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Mott NM, Huynh V, Vemuru S, Parris HJ, Colborn K, Ahrendt G, Christian N, Kim S, Matlock DD, Cumbler E, Tevis SEA. Barriers and facilitators to measuring patient reported outcomes in an academic breast cancer clinic: An application of the RE-AIM framework. Am J Surg 2024; 228:180-184. [PMID: 37741803 PMCID: PMC11044988 DOI: 10.1016/j.amjsurg.2023.09.022] [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: 07/13/2023] [Revised: 08/14/2023] [Accepted: 09/13/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND Patient reported outcome measures (PROMs) are important for patient-centered, value-based care; however, implementation into surgical practice remains limited. We aimed to demonstrate feasibility of measuring PROMs in an academic breast cancer clinic. METHODS We conducted a pilot study implementing the patient-reported outcome measure BREAST-Q among patients with Stage 0-III breast cancer at a single institution from 06/2019-03/2023 using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Barriers and facilitators were characterized. Survey completion was assessed pre-operatively and up to 12 months post-operatively. RESULTS Barriers included limited time and lack of incorporation into the electronic medical record. Facilitators included utilizing trained team members and an automated workflow. Among eligible patients, 74% completed BREAST-Q at 2-weeks post-operatively and 55% at 12 months post-operatively. CONCLUSIONS We describe the implementation of a PROM using the RE-AIM framework, highlighting facilitators and barriers that may assist others in collecting patient-reported outcome data.
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Affiliation(s)
- Nicole M Mott
- University of Colorado Anschutz Medical Campus, Department of Surgery, Aurora, CO, USA
| | - Victoria Huynh
- University of Colorado Anschutz Medical Campus, Department of Surgery, Aurora, CO, USA
| | - Sudheer Vemuru
- University of Colorado Anschutz Medical Campus, Department of Surgery, Aurora, CO, USA
| | - Hannah J Parris
- University of Colorado Anschutz Medical Campus, Department of Medicine, Aurora, CO, USA
| | - Kathryn Colborn
- University of Colorado Anschutz Medical Campus, Department of Surgery, Aurora, CO, USA; University of Colorado Cancer Center, Aurora, CO, USA
| | - Gretchen Ahrendt
- University of Colorado Anschutz Medical Campus, Department of Surgery, Aurora, CO, USA; University of Colorado Cancer Center, Aurora, CO, USA
| | - Nicole Christian
- University of Colorado Anschutz Medical Campus, Department of Surgery, Aurora, CO, USA; University of Colorado Cancer Center, Aurora, CO, USA
| | - Simon Kim
- University of Colorado Anschutz Medical Campus, Department of Surgery, Aurora, CO, USA
| | - Daniel D Matlock
- University of Colorado Anschutz Medical Campus, Department of Medicine, Aurora, CO, USA; VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, CO, USA
| | - Ethan Cumbler
- University of Colorado Anschutz Medical Campus, Department of Surgery, Aurora, CO, USA; University of Colorado Anschutz Medical Campus, Department of Medicine, Aurora, CO, USA
| | - Sarah E A Tevis
- University of Colorado Anschutz Medical Campus, Department of Surgery, Aurora, CO, USA; University of Colorado Cancer Center, Aurora, CO, USA.
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Hartman TJ, Nie JW, Anwar FN, Roca AM, Loya AC, Medakkar SS, MacGregor KR, Oyetayo OO, Zheng E, Federico VP, Massel DH, Sayari AJ, Lopez GD, Singh K. Impact of Preoperative Symptom Duration on Patient-reported Outcomes After Minimally Invasive Transforaminal Interbody Fusion for Degenerative Spondylolisthesis. Clin Spine Surg 2024:01933606-990000000-00252. [PMID: 38245808 DOI: 10.1097/bsd.0000000000001560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 11/29/2023] [Indexed: 01/22/2024]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To assess the impact of preoperative symptom duration (PSD) on patient-reported outcome measures (PROMs) after minimally invasive (MIS) transforaminal lumbar interbody fusion (TLIF) for degenerative spondylolisthesis (DSpond). BACKGROUND A prolonged duration of preoperative symptoms may implicate inferior long-term outcomes postsurgery. Prior studies of lumbar fusion recipients are limited by the inclusion of heterogeneous populations. METHODS A single-surgeon registry was retrospectively queried for privately insured patients who had undergone primary, elective, single-level MIS-TLIF for DSpond with a recorded symptom start date. Cohorts were formed by PSD: shorter duration (PSD <1 y) or greater duration (GD; PSD ≥1 y). PROMs evaluated included Patient-reported Outcomes Measurement Information System-Physical Function, Oswestry Disability Index, Visual Analog Scale-Back, Visual Analog Scale-Leg, and 9-item Patient Health Questionnaire. The magnitude of PROM (∆PROM) improvement from preoperative baseline to 6 weeks and final follow-up (∆PROM-FF) were compared between cohorts. Intercohort achievement rates of a minimum clinically important difference in each PROM were compared. RESULTS A total of 133 patients included 85 patients with GD cohort. There were no significant differences in pre hoc demographics and perioperative characteristics between cohorts, as well as preoperative, 6-week, or final follow-up PROMs between cohorts. Both cohorts demonstrated significant improvement in all PROMs at 6 weeks and final follow-up (P ≤ 0.049, all). There were no significant intercohort differences demonstrated in minimum clinically important difference achievement rates, ∆PROM-6W, or ∆PROM-FF in any PROM. CONCLUSIONS Regardless of the symptom duration before MIS-TLIF for DSpond, patients demonstrate significant improvement in physical function, pain, disability, and mental health. Patients with a GD of preoperative symptoms did not report inferior scores in any PROM domain. Patients with a GD of preoperative symptoms did not suffer inferior rates of clinically meaningful improvement after surgical intervention. These findings should be considered when counseling patients before surgical intervention for DSpond.
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Affiliation(s)
- Timothy J Hartman
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
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Schroeder H, Israeli A, Liebergall M, Or O, Abu Ahmad W, Paltiel O, Justo D, Zimlichman E. Utilising patient-reported outcomes for goal-directed therapy of hip fracture patients: a sequential controlled trial. BMJ Open Qual 2023; 12:e002402. [PMID: 38154820 PMCID: PMC10759100 DOI: 10.1136/bmjoq-2023-002402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 12/02/2023] [Indexed: 12/30/2023] Open
Abstract
BACKGROUND Hip fracture patients (HFPs) frequently have multiple underlying conditions, necessitating that agreed-upon goals take these complications into consideration. Communication regarding goals between medical-personnel and patients is not always effective. Patient-reported outcomes (PROs) can outline personal goals and help promote quality health care in HFPs. Few studies have been published on this topic. The study's aim was to outline the process of using PROs for goal-directed therapy among HFPs. METHODS This sequential controlled trial was conducted among HFPs from two medical centres. The control and the intervention group received integrative rehabilitation. PROs were measured in both groups using the SF36 questionnaire three times postsurgery: 24-48 hours, 2 weeks and 3 months. During the first round of questioning, only the intervention group was asked 'what matters most to you?' during the rehabilitative process. Accordingly, agreed-upon goals that were determined by the SF36's eight topics and were incorporated into the HFP's rehabilitative process. A Likert scale of 1-5, '1' indicating no-achievement and '5' full-achievement, was used to assess the goal achievement 4-6 months post-fracture. RESULTS 84 HFPs participated in the study: 40 and 44 in the intervention and control group, respectively. In both groups, PROs declined after the HF, then improved somewhat 3 months later, but did not return to prefracture scores. Among the intervention group, 39% reached their specific goals (Likert level 5). Patients who achieved their goals had better PROs in comparison to others. The intervention group indicated PROs helped them articulate their desires and introduced them to new areas of care. CONCLUSIONS Shifting from asking 'what's the matter?' to 'what matters most to you?' can improve the understanding of HFPs' own priorities, promote quality outcomes and enhance patient-centred care. Using PROs as a guide for goal-directed therapy can create a more inclusive process that includes the patients' most important health determinants and needs.
