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Brown S, Hind D, Strong E, Bradburn M, Din FVN, Lee E, Lee MJ, Lund J, Moffatt C, Morton J, Senapati A, Shackley P, Vaughan-Shaw P, Wysocki AP, Callaghan T, Jones H, Wickramasekera N. Treatment options for patients with pilonidal sinus disease: PITSTOP, a mixed-methods evaluation. Health Technol Assess 2024; 28:1-113. [PMID: 39045854 DOI: 10.3310/kfdq2017] [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: 07/25/2024] Open
Abstract
Background There is no consensus on optimal management of pilonidal disease. Surgical practice is varied, and existing literature is mainly single-centre cohort studies of varied disease severity, interventions and outcome assessments. Objectives A prospective cohort study to determine: • disease severity and intervention relationship • most valued outcomes and treatment preference by patients • recommendations for policy and future research. Design Observational cohort study with nested mixed-methods case study. Discrete choice experiment. Clinician survey. Three-stage Delphi survey for patients and clinicians. Inter-rater reliability of classification system. Setting Thirty-one National Health Service trusts. Participants Patients aged > 16 years referred for elective surgical treatment of pilonidal disease. Interventions Surgery. Main outcome measures Pain postoperative days 1 and 7, time to healing and return to normal activities, complications, recurrence. Outcomes compared between major and minor procedures using regression modelling, propensity score-based approaches and augmented inverse probability weighting to account for measured potential confounding features. Results Clinician survey: There was significant heterogeneity in surgeon practice preference. Limited training opportunities may impede efforts to improve practice. Cohort study: Over half of patients (60%; N = 667) had a major procedure. For these procedures, pain was greater on day 1 and day 7 (mean difference day 1 pain 1.58 points, 95% confidence interval 1.14 to 2.01 points, n = 536; mean difference day 7 pain 1.53 points, 95% confidence interval 1.12 to 1.95 points, n = 512). There were higher complication rates (adjusted risk difference 17.5%, 95% confidence interval 9.1 to 25.9%, n = 579), lower recurrence (adjusted risk difference -10.1%, 95% confidence interval -18.1 to -2.1%, n = 575), and longer time to healing (>34 days estimated difference) and time to return to normal activities (difference 25.9 days, 95% confidence interval 18.4 to 33.4 days). Mixed-methods analysis: Patient decision-making was influenced by prior experience of disease and anticipated recovery time. The burden involved in wound care and the gap between expected and actual time for recovery were the principal reasons given for decision regret. Discrete choice experiment: The strongest predictors of patient treatment choice were risk of infection/persistence (attribute importance 70%), and shorter recovery time (attribute importance 30%). Patients were willing to trade off these attributes. Those aged over 30 years had a higher risk tolerance (22.35-34.67%) for treatment failure if they could experience rapid recovery. There was no strong evidence that younger patients were willing to accept higher risk of treatment failure in exchange for a faster recovery. Patients were uniform in rejecting excision-and-leave-open because of the protracted nursing care it entailed. Wysocki classification analysis: There was acceptable inter-rater agreement (κ = 0.52, 95% confidence interval 0.42 to 0.61). Consensus exercise: Five research and practice priorities were identified. The top research priority was that a comparative trial should broadly group interventions. The top practice priority was that any interventions should be less disruptive than the disease itself. Limitations Incomplete recruitment and follow-up data were an issue, particularly given the multiple interventions. Assumptions were made regarding risk adjustment. Conclusions and future work Results suggest the burden of pilonidal surgery is greater than reported previously. This can be mitigated with better selection of intervention according to disease type and patient desired goals. Results indicate a framework for future higher-quality trials that stratify disease and utilise broad groupings of common interventions with development of a patient-centred core outcome set. Trial registration This trial is registered as ISRCTN95551898. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 17/17/02) and is published in full in Health Technology Assessment; Vol. 28, No. 33. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Steven Brown
- Department of General Surgery, Northern General Hospital, Sheffield, UK
| | - Daniel Hind
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Emily Strong
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Mike Bradburn
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Farhat Vanessa Nasim Din
- Academic Coloproctology, Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Ellen Lee
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Matthew J Lee
- Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield, UK
| | - Jonathan Lund
- Derby Royal Infirmary, University Hospitals of Derby and Burton, Derby, UK
| | | | - Jonathan Morton
- Addenbrookes Hospital, Cambridge University Hospitals, Cambridge, UK
| | - Asha Senapati
- St Mark's Hospital, London, UK; Queen Alexandra Hospital, Portsmouth, UK
| | - Philip Shackley
- School of Health and Related Research, Regent Court, Sheffield, UK
| | - Peter Vaughan-Shaw
- Department of Colorectal Surgery, Western General Hospital, Edinburgh, UK
| | | | - Tia Callaghan
- Sheffield Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Helen Jones
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Irvine I, Hayden R, Greene L, Ryan AG. An Update on Patient-Reported Outcomes in Interventional Radiology: The Future Measure of Our Success. Cardiovasc Intervent Radiol 2023; 46:1657-1661. [PMID: 37620593 DOI: 10.1007/s00270-023-03530-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 07/29/2023] [Indexed: 08/26/2023]
Abstract
The field of interventional radiology continues to expand rapidly, offering an increasing range of alternatives to open surgical procedures. This minimally invasive imaging-guided approach promises faster recovery times and a theoretically improved patient experience; however, there is limited evidence documenting that these promises are actually delivered. Patient-reported outcomes are a way of collecting data on the patient experience increasingly used in clinical trials and the provision of surgical services and informing clinical practice across a range of elective procedures. Currently underutilised in interventional radiology, patient-reported outcomes have the potential to significantly impact how we deliver care by allowing evaluation of the perceived benefit derived by a patient after undergoing a procedure and to permit comparison with more invasive open procedures from the patient perspective.
