID: 33941208 PMCID: PMC8091685 DOI: 10.1186/s12969-021-00551-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 04/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient reported outcome measures (PROMs) provide valuable insight on patients' well-being and facilitates communication between healthcare providers and their patients. The increased integration of the technology within the healthcare setting presents the opportunity to collect PROMs electronically, rather than on paper. The Childhood Health Assessment Questionnaire (CHAQ) and Quality of My Life (QoML) are common PROMs collected from pediatric rheumatology patients. The objectives of this study are to (a) determine the equivalence of the paper and electronic forms (e-form) of CHAQ and QoML questionnaires; (b) identify potential benefits and barriers associated with using an e-form to capture PROMs; and (c) gather feedback on user experience. METHODS Participants completed both a paper and an e-form of the questionnaires in a randomized order, following which they completed a feedback survey. Agreement of the scores between the forms were statistically analyzed using the intraclass correlation coefficient (ICC) (95 % Confidence Interval (CI)) and bias was assessed using a Bland-Altman plot. Completion and processing times of the forms were compared using mean and median measures. Quantitative analysis was performed to assess user experience ratings, while comments were qualitatively analyzed to identify important themes. RESULTS 196 patients participated in this project. Scores on the forms had high ICC agreement > 0.9. New patients took longer than returning patients to complete the forms. Overall, the e-form was completed and processed in a shorter amount of time than the paper form. 83 % of survey respondents indicated that they either preferred the e-form or had no preference. Approximately 10 % of respondents suggested improvements to improve the user interface. CONCLUSIONS E-forms collect comparable information in an efficient manner to paper forms. Given that patients and caregivers indicated they preferred completing PROMs in this manner, we will implement their suggested changes and incorporate e-forms as standard practice for PROMs collection in our pediatric rheumatology clinic.
Collapse
Affiliation(s)
- Jennifer Y. Yu
- The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8 Canada
| | - Talia Goldberg
- The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8 Canada
| | - Nicholas Lao
- The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8 Canada
| | - Brian M. Feldman
- The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8 Canada ,Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario Canada ,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario Canada ,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada
| | - Y. Ingrid Goh
- The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8 Canada ,Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario Canada
| |
Collapse
|
50
|
Stausberg J, Harkener S, Semler SC. Recent Trends in Patient Registries for Health Services Research. Methods Inf Med 2021; 60:e1-e8. [PMID: 33862662 PMCID: PMC8294939 DOI: 10.1055/s-0041-1724104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background
Patient registries are an established methodology in health services research. Since more than 150 years, registries collect information concerning groups of similar patients to answer research questions. Elaborated recommendations about an appropriate development and an efficient operation of registries are available. However, the scene changes rapidly.
Objectives
The aim of the study is to describe current trends in registry research for health services research.
Methods
Registries developed within a German funding scheme for model registries in health services research were analyzed. The observations were compared with recent recommendations of the Agency for Healthcare Research and Quality (AHRQ) on registries in the 21st century.
Results
Analyzing six registries from the funding scheme revealed the following trends: recruiting healthy individuals, representing familial or other interpersonal relationships, recording of patient-reported experiences or outcomes, accepting participants as study sites, active informing of participants, integrating the registry with other data collections, and transferring data from the registry to electronic patient records. This list partly complies with the issues discussed by the AHRQ. The AHRQ structured its ideas in five chapters, increasing focus on the patient, engaging patients as partners, digital health and patient registries, direct-to-patient registry, and registry networks.
Conclusion
For the near future, it can be said that the concept and the design of a registry should place the patient in the center. Registries will be increasingly linked together and interconnected with other data collections. New challenges arise regarding the management of data quality and the interpretation of results from less controlled settings. Here, further research related to the methodology of registries is needed.
Collapse
Affiliation(s)
- Jürgen Stausberg
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), Faculty of Medicine, University Duisburg-Essen, Essen, Nordrhein-Westfalen, Germany
| | - Sonja Harkener
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), Faculty of Medicine, University Duisburg-Essen, Essen, Nordrhein-Westfalen, Germany
| | - Sebastian C Semler
- TMF Technology, Methods, and Infrastructure for Networked Medical Research, Berlin, Germany
| |
Collapse
|