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Affiliation(s)
- Hanna Schroeder
- School of Nursing in the Faculty of Medicine, Henrietta Szold Hadassah, Hebrew University of Jerusalem, Jerusalem, Israel
- Strategic and Economic Planning Administration, Israel Ministry of Health, Jerusalem, Israel
| | - Avi Israeli
- Dr. Julien Rozan Professor of Healthcare, Hebrew University - Hadassah Medical School, Jerusalem, Israel
- Office of the Chief Scientist, Israel Ministry of Health, Jerusalem, Israel
- Hadassah University Medical Center, Jerusalem, Israel
| | - Meir Liebergall
- Orthopedic Department of Surgery, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Omer Or
- Orthopedic Department of Surgery, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Wiessam Abu Ahmad
- Braun School of Public Health, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ora Paltiel
- Braun School of Public Health, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dan Justo
- Geriatrics Division, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Eyal Zimlichman
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Central Management, Sheba Medical Center at Tel Hashomer, Tel Hashomer, Israel
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Chiche L, Yang HK, Abbassi F, Robles-Campos R, Stain SC, Ko CY, Neumayer LA, Pawlik TM, Barkun JS, Clavien PA. Quality and Outcome Assessment for Surgery. Ann Surg 2023; 278:647-654. [PMID: 37555327 DOI: 10.1097/sla.0000000000006077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
ABSTRACT This forum summarizes the proceedings of the joint European Surgical Association (ESA)/American Surgical Association (ASA) symposium on Quality and Outcome Assessment for Surgery that took place in Bordeaux, France, as part of the celebrations of the 30th anniversary of the ESA. Three presentations focused on a) the main messages from the Outcome4Medicine Consensus Conference, which took place in Zurich, Switzerland, in June 2022, b) the patient perspective, and c) benchmarking were hold by ESA members and discussed by ASA members in a symposium attended by members of both associations.
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Affiliation(s)
| | - Han-Kwang Yang
- Seoul National University College of Medicine, Seoul, Republic of Korea
| | | | | | | | - Clifford Y Ko
- University of California at Los Angeles and the American College of Surgeons, Los Angeles, CA
| | - Leigh A Neumayer
- University of Florida, College of Medicine-Jacksonville, Jacksonville, FL
| | | | - Jeffrey S Barkun
- Department of Surgery, Faculty of Medicine, McGill University, Montreal, QC, Canada
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Bekmuratova S, Bahle-Lampe A, Pflaster T. Physical therapists' experience using focus on therapeutic outcome in outpatient clinics: A qualitative study. Health Serv Manage Res 2023; 36:240-248. [PMID: 35943297 DOI: 10.1177/09514848221118749] [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] [Indexed: 11/16/2022]
Abstract
While patient-reported outcomes measures (PROMs) are used in many practice settings as a standardized system of outcome measures, various factors may impact the meaningful use of PROMs by clinicians operating in various settings. Very limited research exists that focused on examining the use of FOTO® in outpatient rehabilitation settings. This study aimed to explore the barriers and facilitators in achieving FOTO® treatment completion rates and patient functional outcomes among physical therapists. Additionally, the study aimed to explore the internal acceptance of FOTO as a useful tool in rehabilitation from the perspectives of physical therapists. Qualitative data were collected through four focus group interviews with physical therapists at outpatient rehabilitation clinics. The interviews were audio-recorded and transcribed, and transcribed, and qualitative content analysis was applied for data analysis. Four major themes emerged from qualitative data analyses including (a) use of FOTO® in clinical practice, (b) reasons why the FOTO® process may not be followed, (c), therapists' perceptions of FOTO®, and (d) perceived barriers and enablers related to FOTO®. The study concluded that multi-level determinants impact the successful use of FOTO® by therapists in outpatient rehabilitation settings. The findings have important implications for clinical practice, organizational leaders, and PROM developers.
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Rothrock NE, Wilson SA, Heng M, Hodor A, Joeris A, Kaat AJ, McKelvey K, Schalet BD, Vrahas M. Using bookmarking methods with orthopedic clinicians and patients with fractures produces score interpretation labels for patient-reported outcome measures. Qual Life Res 2023; 32:2779-2787. [PMID: 37227662 PMCID: PMC10474193 DOI: 10.1007/s11136-023-03439-5] [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] [Accepted: 05/14/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The objective of this study was to determine the patient-reported outcome measure (PROM) score ranges associated with descriptive labels (i.e., within normal limits, mild, moderate, severe) by using bookmarking methods with orthopedic clinicians and patients who have experienced a bone fracture. STUDY DESIGN AND SETTING We created vignettes comprised of six items and responses from the Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity Function, Physical Function, and Pain Interference item banks reflecting different levels of severity. Two groups of patients with fractures (n = 11) and two groups of orthopedic clinicians (n = 16) reviewed the vignettes and assigned descriptive labels independently and then discussed as a group until reaching consensus via a videoconference platform. RESULTS PROMIS Physical Function and Pain Interference thresholds (T = 50, 40, 25/30 and T = 50/55, 60, 65/70, respectively) for patients with bone fractures were consistent with the results from other patient populations. Upper Extremity thresholds were about 10 points (1 SD) more severe (T = 40, 30, 25/20) compared to the other measures. Patient and clinician perspectives were similar. CONCLUSION Bookmarking methods generated meaningful score thresholds for PROMIS measures. These thresholds between severity categories varied by domain. Threshold values for severity represent important supplemental information to interpret PROMIS scores clinically.
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Affiliation(s)
- Nan E Rothrock
- Feinberg School of Medicine of Northwestern University, Chicago, IL, USA.
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave, Suite 2700, Chicago, IL, 60611, USA.
| | - Sandra A Wilson
- Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - Marilyn Heng
- Department of Orthopaedics, University of Miami Miller School of Medicine, Miami, FL, USA
- Orthopaedic Trauma Service, Ryder Trauma Center, Jackson Memorial Hospital, Miami, FL, USA
| | - Aleksandra Hodor
- AO Innovation Translation Center, AO Foundation, Dubendorf, Switzerland
| | - Alexander Joeris
- AO Innovation Translation Center, AO Foundation, Dubendorf, Switzerland
| | - Aaron J Kaat
- Feinberg School of Medicine of Northwestern University, Chicago, IL, USA
| | - Karma McKelvey
- Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Benjamin D Schalet
- Feinberg School of Medicine of Northwestern University, Chicago, IL, USA
| | - Mark Vrahas
- Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Snowdon DA, Srikanth V, Beare R, Noeske KE, Le E, O'Bree B, Andrew NE. Acceptability of the routine use and collection of a generic patient reported outcome measure from the perspective of healthcare staff: a qualitative study. J Patient Rep Outcomes 2023; 7:81. [PMID: 37522943 PMCID: PMC10390450 DOI: 10.1186/s41687-023-00617-4] [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: 11/20/2022] [Accepted: 07/11/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) provide a measure of self-perceived health status or health-related quality of life. They have been used to support provider-patient decisions, healthcare delivery, and value-based healthcare models. A barrier to routine collection of PROMs is the perception that PROMs lack clinical utility. As such, it is important to establish clinicians' acceptability of the PROM prior to large-scale implementation. This study explored the acceptability of the routine use and collection of a generic PROM in healthcare services from the perspective of healthcare staff. METHODS Individual semi-structured interviews were completed from September 2020 to March 2021 with 26 staff from two multi-disciplinary community healthcare services in Melbourne, Australia. Interviews explored their experiences of using the EQ-5D-5L in their routine care. Interviews were recorded and transcribed verbatim. Data were analysed according to a framework approach, using inductive and deductive techniques. RESULTS Participants discussed the acceptability of the EQ-5D-5L with reference to four themes: practicalities of use; holistic nature; influence on client care; and influence on health service. Participants found the EQ-5D-5L quick and easy to administer, and appreciated that it measured multiple domains of health that were relevant to their clients' care. They believed the EQ-5D-5L helped to identify client problems, and inform service delivery. They also reported features that were less acceptable, including a lack of item specificity to some healthcare disciplines. Participants reported the challenge of managing conflict between their assessment of the client's health and the client's perspective of their own health, leading some to question whether the client could provide an accurate reflection of their own health. CONCLUSIONS The EQ-5D-5L has several features that healthcare staff viewed as acceptable for routine collection and use in healthcare. Training on the validity of the patient reported perspective and broadening the scope of PROMs collection beyond the EQ-5D-5L should be considered to facilitate large-scale implementation.