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Affiliation(s)
- Iain Irvine
- Division of Interventional Radiology, Radiology Department, University Hospital Waterford, Dunmore Road, Co Waterford, Ireland.
| | - Reiltin Hayden
- Division of Interventional Radiology, Radiology Department, University Hospital Waterford, Dunmore Road, Co Waterford, Ireland
| | - Laura Greene
- Division of Interventional Radiology, Radiology Department, University Hospital Waterford, Dunmore Road, Co Waterford, Ireland
| | - Anthony G Ryan
- Division of Interventional Radiology, Radiology Department, University Hospital Waterford, Dunmore Road, Co Waterford, Ireland
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3
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Depla AL, Lamain-de Ruiter M, Laureij LT, Ernst-Smelt HE, Hazelzet JA, Franx A, Bekker MN. Patient-Reported Outcome and Experience Measures in Perinatal Care to Guide Clinical Practice: Prospective Observational Study. J Med Internet Res 2022; 24:e37725. [PMID: 35787519 PMCID: PMC9297146 DOI: 10.2196/37725] [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: 03/04/2022] [Revised: 05/04/2022] [Accepted: 05/31/2022] [Indexed: 11/21/2022] Open
Abstract
Background The International Consortium for Health Outcomes Measurement has published a set of patient-centered outcome measures for pregnancy and childbirth (PCB set), including patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs). To establish value-based pregnancy and childbirth care, the PCB set was implemented in the Netherlands, using the outcomes on the patient level for shared decision-making and on an aggregated level for quality improvement. Objective This study aims to report first outcomes, experiences, and practice insights of implementing the PCB set in clinical practice. Methods In total, 7 obstetric care networks across the Netherlands, each consisting of 1 or 2 hospitals and multiple community midwifery practices (ranging in number from 2 to 18), implemented the PROM and PREM domains of the PCB set as part of clinical routine. This observational study included all women participating in the clinical project. PROMs and PREMs were assessed with questionnaires at 5 time points: 2 during pregnancy and 3 post partum. Clinical threshold values (alerts) supported care professionals interpreting the answers, indicating possibly alarming outcomes per domain. Data collection took place from February 2020 to September 2021. Data analysis included missing (pattern) analysis, sum scores, alert rates, and sensitivity analysis. Results In total, 1923 questionnaires were collected across the 5 time points: 816 (42.43%) at T1 (first trimester), 793 (41.23%) at T2 (early third trimester), 125 (6.5%) at T3 (maternity week), 170 (8.84%) at T4 (6 weeks post partum), and 19 (1%) at T5 (6 months post partum). Of these, 84% (1615/1923) were filled out completely. Missing items per domain ranged from 0% to 13%, with the highest missing rates for depression, pain with intercourse, and experience with pain relief at birth. No notable missing patterns were found. For the PROM domains, relatively high alert rates were found both in pregnancy and post partum for incontinence (469/1798, 26.08%), pain with intercourse (229/1005, 22.79%), breastfeeding self-efficacy (175/765, 22.88%), and mother-child bonding (122/288, 42.36%). Regarding the PREM domains, the highest alert rates were found for birth experience (37/170, 21.76%), shared decision-making (101/982, 10.29%), and discussing pain relief ante partum (310/793, 39.09%). Some domains showed very little clinical variation; for example, role of the mother and satisfaction with care. Conclusions The PCB set is a useful tool to assess patient-reported outcomes and experiences that need to be addressed over the whole course of pregnancy and childbirth. Our results provide opportunities to improve and personalize perinatal care. Furthermore, we could propose several recommendations regarding methods and timeline of measurements based on our findings. This study supports the implementation of the PCB set in clinical practice, thereby advancing the transformation toward patient-centered, value-based health care for pregnancy and childbirth.