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Affiliation(s)
- David A Snowdon
- National Centre for Healthy Ageing, Melbourne, VIC, Australia.
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, VIC, Australia.
- Academic Unit, Peninsula Health, Frankston, VIC, Australia.
| | - Velandai Srikanth
- National Centre for Healthy Ageing, Melbourne, VIC, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Academic Unit, Peninsula Health, Frankston, VIC, Australia
| | - Richard Beare
- National Centre for Healthy Ageing, Melbourne, VIC, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Academic Unit, Peninsula Health, Frankston, VIC, Australia
- Developmental Imaging, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Kate E Noeske
- Academic Unit, Peninsula Health, Frankston, VIC, Australia
| | - Elizabeth Le
- National Centre for Healthy Ageing, Melbourne, VIC, Australia
- Academic Unit, Peninsula Health, Frankston, VIC, Australia
| | - Bridget O'Bree
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Academic Unit, Peninsula Health, Frankston, VIC, Australia
| | - Nadine E Andrew
- National Centre for Healthy Ageing, Melbourne, VIC, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Academic Unit, Peninsula Health, Frankston, VIC, Australia
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Riddle DL. KOOS score maps were externally validated to inform knee arthroplasty shared decision making. Knee Surg Sports Traumatol Arthrosc 2023; 31:1491-1499. [PMID: 36622418 PMCID: PMC10065897 DOI: 10.1007/s00167-023-07315-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/04/2023] [Indexed: 01/10/2023]
Abstract
PURPOSE The Knee injury and Osteoarthritis Outcome Survey (KOOS) profile of outcome measures are among the most commonly used outcome measures in knee arthroplasty (KA). The purpose was to develop and externally validate "score maps" (one-page figural depictions of most likely scores) for KOOS Pain and Function subscales to facilitate a variety of clinical decisions related to shared decision making prior to KA. METHODS Presurgical KA data collected within 1 year of surgery and obtained in two independent studies were used in this cross-sectional study. Score maps were designed to be easily understandable, single-page graphical depictions of predicted KOOS Pain, and KOOS Function, daily activity subscales. To create the score maps, individual item scores from one dataset were used to determine the most probable responses for each item for the entire range of possible scores. Predicted KOOS score maps were derived from Osteoarthritis Initiative (OAI) data and externally validated using an independent single site KA cohort study. Score map predicted scores from OAI were compared to actual presurgical KOOS subscale scores using Weighted Kappa (Κw) agreement coefficients and actual versus predicted differences in scores. RESULTS The score maps derived from OAI and applied to actual scores in the validation sample demonstrated moderate to substantial chance-corrected agreement for both KOOS Pain and KOOS Function, daily activity subscale items. For example, KOOS Pain score map scores applied to the external validation dataset showed chance-corrected agreement with Κw ranging from 0.43 to 0.73. Score maps predicted actual item scores within ± 1 point at least 94% of the time. Findings for the KOOS Function, daily activity subscale items were similar. CONCLUSIONS Score maps derived from OAI data agreed with actual KOOS scores obtained on an independent dataset at an acceptable degree of precision. Easy-to-use KOOS Pain and Function, daily activity score maps have potential to facilitate a variety of important clinical decisions during discussions between patients and surgeons prior to KA. LEVEL OF EVIDENCE Level III prognostic study.
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Affiliation(s)
- Daniel L Riddle
- Departments of Physical Therapy, Orthopaedic Surgery and Rheumatology, Virginia Commonwealth University, 900 East Leigh Street, Fourth Floor, Room 100, Richmond, VA, USA.
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Hyland CJ, Mou D, Virji AZ, Sokas CM, Bokhour B, Pusic AL, Mjåset C. How to make PROMs work: qualitative insights from leaders at United States hospitals with successful PROMs programs. Qual Life Res 2023:10.1007/s11136-023-03388-z. [PMID: 36928649 PMCID: PMC10018634 DOI: 10.1007/s11136-023-03388-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE Elucidate facilitators, barriers, and key lessons learned regarding the implementation of system-wide clinical patient-reported outcome measure (PROM) programs among United States (US) healthcare leaders. METHODS We conducted semi-structured interviews with 35 US healthcare leaders, including chief-level executives, data directors, PROM directors, and department chairs involved in PROM implementation across seven diverse healthcare systems from February to June 2020. Transcripts were coded, evaluated for qualitative themes, and categorized according to the consolidated framework for implementation research (CFIR). RESULTS According to US hospital leaders with experience in existing clinical PROM programs, there are facilitators and barriers to implementation success in each CFIR domain. Allowing clinicians to select PROM measures and ensuring a user-friendly data platform (intervention); adapting data collection to patient home environments (outer setting); informing clinicians of the multi-faceted use of PROM data for research, clinical care, and business (inner setting); implementing PROM education earlier into clinician training (characteristics of individuals); and establishing specialty-agnostic PROM implementation teams (process) were among key facilitators to implementation success. CONCLUSION Leaders of geographically and clinically diverse PROM programs in the US identify common themes that facilitate successful implementation. Drivers of success depend on factors within and outside the clinical environment. These findings may serve to guide both establishing new PROM programs and refining existing PROM programs.
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Affiliation(s)
| | - Danny Mou
- Department of Surgery, Emory University, Atlanta, Georgia
| | | | - Claire M Sokas
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Barbara Bokhour
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | | | - Christer Mjåset
- Harvard T.H. Chan School of Public Health, Boston, MA, USA.,The Commonwealth Fund, 1 E 75th St, New York City, NY, USA
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Pronk Y, van der Weegen W, Schreurs BW, Pilot P. Quality of total hip arthroplasty health care based on four years of patient-reported outcomes in the Netherlands. Health Qual Life Outcomes 2023; 21:24. [PMID: 36918879 PMCID: PMC10011788 DOI: 10.1186/s12955-023-02104-2] [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: 01/23/2023] [Accepted: 02/21/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Joint arthroplasty registries have incorporated patient-reported outcomes (PROs) to evaluate outcomes from a patients' perspective to improve total hip arthroplasty (THA). To draw valid conclusions on PROs, a minimum response rate (RR) of 60% is advised. This study investigated (1) if the quality of THA health care based on PROs improved over the years in the Netherlands, (2) if RRs improved over the years, and (3) difference in PROs over the years in hospitals with RR ≥ 60% compared to RR < 60%. METHODS Longitudinal study with publicly available datasets from 2016 to 2019. Primary outcome was increase/decrease in PRO change scores including 95%CI ranges over the years between preoperatively and 3 months postoperatively (pre-3 m), and 12 months postoperatively (pre-12 m). Improved quality of health care was arbitrary defined as when ≥ 3 of 4 included scores or ranges were statistically significant improved. Secondary outcome was increase/decrease in RRs over the years. Subgroups RR ≥ 60% and RR < 60% were compared. RESULTS Hospitals (%) collecting THA PROs increased from 78 to 92%. EQ VAS change score increased over the years, and 95%CI ranges of EQ VAS, EQ-5D descriptive system and NRS pain during activity decreased over the years at pre-3 m (p < 0.05). All THA pre-12 m PRO change scores and 95%CI ranges remained equal (p > 0.05). Pre-3 m RR remained equal (around 43%, p = 0.107) and pre-12 m RR decreased 9% (49% to 40%, p = 0.008). Pre-3 m subgroup RR ≥ 60% was too small to analyse (5%). No difference was found between pre-12 m subgroups (RR ≥ 60% = 16%), p > 0.05). CONCLUSIONS Quality of THA health care based on PROs seems equal in the Netherlands between 2016 and 2019. Although more hospitals participated in PRO collection, low RRs with large IQRs are observed and only 16% of the hospitals achieved the advised RR ≥ 60%. Multiple recommendations are provided to improve PRO collection and use.
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Affiliation(s)
- Yvette Pronk
- Research Department, Kliniek ViaSana, Hoogveldseweg 1, 5451 AA, Mill, The Netherlands
| | - Walter van der Weegen
- Department of Orthopaedic Surgery, Sports & Orthopaedics Research Centre, Sint Anna Ziekenhuis, Bogardeind 2, 5664 EH, Geldrop, The Netherlands.
| | - Berend Willem Schreurs
- Department of Orthopaedic Surgery, Radboudumc, Geert Grooteplein Zuid 10, 6562 GA, Nijmegen, The Netherlands.,Landelijke Registratie Orthopedische Implantaten (LROI), Bruistensingel 230, 5232 AD, 's-Hertogenbosch, The Netherlands
| | - Peter Pilot
- IMUKA, Kanaalstraat 10, 6116 AD, Roosteren, The Netherlands
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Dunbar P, Keyes LM, Browne JP. Determinants of regulatory compliance in health and social care services: A systematic review using the Consolidated Framework for Implementation Research. PLoS One 2023; 18:e0278007. [PMID: 37053186 PMCID: PMC10101495 DOI: 10.1371/journal.pone.0278007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/13/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND The delivery of high quality care is a fundamental goal for health systems worldwide. One policy tool to ensure quality is the regulation of services by an independent public authority. This systematic review seeks to identify determinants of compliance with such regulation in health and social care services. METHODS Searches were carried out on five electronic databases and grey literature sources. Quantitative, qualitative and mixed methods studies were eligible for inclusion. Titles and abstracts were screened by two reviewers independently. Determinants were identified from the included studies, extracted and allocated to constructs in the Consolidated Framework for Implementation Research (CFIR). The quality of included studies was appraised by two reviewers independently. The results were synthesised in a narrative review using the constructs of the CFIR as grouping themes. RESULTS The search yielded 7,500 articles for screening, of which 157 were included. Most studies were quantitative designs in nursing home settings and were conducted in the United States. Determinants were largely structural in nature and allocated most frequently to the inner and outer setting domains of the CFIR. The following structural characteristics and compliance were found to be positively associated: smaller facilities (measured by bed capacity); higher nurse-staffing levels; and lower staff turnover. A facility's geographic location and compliance was also associated. It was difficult to make findings in respect of process determinants as qualitative studies were sparse, limiting investigation of the processes underlying regulatory compliance. CONCLUSION The literature in this field has focused to date on structural attributes of compliant providers, perhaps because these are easier to measure, and has neglected more complex processes around the implementation of regulatory standards. A number of gaps, particularly in terms of qualitative work, are evident in the literature and further research in this area is needed to provide a clearer picture.
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Affiliation(s)
- Paul Dunbar
- Health Information and Quality Authority, Mahon, Cork, Ireland
| | - Laura M Keyes
- Health Information and Quality Authority, Mahon, Cork, Ireland
| | - John P Browne
- School of Public Health, University College Cork, Cork, Ireland
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Schroeder HS, Israeli A, Liebergall MI, Or O, Andrews CS, Justo D, Zimlichman E. The Suitability of Measuring Patient-Reported Outcomes in Older Adults Following a Hip Fracture Using the Short-Form 36 Questionnaire: A Qualitative Description Approach. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231171819. [PMID: 37183709 DOI: 10.1177/00469580231171819] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Hip-fractures (HF) in older adults are associated with poor outcomes and high costs. Measuring quality-of-care of HF patients has focused on clinical definitions rather than on measuring outcomes that are meaningful to the patient. Healthcare systems worldwide are increasingly interested in patient-reported outcome measures (PROs). The Short-form (SF36) questionnaire is a recommended measure among older adults however it's comprehensiveness and uniqueness for specific patients after a HF is not clear. The aims of this study were to: understand the perspective of the older adults experience following HF, to assess the suitability of the SF36 as a PRO for HF and to determine the best timing for questioning. A qualitative description approach was used. This took place in 2 large academic medical-centers in Israel. The inquiry was done in 2 parts by semi-structured interview. A total 15 HF patients were interviewed. Categories and themes emerging from their responses were similar to the 8 domains of the SF36 questionnaire, but the participants added clarity regarding their own needs for setting goals. In the second part, participants agreed that the SF36 reflected common issues and served as an adequate measure for personal-goal setting. The study encourages patient-centered care in older adults recovering from HF, providing evidence that the SF36 is a suitable tool for measuring PROs in HF patients. Healthcare systems focus on clinical-outcome indicators and do not reflect how the patient views his outcomes. This study provides evidence that care should be customized for each person.
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Affiliation(s)
- Hanna S Schroeder
- Braun School of Public Health, the Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Avi Israeli
- Dr. Julien Rozan Professor of Family Medicine and Health Promotion, Hebrew University - Hadassah Medical School
- Department of Health Policy, Health Care Management and Health Economics, Hebrew University - Hadassah Faculty of Medicine
- Chief Scientist, Israel Ministry of Health
| | - Meir Iri Liebergall
- Orthopedic Department of Surgery, Hadassah Medical Center, Hebrew University, Jerusalem Israel
| | - Omer Or
- Orthopedic Department of Surgery, Hadassah Medical Center, Hebrew University, Jerusalem Israel
| | | | - Dan Justo
- Geriatics Department, Sheba Medical Center, Ramat-Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eyal Zimlichman
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Central Management,Sheba Medical Center, Ramat-Gan, Israel
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Development of a score map to guide interpretation of WOMAC Pain scores prior to knee arthroplasty. Knee 2022; 39:153-160. [PMID: 36202019 DOI: 10.1016/j.knee.2022.09.011] [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: 05/10/2022] [Revised: 08/10/2022] [Accepted: 09/18/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Scores from patient reported outcome measures (PROMs) are challenging to interpret for both clinicians and patients. PROMs obtained prior to knee arthroplasty (KA) could be used to inform important decisions related to KA made by both patients and clinicians. The purpose of this study was to develop a "score map" to allow for efficient and meaningful use of PROMs scores for patients considering KA. METHODS Knee arthroplasty data obtained between one day and twelve months preoperatively from two multicenter studies were combined and used to develop and test the accuracy of a Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain Scale score map. To develop the score map, individual item scores were used to determine the most probable responses to items for the entire range of possible WOMAC Pain scores. Predicted WOMAC Pain scores, using the most probable response for each possible score on the score map, were compared to actual presurgical WOMAC Pain scores using Weighted Kappa (Κw) agreement coefficients. The score map is an easy-to-use graphical display of the entire range of WOMAC Pain scores from no pain to extreme pain for each item comprising the WOMAC Pain scale. RESULTS Data from 780 patients were used in the analyses. The score map predicted WOMAC Pain scores and showed substantial agreement with actual WOMAC Pain scores Κw = 0.68 (95 %CI = 0.58, 0.77) to Κw = 0.77 (95 % CI = 0.75, 0.79). Perfect prediction of actual scores occurred between 55.1 % and 62.5 % of the time for all WOMAC Pain items. CONCLUSION The WOMAC Pain score map has potential for facilitating a variety of important clinical decisions and discussions between patients and practitioners during healthcare encounters related to KA candidacy. For example, by comparing a patents' scores to literature-based estimates, patients may better understand how their WOMAC Pain scores compare to other persons who underwent KA, how much a score may change, on average, after surgery and whether this change might be acceptable to them.