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Affiliation(s)
- Anne Louise Depla
- Department of Obstetrics and Gynecology, Wilhemina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marije Lamain-de Ruiter
- Department of Obstetrics and Gynecology, Wilhemina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands.,Department of Obstetrics and Gynecology, Division of Obstetrics and Fetal Medicine, Erasmus Medical Center Sophia, Rotterdam, Netherlands
| | - Lyzette T Laureij
- Department of Obstetrics and Gynecology, Division of Obstetrics and Fetal Medicine, Erasmus Medical Center Sophia, Rotterdam, Netherlands
| | - Hiske E Ernst-Smelt
- Department of Obstetrics and Gynecology, Division of Obstetrics and Fetal Medicine, Erasmus Medical Center Sophia, Rotterdam, Netherlands
| | - Jan A Hazelzet
- Department of Public Health, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Arie Franx
- Department of Obstetrics and Gynecology, Division of Obstetrics and Fetal Medicine, Erasmus Medical Center Sophia, Rotterdam, Netherlands
| | - Mireille N Bekker
- Department of Obstetrics and Gynecology, Wilhemina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
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Caccese M, Imbevaro S, Feltrin A, Costardi D, Giordano N, Maran M, Martino R, Ottolitri K, Shams M, Vascon F, Roma A, Galiano A, Maruzzo M, Marino D, Lombardi G, Lonardi S, Brunello A, Zagonel V. Cancer Patient-Reported Experience Measures (PREMs) Regarding the Policies Implemented to Contain the Spread of Sars-CoV-2 and Vaccination Campaign at Veneto Institute of Oncology. Patient Prefer Adherence 2022; 16:353-362. [PMID: 35173420 PMCID: PMC8841696 DOI: 10.2147/ppa.s351771] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 12/24/2021] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The SARS-CoV-2 spread has impacted Healthcare systems. COVID-19 pandemic has had consequences for patients with cancer, being associated with delays in diagnosis, in treatment And follow-up care, increase in overall infection rates and higher mortality. A survey on COVID-19 and a vaccination-questionnaire were developed at different times of the outbreak, to evaluate cancer patient-reported experience measures (PREMs) on the policies implemented to reduce the infection from SARS-CoV-2 and on the timing and methods of COVID-19 vaccination. PATIENTS AND METHODS The survey was distributed to all patients accessing the Institute during the "first-wave" Of the pandemic, evaluating patients' concerns about the pandemic, the pandemics' consequences on their cancer care, and their perception Of the measures adopted to limit the infection spread. The vaccination-questionnaire was proposed to 10% of the first 5297 cancer patients vaccinated with two doses of the Pfizer-BioNTechCOVID-19 vaccine. This questionnaire aimed at assessing the degree Of satisfaction with the Institutional vaccination campaign and vaccination-related adverse events. RESULTS From May 18th 2020 to June 15th 2020 the survey was completed by 3238 patients. Most of the responders expressed concern on the pandemic yet acknowledging their oncological disease as a priority. Measures implemented were appreciated by patients. Telemedicine was positively evaluated and the absence of the caregiver during the visit did not determine discomfort for two thirds of patients. From March 6th 2021 to May 8th 2021 the vaccination-questionnaire was completed by 357 patients. The 98.8% were satisfied with the vaccination campaign. No serious vaccination-correlated adverse events were reported. No patient had to delay/discontinue chemotherapy due to vaccination. CONCLUSION PREMs during COVID-19 pandemic and related vaccination can provide important information to help reorganization of the health care systems for cancer care. Patients' feedback on the organizational changes implemented in the emergency period are essential for healthcare improvement and to help informed choices that are consistent with patients' needs.