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The smallest worthwhile effect is superior to the MCID for estimating acceptable benefits of knee arthroplasty. J Clin Epidemiol 2022; 152:201-208. [PMID: 36404574 DOI: 10.1016/j.jclinepi.2022.10.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/05/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVES Traditionally, the minimal clinically important difference (MCID) is used to judge the meaningfulness of outcomes in total knee arthroplasty (TKA). However, MCID estimates do not consider patient costs, potential side effects, and inconveniences. MCIDs vary substantially across TKA studies and have several conceptual and psychometric problems. A more scientifically sound alternative for estimating benefits patients expect TKA is the smallest worthwhile effect (SWE), measured with the benefit-harm trade-off method. METHODS We recruited 121 participants and followed them for 6 months after surgery. All participants completed Knee Injury and Osteoarthritis Score (KOOS) Pain and Function, and underwent an interview using the benefit-harm trade-off method. RESULTS The absolute SWE at the 50th percentile (approximating the average patient) was 31 points KOOS Pain improvement and 28 points for KOOS Function, daily living. Construct validity was supported with strong associations between meeting SWE (yes or no) and satisfaction with 6-month outcome (yes or no) using Pearson Chi Square (24.5, P < 0.001). CONCLUSION Current MCID-based methods for interpreting KOOS change scores have flaws while the SWE method is conceptually superior. We determined the SWE of TKA that would justify the costs, risks, and inconveniences of surgery. SWE estimates suggest that patients expect a substantially greater change in KOOS scores than would be expected using MCID estimates. Clinicians can use SWE estimates when discussing likely outcomes and potential TKA benefits and risks with their patients.
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Ziegenfuss JY, Grossman ES, Solberg LI, Chrenka EA, Werner A, Asche SE, Norton CK, Nelson A, Reams M, Whitebird RR. Is the Promise of PROMs Being Realized? Implementation Experience in a Large Orthopedic Practice. Am J Med Qual 2022; 37:489-494. [PMID: 36314931 DOI: 10.1097/jmq.0000000000000079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Patient-reported outcome measures (PROMs), increasingly used for research and quality measurement, are lauded for their potential to improve patient-centered care, both through aggregate reporting and when integrated into clinical practice. However, there are few published studies of the resultant use of PROMs in clinical practice. This case study describes the implementation and use of PROMS in a Midwestern multispecialty medical group orthopedic practice among patients undergoing total knee and hip surgery. Specifically, rates of PROMs use by care teams are tracked over time once made available in the electronic health record. During this time, the orthopedics department achieved a patient PROMS survey response rate of 68% at baseline, 58% 3 months post-surgery, and 55% 12 months post-surgery. However, these data were only accessed by the care teams for fewer than 1% of associated clinical encounters. This suggests that making PROMs available for care team review in the electronic health record, even when coupled with relatively high response rates from patients and departmental leadership support is not enough to encourage integration of PROMs into clinical care for patients. Additional effort is required to identify barriers to PROMs use in clinical care and to test methods to enhance use.
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Affiliation(s)
| | | | | | | | - Ann Werner
- HealthPartners Institute, Minneapolis, MN
| | | | - Christine K Norton
- Patient Advocate and Independent Patient Research Consultant, Cottage Grove, MN
| | | | | | - Robin R Whitebird
- Morrison Family College of Health, School of Social Work, University of St. Thomas, St. Paul, MN
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Bernstein DN, Calfee RP, Hammert WC, Rozental TD, Witkowski ML, Porter ME. Value-Based Health Care in Hand Surgery: Where Are We & Where Do We Go From Here? J Hand Surg Am 2022; 47:999-1004. [PMID: 35941002 DOI: 10.1016/j.jhsa.2022.06.019] [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: 01/03/2022] [Revised: 04/17/2022] [Accepted: 06/21/2022] [Indexed: 02/02/2023]
Abstract
Health care delivery is broken. The cost of care continues to skyrocket and the outcomes most important to patients are often a mystery. Further, care is often delivered via a fee-for-service model where surgeons are rewarded for the quantity, not the quality, of services provided. Such a health care delivery system is not sustainable and does not incentivize stakeholders to focus on the most important element of the health care delivery "puzzle": the patient. Fortunately, we are in the midst of transforming our health care delivery system, with a focus on optimizing the value of care delivery (ie, health outcomes achieved per dollar spent across a full care cycle). In hand surgery, progress has been made as part of this health system evolution. However, there remains much to accomplish. In this article, the authors review the 6 components of a strategic agenda for moving to a high-value health care delivery system for hand surgery, focusing on where we are today and where we need to go from here.
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Affiliation(s)
- David N Bernstein
- Harvard Combined Orthopaedic Residency Program, Massachusetts General Hospital, Boston, MA; Institute for Strategy & Competitiveness, Harvard Business School, Boston, MA.
| | - Ryan P Calfee
- Department of Orthopedic Surgery, Washington University School of Medicine, St Louis, MO
| | - Warren C Hammert
- Department of Orthopaedics & Physical Performance, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Tamara D Rozental
- Carl J. Shapiro Department of Orthopaedics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Mary L Witkowski
- Institute for Strategy & Competitiveness, Harvard Business School, Boston, MA
| | - Michael E Porter
- Institute for Strategy & Competitiveness, Harvard Business School, Boston, MA
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Surgeon Engagement with Patient-Reported Measures in Australian and Aotearoa New Zealand Bariatric Practices. Obes Surg 2022; 32:3410-3418. [PMID: 35974291 PMCID: PMC9532331 DOI: 10.1007/s11695-022-06237-z] [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: 03/17/2022] [Revised: 07/27/2022] [Accepted: 08/04/2022] [Indexed: 10/30/2022]
Abstract
PURPOSE Patient-reported measures are an important emerging metric in outcome monitoring; however, they remain ill-defined and underutilized in bariatric clinical practice. This study aimed to determine the characteristics of patient-reported measures employed in bariatric practices across Australia and Aotearoa New Zealand, including barriers to their implementation and to what extent clinicians are receptive to their use. METHODS An online survey was distributed to all bariatric surgeons actively contributing to the Australian and Aotearoa New Zealand Bariatric Surgery Registry (n = 176). Participants reported their use of patient-reported measures and identified the most important and useful outcomes of patient-reported data for clinical practice. RESULTS Responses from 64 participants reported on 120 public and private bariatric practices across Australia and Aotearoa New Zealand. Most participants reported no collection of any patient-reported measure (39 of 64; 60.9%), citing insufficient staff time or resources as the primary barrier to the collection of both patient-reported experience measures (34 of 102 practices; 33.3%) and patient-reported outcome measures (30 of 84 practices; 35.7%). Participants indicated data collection by the Registry would be useful (47 of 57; 82.5%), highlighting the most valuable application to be a monitoring tool, facilitating increased understanding of patient health needs, increased reporting of symptoms, and enhanced patient-physician communication. CONCLUSION Despite the current lack of patient-reported measures, there is consensus that such data would be valuable in bariatric practices. Widespread collection of patient-reported measures by registries could improve the collective quality of the data, while avoiding implementation barriers faced by individual surgeons and hospitals.
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Mou D, Mjaset C, Sokas CM, Virji A, Bokhour B, Heng M, Sisodia RC, Pusic AL, Rosenthal MB. Impetus of US hospital leaders to invest in patient-reported outcome measures (PROMs): a qualitative study. BMJ Open 2022; 12:e061761. [PMID: 35793919 PMCID: PMC9260769 DOI: 10.1136/bmjopen-2022-061761] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Though hospital leaders across the USA have invested significant resources in collection of patient-reported outcome measures (PROMs), there are very limited data on the impetus for hospital leadership to establish PROM programmes. In this qualitative study, we identify the drivers and motivators of PROM collection among hospital leaders in the USA. DESIGN Exploratory qualitative study. SETTING Thirty-seven hospital leaders representing seven different institutions with successful PROMs programs across twenty US states. METHODS Semistructured interviews conducted with hospital leaders. Transcripts were analysed using thematic analysis. RESULTS Leaders strongly believe that collecting PROMs is the 'right thing to do' and that the culture of the institution plays an important role in enabling PROMs. The study participants often believe that their institutions deliver superior care and that PROMs can be used to demonstrate the value of their services to payors and patients. Direct financial incentives are relatively weak motivators for collection of PROMs. Most hospital leaders have reservations about using PROMs in their current state as a meaningful performance metric. CONCLUSION These findings suggest that hospital leaders feel a strong moral imperative to collect PROMs, which is also supported by the culture of their institution. Although PROMs are used in negotiations with payors, direct financial return on investment is not a strong driver for the collection of PROMs. Understanding why leaders of major healthcare institutions invest in PROMs is critical to understanding the role that PROMs play in the US healthcare system.
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Affiliation(s)
- Danny Mou
- Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Physician Organization, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Christer Mjaset
- Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- Commonwealth Fund, New York, New York, USA
| | - Claire M Sokas
- Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Azan Virji
- Harvard Medical School, Boston, Massachusetts, USA
| | - Barbara Bokhour
- Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Marilyn Heng
- Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rachel C Sisodia
- Physician Organization, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Andrea L Pusic
- Division of Plastic and Reconstructive Surgery, Patient Reported Outcome Value and Experience (PROVE) Center, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Meredith B Rosenthal
- Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA
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19
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Early vs. standard reversal ileostomy: a systematic review and meta-analysis. Tech Coloproctol 2022; 26:851-862. [PMID: 35596904 PMCID: PMC9123394 DOI: 10.1007/s10151-022-02629-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 04/24/2022] [Indexed: 11/28/2022]
Abstract
Background Formation of a defunctioning loop ileostomy is common after mid and low rectal resection. Historically, they were reversed between 3 and 6 months after initial resection. Recently, earlier closure (< 14 days) has been suggested by some current randomised controlled trials. The aim of this study was to investigate the effect of early stoma closure on surgical and patient outcomes. Methods A systematic review of the current randomised controlled trial literature comparing early and standard ileostomy closure after rectal surgery was performed. Specifically, we examined surgical outcomes including; morbidity, mortality and quality of life. Results Six studies met the predefined criteria and were included in our analysis. 275 patients underwent early stoma closure compared with 259 patients having standard closure. Overall morbidity was similar between both groups (25.5% vs. 21.6%) (OR, 1.47; 95% CI 0.75–2.87). However, there tended to be more reoperations (8.4 vs. 4.2%) (OR, 2.02, 95% CI 0.99–4.14) and small bowel obstructions/postoperative ileus (9.3% vs. 4.4%) (OR 0.44, 95% CI 0.22–0.90) in the early closure group, but no difference across the other domains. Conclusions Early closure appears to be a feasible in highly selective cases after good perioperative counselling and shared decision-making. Further research on quality of life outcomes and long term benefits is necessary to help define which patients are suitable candidates for early closure.
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20
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Ortega G, Allar BG, Kaur MN, Edelen MO, Witt EE, Fayanju OM, Telem DA, Wagman LD, Sisodia RC, Powe NR, Pusic AL. Prioritizing Health Equity in Patient-reported Outcome Measurement to Improve Surgical Care. Ann Surg 2022; 275:488-491. [PMID: 34387209 DOI: 10.1097/sla.0000000000005169] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Gezzer Ortega
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Patient-Reported Outcomes, Value & Experience (PROVE) Center, Brigham and Women's Hospital, Boston, MA
| | - Benjamin G Allar
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA
- Harvard T.H. Chan School of Public Health, Boston, MA
| | - Manraj N Kaur
- Patient-Reported Outcomes, Value & Experience (PROVE) Center, Brigham and Women's Hospital, Boston, MA
| | - Maria O Edelen
- Patient-Reported Outcomes, Value & Experience (PROVE) Center, Brigham and Women's Hospital, Boston, MA
| | - Emily E Witt
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Harvard Medical School, Boston, MA
| | - Oluwadamilola M Fayanju
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Dana A Telem
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Lawrence D Wagman
- Department of Surgery, City of Hope National Medical Center, Duarte, CA
| | - Rachel C Sisodia
- Division of Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Mass General Brigham, Somerville, MA
| | - Neil R Powe
- Department of Medicine, Priscilla Chan and Mark Zuckerberg San Francisco General Hospital, University of California San Francisco School of Medicine, San Francisco, CA
| | - Andrea L Pusic
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Patient-Reported Outcomes, Value & Experience (PROVE) Center, Brigham and Women's Hospital, Boston, MA
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Allar BG, Eruchalu CN, Rahman S, Mou D, Ortega G, Reich A, Pusic A, Brook CD, Sisodia R, Bergmark RW. Lost in translation: A qualitative analysis of facilitators and barriers to collecting patient reported outcome measures for surgical patients with limited English proficiency. Am J Surg 2022; 224:514-521. [DOI: 10.1016/j.amjsurg.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/09/2022] [Accepted: 03/01/2022] [Indexed: 11/16/2022]
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22
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Contemporary Management of Locally Advanced and Recurrent Rectal Cancer: Views from the PelvEx Collaborative. Cancers (Basel) 2022; 14:cancers14051161. [PMID: 35267469 PMCID: PMC8909015 DOI: 10.3390/cancers14051161] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 12/12/2022] Open
Abstract
Pelvic exenteration is a complex operation performed for locally advanced and recurrent pelvic cancers. The goal of surgery is to achieve clear margins, therefore identifying adjacent or involved organs, bone, muscle, nerves and/or vascular structures that may need resection. While these extensive resections are potentially curative, they can be associated with substantial morbidity. Recently, there has been a move to centralize care to specialized units, as this facilitates better multidisciplinary care input. Advancements in pelvic oncology and surgical innovation have redefined the boundaries of pelvic exenterative surgery. Combined with improved neoadjuvant therapies, advances in diagnostics, and better reconstructive techniques have provided quicker recovery and better quality of life outcomes, with improved survival This article provides highlights of the current management of advanced pelvic cancers in terms of surgical strategy and potential future developments.