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Affiliation(s)
- Mario Caccese
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
- Correspondence: Mario Caccese, Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV - IRCCS, Via Gattamelata, 64, Padua, 35128, Italy, Email
| | - Silvia Imbevaro
- General Directorate, Accreditation and Acknowledgment Unit, Veneto Institute of Oncolog IOV - IRCCS, Padua, Italy
| | - Alessandra Feltrin
- Health Department, Psycho-Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Daniela Costardi
- Scientific Directorate, Patient Education and Empowerment, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Nadia Giordano
- Department of Oncology, Oncology 3, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Maristella Maran
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Rosalba Martino
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Ketti Ottolitri
- Health Department, Clinical Risk Office, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Malihe Shams
- Health Department, Psycho-Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Federica Vascon
- Department of Imaging and Health Physics, Radiotherapy Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Anna Roma
- Department of Oncology, Oncology 3, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Antonella Galiano
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Marco Maruzzo
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Dario Marino
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Giuseppe Lombardi
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Sara Lonardi
- Department of Oncology, Oncology 3, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Antonella Brunello
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Vittorina Zagonel
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
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Chiloiro G, Romano A, D’Aviero A, Dinapoli L, Zane E, Tenore A, Boldrini L, Balducci M, Gambacorta MA, Mattiucci GC, Malavasi P, Cesario A, Valentini V. Patients' Satisfaction by SmileIn TM Totems in Radiotherapy: A Two-Year Mono-Institutional Experience. Healthcare (Basel) 2021; 9:healthcare9101268. [PMID: 34682948 PMCID: PMC8535794 DOI: 10.3390/healthcare9101268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/14/2021] [Accepted: 09/23/2021] [Indexed: 12/25/2022] Open
Abstract
Background: Patient’s satisfaction is recognized as an indicator to monitor quality in healthcare services. Patient-reported experience measures (PREMs) may contribute to create a benchmark of hospital performance by assessing quality and safety in cancer care. Methods: The areas of interest assessed were: patient-centric welcome perception (PCWP), punctuality, professionalism and comfort using the Lean Six Sigma (LSS) methodology. The RAMSI (Radioterapia Amica Mia SmileINTM (SI) My Friend RadiotherapySI), project provided for the placement of SI totems with four push buttons using HappyOrNot technology in a high-volume radiation oncology (RO) department. The SI technology was implemented in the RO department of the Fondazione Policlinico Universitario A. Gemelli IRCCS. SI totems were installed in different areas of the department. The SI Experience Index was collected, analyzed and compared. Weekly and monthly reports were created showing hourly, daily and overall trends. Results: From October 2017 to November 2019, a total of 42,755 votes were recorded: 8687, 10,431, 18,628 and 5009 feedback items were obtained for PCWP, professionalism, punctuality, and comfort, respectively. All areas obtained a SI-approved rate ≥ 8.0. Conclusions: The implementation of the RAMSI system proved to be doable according to the large amount of feedback items collected in a high-volume clinical department. The application of the LSS methodology led to specific corrective actions such as modification of the call-in-clinic system during operations planning. In order to provide healthcare optimization, a multicentric and multispecialty network should be defined in order to set up a benchmark.
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Affiliation(s)
- Giuditta Chiloiro
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.C.); (L.B.); (M.A.G.); (V.V.)
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (A.R.); (L.D.); (A.T.); (M.B.); (G.C.M.)
| | - Angela Romano
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (A.R.); (L.D.); (A.T.); (M.B.); (G.C.M.)
| | - Andrea D’Aviero
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (A.R.); (L.D.); (A.T.); (M.B.); (G.C.M.)
- Correspondence:
| | - Loredana Dinapoli
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (A.R.); (L.D.); (A.T.); (M.B.); (G.C.M.)
- UOS Psicologia Clinica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
| | - Elisa Zane
- Alta Scuola per l’Ambiente—ASA—Università Cattolica del Sacro Cuore, 25121 Brescia, Italy; (E.Z.); (p.m.)
| | - Angela Tenore
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (A.R.); (L.D.); (A.T.); (M.B.); (G.C.M.)
| | - Luca Boldrini
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.C.); (L.B.); (M.A.G.); (V.V.)
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (A.R.); (L.D.); (A.T.); (M.B.); (G.C.M.)
| | - Mario Balducci
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (A.R.); (L.D.); (A.T.); (M.B.); (G.C.M.)
| | - Maria Antonietta Gambacorta
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.C.); (L.B.); (M.A.G.); (V.V.)
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (A.R.); (L.D.); (A.T.); (M.B.); (G.C.M.)
| | - Gian Carlo Mattiucci
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (A.R.); (L.D.); (A.T.); (M.B.); (G.C.M.)
| | - Pierluigi Malavasi
- Alta Scuola per l’Ambiente—ASA—Università Cattolica del Sacro Cuore, 25121 Brescia, Italy; (E.Z.); (p.m.)
- Facoltà di Scienze della Formazione, Università Cattolica del Sacro Cuore, 25121 Brescia, Italy
| | - Alfredo Cesario
- Open Innovation, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy;
| | - Vincenzo Valentini
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.C.); (L.B.); (M.A.G.); (V.V.)
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (A.R.); (L.D.); (A.T.); (M.B.); (G.C.M.)
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Strong E, Callaghan T, Beal E, Moffatt C, Wickramasekera N, Brown S, Lee MJ, Winton C, Hind D. Patient decision-making and regret in pilonidal sinus surgery: a mixed-methods study. Colorectal Dis 2021; 23:1487-1498. [PMID: 33645880 DOI: 10.1111/codi.15606] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/05/2021] [Accepted: 02/09/2021] [Indexed: 12/11/2022]
Abstract
AIM Little is known about optimal management strategies for pilonidal sinus disease (PSD). We conducted a mixed-methods study to understand why patients make, and sometimes regret, treatment decisions. METHOD We conducted longitudinal semi-structured interviews at the time of surgery and 6 months later with 20 patients from 13 UK hospitals. Framework analysis was performed, and themes were mapped to (1) the coping in deliberation framework and (2) an acceptability framework. Results were triangulated with those from structured survey instruments evaluating shared decision-making (SDM, best = 9) at baseline and decision regret (DR, most regret = 100) at 6 months. RESULTS Nine of 20 patients were not offered a choice of treatment, but this was not necessarily seen as negative (SDM median 4; range 2-4). Factors that influenced decision-making included previous experience and anticipated recovery time. Median (range) DR was 5 (0-50). Those with the highest DR (scores 40-50) were, paradoxically, also amongst the highest scores on SDM (scores 4). Burden of wound care and the disparity between anticipated and actual recovery time were the main reasons for decision regret. CONCLUSION To minimize regret about surgical decisions, people with PSD need better information about the burden of wound care and the risks of recurrence associated with different surgical approaches.
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Affiliation(s)
- Emily Strong
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Tia Callaghan
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Erin Beal
- University of Liverpool, Liverpool, UK
| | - Christine Moffatt
- School of Social Sciences, Nottingham Trent University, Nottingham, UK
| | | | - Steven Brown
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK.,Department of General Surgery, Northern General Hospital, Sheffield, South Yorkshire, UK
| | - Matthew J Lee
- Department of General Surgery, Northern General Hospital, Sheffield, South Yorkshire, UK.,Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield, South Yorkshire, UK
| | - Catherine Winton
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Daniel Hind
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
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7
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Depla AL, Crombag NM, Franx A, Bekker MN. Implementation of a standard outcome set in perinatal care: a qualitative analysis of barriers and facilitators from all stakeholder perspectives. BMC Health Serv Res 2021; 21:113. [PMID: 33530989 PMCID: PMC7852077 DOI: 10.1186/s12913-021-06121-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 01/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To improve their quality, healthcare systems are increasingly focused on value delivered to patients. For perinatal care, the International Consortium for Health Outcomes Measurement (ICHOM) proposed a patient-centred outcome set with both clinical and patient-reported measures for pregnancy and childbirth (PCB set). This study aimed to identify factors that affect the implementation of the PCB set at the pre-implementation stage, using the consolidated framework for implementation research (CFIR). METHODS In this qualitative study, we conducted semi-structured interviews amongst a purposive sample of key stakeholders within an obstetric care network (OCN): 1) patients, 2) perinatal care professionals involved in the full cycle of perinatal care, and 3) policy makers, including hospital managers, administrative staff and health care insurers. While the CFIR guided data capture and structuring, thematic analysis revealed overarching themes that best reflected the barriers and facilitators from different stakeholder perspectives. Within these overarching themes, the CFIR constructs were maintained. RESULTS Interviews were conducted with 6 patients, 16 professionals and 5 policy makers. Thematic analysis supported by the CFIR framework identified four main themes: the instrument and its implementation process, use in individual patient care, use in quality improvement, and the context of the OCN. Important barriers included professional workload, data reliability, and interprofessional and interorganizational collaboration. Potential facilitators were the PCB set's direct value in individual care, interprofessional feedback and education, and aligning with existing systems. Prominent variations between stakeholder groups included the expected patient burden, the level of use, transparency of outcomes and the degree of integrated care. CONCLUSIONS This study clarified critical factors that affect successful implementation of the PCB set in perinatal care. Practice recommendations, suggested at multiple levels, can enable structural patient-centred care improvement and may unite stakeholders towards integrated birth care.