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Melly C, McGeehan G, O’Connor N, Johnston A, Bass G, Mohseni S, Donohoe C, Bucholc M, Sugrue M. OUP accepted manuscript. BJS Open 2022; 6:6603491. [PMID: 35668711 PMCID: PMC9171002 DOI: 10.1093/bjsopen/zrac062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/24/2022] [Accepted: 04/06/2022] [Indexed: 11/24/2022] Open
Abstract
Background Healthcare requires patient feedback to improve outcomes and experience. This study undertook a systematic review of the depth, variability, and digital suitability of current patient-reported outcome measures (PROMs) in patients undergoing laparoscopic cholecystectomy. Methods A PROSPERO-registered (registration number CRD42021261707) systematic review was undertaken for all relevant English language articles using PubMed version of MEDLINE, Scopus, and Web of Science electronic databases in June 2021. The search used Boolean operators and wildcards and included the keywords: laparoscopic cholecystectomy AND patient outcome OR patient-reported outcome OR patient-reported outcome measure OR PRO OR PROM. Medical Subjects Heading terms were used to search PubMed and Scopus. Articles published from 1 January 2011 to 2 June 2021 were included. Results A total of 4960 individual articles were reviewed in this study, of which 44 were found to evaluate PROMs in patients undergoing laparoscopic cholecystectomy and underwent methodological index for non-randomized studies (MINORS) grading. Twenty-one articles spanning 19 countries and four continents met all inclusion criteria and were included in the qualitative data synthesis. There was significant heterogeneity in PROMs identified with eight different comprehensive PROM tools used in the 21 studies. There was wide variation in the time points at which PROMs were recorded. Fourteen of 21 studies recorded PROMs before and after surgery, and 7 of 21 recorded PROMs only after surgery. Follow-up intervals ranged from 3 days to 2 years after surgery. Conclusions This study identified that while post-laparoscopic cholecystectomy PROMs are infrequently measured currently, tools are widely available to achieve this in clinical practice. PROMs may not capture all the outcomes but should be incorporated into future cholecystectomy outcome research. The EQ-5D™ (EuroQoL Group, Rotterdam, the Netherlands) provides a simple platform for the modern digital era.
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Affiliation(s)
| | - Gearoid McGeehan
- Department of Surgery, Letterkenny University Hospital and Donegal Clinical Research Academy, Donegal, Ireland
- University of Limerick School of Medicine, University of Limerick, Limerick, Ireland
| | - Niall O’Connor
- Department of Surgery, Letterkenny University Hospital and Donegal Clinical Research Academy, Donegal, Ireland
| | - Alison Johnston
- Department of Surgery, Letterkenny University Hospital and Donegal Clinical Research Academy, Donegal, Ireland
| | - Gary Bass
- Division of Traumatology, Emergency Surgery and Surgical Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Shahin Mohseni
- Division of Trauma and Emergency Surgery, Department of Surgery Orebro University Hospital, & School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Claire Donohoe
- Department of Surgery, Trinity College Dublin, St James’ Hospital, Dublin, Ireland
| | - Magda Bucholc
- Intelligent Systems Research Centre, School of Computing, Engineering and Intelligent Systems, Ulster University, Magee Campus, Derry-Londonderry, UK
| | - Michael Sugrue
- Department of Surgery, Letterkenny University Hospital and Donegal Clinical Research Academy, Donegal, Ireland
- EU INTERREG Centre for Personalized Medicine, Intelligent Systems Research Centre, School of Computing, Engineering and Intelligent Systems, Ulster University, Magee Campus, Derry-Londonderry, UK
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Sokas C, Hu F, Edelen M, Sisodia R, Pusic A, Cooper Z. A Review of PROM Implementation in Surgical Practice. Ann Surg 2022; 275:85-90. [PMID: 34183512 DOI: 10.1097/sla.0000000000005029] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To synthesize the current state of PROM implementation and collection in routine surgical practice through a review of the literature. SUMMARY OF BACKGROUND DATA Patient-reported outcomes (PROs) are increasingly relevant in the delivery of high quality, individualized patient care. For surgeons, PROMs can provide valuable insight into changes in patient quality of life before and after surgical interventions. Despite consensus within the surgical community regarding the promise of PROMs, little is known about their real-world implementation. METHODS The literature search was conducted in MEDLINE and Embase for studies published after 2012. We conducted a scoping review to synthesize the current state of implementation of PROs across all sizes and types of surgical practices. Studies were included if they met the following inclusion criteria: (1) patients ≥18 years 2) routine surgical practice, (3) use of a validated PRO instrument in the peri-operative period to report on general or disease-specific health-related quality of life, (4) primary or secondary outcome was implementation. Two independent reviewers screened 1524 titles and abstracts. FINDINGS 16 studies were identified that reported on the implementation of PROMs for surgical patients. Sample size ranged from 41 patients in a single-center pilot study to 1324 patients in a study across 17 institutions. PROs were collected pre-operatively in 3 studies, post-operatively in 10, and at unspecified times in 4. The most commonly reported implementation outcomes were fidelity (12) and feasibility (11). Less than half of studies analyzed nonrespondents. All studies concluded that collection of PROMs was successful based on outcomes measured. CONCLUSIONS The identified studies suggest that implementation metrics including minimum standards of collection pre- and postintervention, reporting for response rates in the context of patient eligibility and analysis of respondents and nonrespondents, in addition to transparency regarding the resources utilized and cost, can facilitate adoption of PROMs in clinical care and accountability for surgical outcomes.
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Affiliation(s)
- Claire Sokas
- Brigham and Woman's Hospital, Center for Surgery and Public Health, Boston, Massachusetts
| | - Frances Hu
- Brigham and Woman's Hospital, Center for Surgery and Public Health, Boston, Massachusetts
| | - Maria Edelen
- Brigham and Woman's Hospital, Patient Reported Outcomes, Value and Experience Center, Boston, Massachusetts
- RAND Corporation, Boston, Massachusetts
| | - Rachel Sisodia
- Massachusetts General Hospital, Department of Obstetrics and Gynecology, Boston, Massachusetts
- Mass General Brigham, Department of Quality and Patient Experience, Boston, Massachusetts
| | - Andrea Pusic
- Brigham and Woman's Hospital, Patient Reported Outcomes, Value and Experience Center, Boston, Massachusetts
- Brigham and Woman's Hospital, Department of Surgery, Boston, Massachusetts
| | - Zara Cooper
- Brigham and Woman's Hospital, Center for Surgery and Public Health, Boston, Massachusetts
- Brigham and Woman's Hospital, Department of Surgery, Boston, Massachusetts
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Noel CW, Forner D, Chepeha DB, Baran E, Chan KKW, Parmar A, Husain Z, Karam I, Hallet J, Coburn NG, Eskander A. The Edmonton Symptom Assessment System: A narrative review of a standardized symptom assessment tool in head and neck oncology. Oral Oncol 2021; 123:105595. [PMID: 34775181 DOI: 10.1016/j.oraloncology.2021.105595] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 10/01/2021] [Accepted: 10/19/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Symptom burden is common in head and neck cancer patients though it frequently remains undetected and untreated. The Edmonton Symptom Assessment System - revised version (ESAS-r) is a generic symptom scale deployed in many outpatient settings worldwide. The ESAS-r is meant to improve symptom detection and management. We sought to review the ESAS-r and its psychometric properties in a head and neck oncology population. METHODS Narrative Review. RESULTS Over the past 30 years, the ESAS-r has emerged as one of the most used symptom scales for cancer patients. Its psychometric properties in a heterogenous cancer population are well supported, proving to be reliable and valid in a variety of settings. The linking of ESAS-r scores with Ontario administrative health data has led to a detailed assessment of validity in head and neck cancer. The ESAS-r can discriminate between high and low levels of symptom burden and is responsive to change over time in this patient population. ESAS-r scores have also been shown to be a strong predictor of future emergency department use and unplanned hospitalization in head and neck cancer patients. CONCLUSIONS The ESAS-r is reliable and valid in the head and neck cancer population and may serve as a useful clinical endpoint in research studies.
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Affiliation(s)
- Christopher W Noel
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
| | - David Forner
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada; Division of Otolaryngology Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Douglas B Chepeha
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada; Department of Otolaryngology Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Elif Baran
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kelvin K W Chan
- Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ambica Parmar
- Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Zain Husain
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Irene Karam
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Julie Hallet
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada; Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Natalie G Coburn
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada; Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada; Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Otolaryngology - Head & Neck Surgery, Sunnybrook Health Sciences Centre and Michael Garron Hospital, University of Toronto, Toronto, Ontario, Canada.