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Affiliation(s)
- Anne L. Depla
- Department of Obstetrics and Gynaecology, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, KE.04.123.1, Lundlaan 6, 3584 EA Utrecht, The Netherlands
| | - Neeltje M. Crombag
- Department of Development and Regeneration, KU Leuven University, Leuven, Belgium
| | - Arie Franx
- Department of Obstetrics and Gynaecology, Erasmus Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Mireille N. Bekker
- Department of Obstetrics and Gynaecology, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, KE.04.123.1, Lundlaan 6, 3584 EA Utrecht, The Netherlands
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8
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Laureij LT, Been JV, Lugtenberg M, Ernst-Smelt HE, Franx A, Hazelzet JA, de Groot PK, Frauenfelder O, Henriquez D, Lamain-de Ruiter M, Neppelenbroek E, Nij Bijvank SWA, Schaap T, Schagen M, Veenhof M, Vermolen JH. Exploring the applicability of the pregnancy and childbirth outcome set: A mixed methods study. PATIENT EDUCATION AND COUNSELING 2020; 103:642-651. [PMID: 31607633 DOI: 10.1016/j.pec.2019.09.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/20/2019] [Accepted: 09/23/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The International Consortium for Health Outcomes Measurement developed the Pregnancy and Childbirth (PCB) outcome set to improve value-based perinatal care. This set contains clinician-reported outcomes and patient-reported outcomes. We validated the set for use in the Netherlands by exploring its applicability among all end-users prior to implementation. METHODS A mixed-methods design was applied. A survey was performed to assess patients (n = 142), professionals (n = 134) and administrators (n = 35) views on the PCB set. To further explore applicability, separate focus groups were held with representatives of each of these groups. RESULTS The majority of survey participants agreed that the PCB set contains the most important outcomes. Patient-reported experience measures were considered relevant by the majority of participants. Perceived relevance of patient-reported outcome measures varied. Main themes from the focus groups were content of the set, data collection timing, implementation (also IT and transparency), and quality-based governance. CONCLUSION This study supports suitability of the PCB outcome set for implementation, evaluation of quality of care and shared decision making in perinatal care. PRACTICE IMPLICATIONS Implementation of the PCB set may change existing care pathways of perinatal care. Focus on transparency of outcomes is required in order to achieve quality-based governance with proper IT solutions.
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Affiliation(s)
- Lyzette T Laureij
- Department of Obstetrics and Gynecology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, the Netherlands.
| | - Jasper V Been
- Department of Obstetrics and Gynecology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, the Netherlands; Department of Pediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, the Netherlands; Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Marjolein Lugtenberg
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Hiske E Ernst-Smelt
- Department of Obstetrics and Gynecology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, the Netherlands
| | - Arie Franx
- Department of Obstetrics and Gynecology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, the Netherlands
| | - Jan A Hazelzet
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Pieter-Kees de Groot
- Department of Pediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, the Netherlands
| | - Odile Frauenfelder
- Department of Pediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, the Netherlands
| | - Dacia Henriquez
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Marije Lamain-de Ruiter
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | | | - Timme Schaap
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Murielle Schagen
- Department of Obstetrics, Spaarne Gasthuis, Haarlem, the Netherlands
| | - Marieke Veenhof
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
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Abstract
There is an increasing emphasis on the incorporation of patient reported outcome measures (PROMs) and patient reported experience measures (PREMs) in healthcare. Development, implementation and adoption of these is fundamental in prioritising orthodontic research and practice.
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Affiliation(s)
- Aliki Tsichlaki
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - Padhraig S Fleming
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK
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Fernandes S, Fond G, Zendjidjian X, Michel P, Baumstarck K, Lancon C, Berna F, Schurhoff F, Aouizerate B, Henry C, Etain B, Samalin L, Leboyer M, Llorca PM, Coldefy M, Auquier P, Boyer L. The Patient-Reported Experience Measure for Improving qUality of care in Mental health (PREMIUM) project in France: study protocol for the development and implementation strategy. Patient Prefer Adherence 2019; 13:165-177. [PMID: 30718945 PMCID: PMC6345324 DOI: 10.2147/ppa.s172100] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Measuring the quality and performance of health care is a major challenge in improving the efficiency of a health system. Patient experience is one important measure of the quality of health care, and the use of patient-reported experience measures (PREMs) is recommended. The aims of this project are 1) to develop item banks of PREMs that assess the quality of health care for adult patients with psychiatric disorders (schizophrenia, bipolar disorder, and depression) and to validate computerized adaptive testing (CAT) to support the routine use of PREMs; and 2) to analyze the implementation and acceptability of the CAT among patients, professionals, and health authorities. METHODS This multicenter and cross-sectional study is based on a mixed method approach, integrating qualitative and quantitative methodologies in two main phases: 1) item bank and CAT development based on a standardized procedure, including conceptual work and definition of the domain mapping, item selection, calibration of the item bank and CAT simulations to elaborate the administration algorithm, and CAT validation; and 2) a qualitative study exploring the implementation and acceptability of the CAT among patients, professionals, and health authorities. DISCUSSION The development of a set of PREMs on quality of care in mental health that overcomes the limitations of previous works (ie, allowing national comparisons regardless of the characteristics of patients and care and based on modern testing using item banks and CAT) could help health care professionals and health system policymakers to identify strategies to improve the quality and efficiency of mental health care. TRIAL REGISTRATION NCT02491866.
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Affiliation(s)
- Sara Fernandes
- Aix-Marseille University, School of Medicine, CEReSS - Health Service Research and Quality of Life Center - EA 3279 Research Unit, Marseille, France, Email
| | - Guillaume Fond
- Aix-Marseille University, School of Medicine, CEReSS - Health Service Research and Quality of Life Center - EA 3279 Research Unit, Marseille, France, Email
| | - Xavier Zendjidjian
- Aix-Marseille University, School of Medicine, CEReSS - Health Service Research and Quality of Life Center - EA 3279 Research Unit, Marseille, France, Email
| | - Pierre Michel
- Aix-Marseille University, School of Medicine, CEReSS - Health Service Research and Quality of Life Center - EA 3279 Research Unit, Marseille, France, Email
| | - Karine Baumstarck
- Aix-Marseille University, School of Medicine, CEReSS - Health Service Research and Quality of Life Center - EA 3279 Research Unit, Marseille, France, Email
| | - Christophe Lancon
- Aix-Marseille University, School of Medicine, CEReSS - Health Service Research and Quality of Life Center - EA 3279 Research Unit, Marseille, France, Email
| | | | | | | | | | | | | | | | | | - Magali Coldefy
- Institute for Research and Information in Health Economics (IRDES), Paris, France
| | - Pascal Auquier
- Aix-Marseille University, School of Medicine, CEReSS - Health Service Research and Quality of Life Center - EA 3279 Research Unit, Marseille, France, Email
| | - Laurent Boyer
- Aix-Marseille University, School of Medicine, CEReSS - Health Service Research and Quality of Life Center - EA 3279 Research Unit, Marseille, France, Email
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11
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Kingsley C, Patel S. Patient-reported outcome measures and patient-reported experience measures. BJA Educ 2017. [DOI: 10.1093/bjaed/mkw060] [Citation(s) in RCA: 231] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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12
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Cinocca S, Rucci P, Randazzo C, Teale E, Pianori D, Ciotti E, Fantini MP. Validation of the Italian version of the Patient Reported Experience Measures for intermediate care services. Patient Prefer Adherence 2017; 11:1671-1676. [PMID: 29033554 PMCID: PMC5630070 DOI: 10.2147/ppa.s140041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Intermediate care (IC) services are a key component of integrated care for elderly people, providing a link between hospital and home through provision of rehabilitation and health and social care. The Patient Reported Experience Measures (PREMs) are designed to measure user experience of care in IC settings. OBJECTIVE To examine the feasibility and the scaling properties of the Italian version of PREMs questionnaires for use in IC services. METHODS A cross-sectional survey was conducted on consecutive users of 1 home-based and 4 bed-based IC services in Emilia-Romagna (Italy). The main outcome measure was the PREMs questionnaire results. PREMs for each home- and bed-based IC services were translated, back-translated, and adapted through consensus among the members of the advisory board and pilot testing of face validity in 15 patients. A total of 199 questionnaires were returned from users of bed-based services and 185 were returned by mail from users of home-based services. The return rates and responses were examined. Mokken analysis was used to examine the scaling properties of the PREMs. RESULTS Analysis performed on the bed-based PREMs (N=154) revealed that 13 items measured the same construct and formed a moderate-strength scale (Loevinger H=0.488) with good reliability (Cronbach's alpha =0.843). Analysis of home-based PREMs (N=134 records) revealed that 15 items constituted a strong scale (Loevinger H=0.543) with good reliability (Cronbach's alpha =0.875). CONCLUSION The Italian versions of the bed- and home-based IC-PREMs questionnaires proved to be valid and reliable tools to assess patients' experience of care. Future plans include monitoring user experience over time in the same facilities and in other Italian IC settings for between-service benchmarking.