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Rao SJ, Nickel JC, Kiell EP, Madden LL. Readability of Commonly Used Patient-Reported Outcome Measures in Laryngology. Laryngoscope 2021; 132:1069-1074. [PMID: 34498753 DOI: 10.1002/lary.29849] [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: 06/16/2021] [Revised: 08/19/2021] [Accepted: 08/21/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Patient-reported outcome measures (PROMs) are used to evaluate patients' symptoms and clinical improvement after an intervention. Advocacy efforts and increased provider awareness regarding health literacy have helped to improve the readability of PROMs. Recent studies in otolaryngology in rhinology, pediatric otolaryngology, and head and neck reported PROM readability scores above the sixth-grade level. However, there is limited data regarding the readability of laryngology PROMs. Thus, this study aims to report the readability levels of PROMs in laryngology by assessing different readability indices and describing the relationship of readability levels to equitable healthcare. METHODS This is a bibliometric study that received approval from institutional review board (IRB) review as a nonhuman subject research study. Recent and widely utilized laryngology PROMs were selected from a publicly available literature search by reviewing laryngology systematic reviews, PubMed, and Google Scholar. Laryngology PROMs were selected from voice, dysphagia, airway, and other PROMs including voice questionnaires administered to patients seeking gender affirming voice care from systematic reviews and expert opinion. There were 37 PROMs included in this study. PROMs were analyzed via Gunning Fog, Simple Measure of Gobbledygook (SMOG), FORCAST, and Flesch Reading Ease Score. RESULTS All laryngology PROMs had readabilities above the recommended sixth-grade level. The mean and standard deviation (SD) of Gunning Fog was 7.30 (2.59), SMOG was 8.70 (1.51), FORCAST was 10.05 (1.51), and Flesch Reading Ease Score was 8.08 (2.76). CONCLUSION Laryngology PROMs are above the recommended middle school reading level. To further promote health equity, readability should be considered when developing future PROMs. LEVEL OF EVIDENCE N/A Laryngoscope, 2021.
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Affiliation(s)
- Shambavi J Rao
- Wake Forest School of Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Joseph C Nickel
- Wake Forest School of Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Eleanor P Kiell
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Lyndsay L Madden
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
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de Vries CEE, Mou D, Poulsen L, Breitkopf T, Makarawung DJS, Wiezer MJ, van Veen RN, Hoogbergen MM, Sorensen JA, Liem RSL, Nienhuijs SW, Tavakkoli A, Pusic AL, Klassen AF. Development and Validation of New BODY-Q Scales Measuring Expectations, Eating Behavior, Distress, Symptoms, and Work Life in 4004 Adults From 4 Countries. Obes Surg 2021; 31:3637-3645. [PMID: 34041700 DOI: 10.1007/s11695-021-05462-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 04/28/2021] [Accepted: 05/05/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE The BODY-Q is a rigorously developed patient-reported outcome measure (PROM) for patients seeking treatment for obesity and body contouring surgery. A limitation of the uptake of the BODY-Q in weight management treatments is the absence of scales designed to measure eating-specific concerns. We aimed to develop and validate 5 new BODY-Q scales measuring weight loss expectations, eating behaviors, distress, symptoms, and work life. MATERIAL AND METHODS In phase 1 (qualitative), patient and expert input was used to develop and refine the new BODY-Q scales. In phase 2 (quantitative), the scales were field-tested in bariatric and weight management clinics in the United States (US), The Netherlands, and Denmark between June 2019 and January 2020. Data were also collected in the US and Canada in September 2019 through a crowdworking platform. Rasch measurement theory (RMT) analysis was used for item reduction and to examine reliability and validity. RESULTS The new BODY-Q scales were refined through qualitative input from 17 patients and 20 experts (phase 1) and field-tested in 4004 participants (phase 2). All items showed ordered thresholds and good fit to the Rasch model. The RMT analysis provided evidence of reliability, with PSI values ≥0.72, Cronbach alpha values ≥0.83, and test-retest values ≥0.79. Better scores on 4 scales (exception expectations scale) correlated with lower BMI, with the strongest correlation between the eating-related distress scale scores and BMI (r= -0.249, P < 0.001). CONCLUSION The new BODY-Q scales can be used in research and clinical practice to assess weight loss treatments from the patient perspective.
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Affiliation(s)
- Claire E E de Vries
- Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA. .,Department of Surgery, OLVG, Amsterdam, The Netherlands.
| | - Danny Mou
- Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Lotte Poulsen
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Trisia Breitkopf
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | | | - Marinus J Wiezer
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Maarten M Hoogbergen
- Department of Plastic and Reconstructive Surgery, Catharina Ziekenhuis, Eindhoven, The Netherlands
| | - Jens A Sorensen
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Ronald S L Liem
- Department of Surgery, Groene Hart Hospital, Gouda, The Netherlands.,Dutch Obesity Clinic, The Hague, The Netherlands
| | - Simon W Nienhuijs
- Department of Surgery, Catharina Ziekenhuis, Eindhoven, The Netherlands
| | - Ali Tavakkoli
- Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Andrea L Pusic
- Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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Alimena S, Sullivan MW, Philp L, Dorney K, Hubbell H, Del Carmen MG, Goodman A, Bregar A, Growdon WB, Eisenhauer EL, Sisodia RC. Patient reported outcome measures among patients with vulvar cancer at various stages of treatment, recurrence, and survivorship. Gynecol Oncol 2020; 160:252-259. [PMID: 33139040 DOI: 10.1016/j.ygyno.2020.10.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/16/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Our goal was to pragmatically describe patient reported outcomes (PROs) in a typical clinic population of vulvar cancer patients, as prior studies of vulvar cancer PROs have examined clinical trial participants. METHODS A prospective PRO program was implemented in the Gynecologic Oncology clinic of a tertiary academic institution in January 2018. Vulvar cancer patients through September 2019 were administered the European Organization for the Research and Treatment of Cancer Quality of life Questionnaire, the Patient Reported Outcome Measurement Information System Instrumental and Emotional Support Scales, and the Functional Assessment of Cancer Therapy-Vulvar questionnaire. Binary logistic regressions were performed to determine adjusted odds ratios for adverse responses to individual questions by insurance, stage, age, time since diagnosis, recurrence, radiation, and surgical radicality. RESULTS Seventy vulvar cancer patients responded to PROs (85.4% response rate). Seventy-one percent were > 1 year since diagnosis, 61.4% had stage I disease, and 28.6% recurred. Publicly insured women had less support and worse quality of life (QOL, aOR 4.15, 95% CI 1.00-17.32, p = 0.05). Women who recurred noted more interference with social activities (aOR 4.45, 95% CI 1.28-15.41, p = 0.019) and poorer QOL (aOR 5.22 95% CI 1.51-18.10, p = 0.009). There were no major differences by surgical radicality. Those >1 year since diagnosis experienced less worry (aOR 0.17, 95% CI 0.04-0.63, p = 0.008). CONCLUSIONS Surgical radicality does not affect symptoms or QOL in vulvar cancer patients, whereas insurance, recurrence, and time since diagnosis do. This data can improve counseling and awareness of patient characteristics that would benefit from social services referral.
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Affiliation(s)
- Stephanie Alimena
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Mackenzie W Sullivan
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Lauren Philp
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Katelyn Dorney
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Harrison Hubbell
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Marcela G Del Carmen
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Annekathryn Goodman
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Amy Bregar
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Whitfield B Growdon
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Eric L Eisenhauer
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rachel Clark Sisodia
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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