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Affiliation(s)
- Sergio Cinocca
- Department of Biomedical and Neuromotor Sciences, Unit of Hygiene, Public Health and Biostatistics, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, Unit of Hygiene, Public Health and Biostatistics, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Correspondence: Paola Rucci, Department of Biomedical and Neuromotor Sciences, Unit of Hygiene, Public Health and Biostatistics, Alma Mater Studiorum, University of Bologna, Via San Giacomo 12, 40126 Bologna, Italy, Tel +39 051 209 4808, Email
| | - Concetta Randazzo
- Department of Biomedical and Neuromotor Sciences, Unit of Hygiene, Public Health and Biostatistics, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Elizabeth Teale
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford, UK
| | - Davide Pianori
- Department of Biomedical and Neuromotor Sciences, Unit of Hygiene, Public Health and Biostatistics, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | | | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, Unit of Hygiene, Public Health and Biostatistics, Alma Mater Studiorum, University of Bologna, Bologna, Italy
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Weldring T, Smith SM. Patient-Reported Outcomes (PROs) and Patient-Reported Outcome Measures (PROMs). Health Serv Insights 2013; 6:61-8. [PMID: 25114561 PMCID: PMC4089835 DOI: 10.4137/hsi.s11093] [Citation(s) in RCA: 489] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
In recent years, there has been an increased focus on placing patients at the center of health care research and evaluating clinical care in order to improve their experience and ensure that research is both robust and of maximum value for the use of medicinal products, therapy, or health services. This paper provides an overview of patients' involvement in clinical research and service evaluation along with its benefits and limitations. We describe and discuss patient-reported outcomes (PROs) and patient-reported outcome measures (PROMs), including the trends in current research. Both the patient-reported experiences measures (PREMs) and patient and public involvement (PPI) initiative for including patients in the research processes are also outlined. PROs provide reports from patients about their own health, quality of life, or functional status associated with the health care or treatment they have received. PROMs are tools and/or instruments used to report PROs. Patient report experiences through the use of PREMs, such as satisfaction scales, providing insight into the patients' experience with their care or a health service. There is increasing international attention regarding the use of PREMS as a quality indicator of patient care and safety. This reflects the ongoing health service commitment of involving patients and the public within the wider context of the development and evaluation of health care service delivery and quality improvement.
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Affiliation(s)
- Theresa Weldring
- Research Nurse, Chelsea and Westminster Hospital, Fulham Road, London SW10 9NH, United Kingdom
| | - Sheree M.S. Smith
- Director, Family and Community Health University Research Group, School of Nursing and Midwifery, University of Western Sydney, Sydney, NSW Australia
- Visiting Professor, Centre for Pharmacology and Therapeutics, Imperial College, Chelsea and Westminster Campus, London, SW10 9NH, United Kingdom
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Weldring T, Smith SMS. Patient-Reported Outcomes (PROs) and Patient-Reported Outcome Measures (PROMs). Health Serv Insights 2013. [PMID: 25114561 DOI: 10.4137/hsi.s11093.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
In recent years, there has been an increased focus on placing patients at the center of health care research and evaluating clinical care in order to improve their experience and ensure that research is both robust and of maximum value for the use of medicinal products, therapy, or health services. This paper provides an overview of patients' involvement in clinical research and service evaluation along with its benefits and limitations. We describe and discuss patient-reported outcomes (PROs) and patient-reported outcome measures (PROMs), including the trends in current research. Both the patient-reported experiences measures (PREMs) and patient and public involvement (PPI) initiative for including patients in the research processes are also outlined. PROs provide reports from patients about their own health, quality of life, or functional status associated with the health care or treatment they have received. PROMs are tools and/or instruments used to report PROs. Patient report experiences through the use of PREMs, such as satisfaction scales, providing insight into the patients' experience with their care or a health service. There is increasing international attention regarding the use of PREMS as a quality indicator of patient care and safety. This reflects the ongoing health service commitment of involving patients and the public within the wider context of the development and evaluation of health care service delivery and quality improvement.
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Affiliation(s)
- Theresa Weldring
- Research Nurse, Chelsea and Westminster Hospital, Fulham Road, London SW10 9NH, United Kingdom
| | - Sheree M S Smith
- Director, Family and Community Health University Research Group, School of Nursing and Midwifery, University of Western Sydney, Sydney, NSW Australia. ; Visiting Professor, Centre for Pharmacology and Therapeutics, Imperial College, Chelsea and Westminster Campus, London, SW10 9NH, United Kingdom
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