The use of patient-reported outcome and experience measures for health policy purposes: A scoping review in oncology

The systematic use of patient-reported measures (PRMs) [i.e., patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs)] is advocated as an effective way to improve care practices. However, whether PRMs can lead to the performance assessment of healthcare organisations (HCOs) through valid quality indicators (QIs) for national purposes (i.e., public reporting and paying for performance) is open to debate. This study undertakes a scoping review to examine the use of PRMs as QIs for health policy purposes and to identify the challenges faced in the emblematic case of oncology. According to PRISMA guidelines, published papers, websites and reports published by national and international initiatives were analysed using five online databases (Web of Science, Scopus, PubMed, JSTOR and Google Advanced Search), and then studied using the same keywords. We selected 61 articles and 19 websites/reports and identified 29 PREMs and 48 PROMs from 14 countries and two international initiatives that routinely used them as QIs for HCOs' comparisons. Four types of barriers to this specific use were identified relating to the definition of a standard set, scientific soundness, data collection, and the actionability of such measures. Despite current developments, different barriers still must be overcome before PRMs can be used for health policy purposes in oncology. Future research is needed to ensure that valid QIs related to PRMs are applied at a national level.

[Development and validation of indicators relating to the quality of prevention and early management of postpartum haemorrhage (COMPAQ-HPST research project)]

OBJECTIVES

To develop and validate a set of quality indicators (QIs) relating to the prevention and early management of postpartum haemorrhage (PPH) in maternity wards. The ultimate aim was to use these QIs for hospital comparison and public diffusion of results.

MATERIALS AND METHODS

In 2009, COMPAQ-HPST developed a set of five QIs from consensus guidelines with the aid of experts and professional associations, relating to: i) the prevention of PH (three QIs) and ii) the initial management of PPH (two QIs). We also tested a questionnaire about the presence of written protocols in maternity wards.

RESULTS

Ninety-seven voluntary maternity wards were included in the study. All five QIs showed wide variations in implementation among hospitals, revealing substantial room for improvement. Results of the questionnaire were variable according to the item considered.

CONCLUSION

We validated five process QIs relating to the prevention and early management of PPH. All these five QIs have been transmitted to HAS for nationwide generalization. They should allow hospitals to implement quality of care improvement in this setting, adapted to their individual and comparative results.

[Assessment of the French surgical checklist: the experience of 17 French cancer centres]

INTRODUCTION

The use of WHO checklist has been associated to a decrease of complication incidence and mortality. This control is mandatory since January the 1st 2010. Evaluation of the quality of documentation is important and includes filling rate, which is a reflexion of participant adhesion and analysis of the circumstances where the team answers "no" during the control.

METHODS

This study concerned 17 among 20 French cancer centres. Percentage of documented checklist, exhaustivity of the answers in each checklist and "no" answers have been compared during two periods: January 2010 and October 2010.

RESULTS

Rate of filled document is satisfactory and stable during the two periods (95.5% versus 95.8%). Exhaustivity was slightly better during the second period (64 and 68%, P=0,039). Nevertheless, variability between centres was large; one centre improved and four centres worsened their scores. Rate of "no" answers was low and increased during the second period (1.5% in January 1.9% in October P<0.001). They mainly concerned antibiotic administration and at a lesser degree bleeding risk, the name of the procedure, equipment problem to be addressed and postoperative management.

DISCUSSION

There is a large discrepancy between centres and for a given centre in reporting quality. Significant progress should be expected using target improvement. This approach implies multiple critical analysis of checklist content in each hospital and in multicentre enquiries.

[The COMPAQH project: researches on quality indicators in hospitals]

After three years, the coordination de la mesure de la performance pour l'amélioration de la qualité hospitalière (COMPAQH) project can deliver its first findings and consider new perspectives of development. Which indicators are diffused? Under which criteria are they assessed? Which interhospital variability is observed? How to consider their application into hospitals? Which balance can we define between internal and external use? And finally, which consideration can we give to this program of quality measurement? This article addresses these different questions, giving a state of the development of this program.

[Quality criteria in medicine: which limits?]

This article aims to develop a critical appraisal of the criteria's development in medicine. The COMPAQH (Coordination for Measuring Performance and Assuring Quality in Hospitals) project (Ministry of Health/ High Authority of Health/ National Institute of Medical Research) helps to support this analysis. This project based on the test of 42 Quality indicators (QI) gives findings not only about the manner to build criteria, but also to interpret and diffuse results among physicians and hospital managers. Criteria must be elaborated in a pragmatic way. They must be in compliance with practice guidelines supported by scientific evidences. The associated risk is to create and develop a normative medicine. Collaboration with professional societies may be useful in preventing this risk.

[Developing quality indicators in hospitals: the COMPAQH project]

BACKGROUND

To select a set of quality indicators (QI) in order to test them in a panel of 36 French hospitals

METHODS

The COMPAQH (COordination for Measuring Performance and Assuring Quality in Hospitals) project is coordinated by the French National Institute for Medical Research and supported by the French Ministry of Health and the French National Evaluation and Accreditation Agency. This project has four objectives: (1) to select a set of QI -2003- (2) to implement them in 2004-2005 in a volunteer panel of hospitals (3) to compare the hospitals anonymously (4) to explore quality management implications. QI were selected with a four-step process: (1) Establishment of a list of national priorities for Quality Improvement in relation with the Ministry of Health. (2) setting up a potential list of QI regarding these priorities. The COMPAQH staff determined a preliminary set of 81 QI, based on data in the literature and evidence about the scientific soundness of quality measures and the effectiveness of methods for improving quality. (3) Evaluation of the preliminary list. Each QI was presented in a pamphlet describing its operational definition, rationale, methodology, workload and responsibility of data collection The hospital panel (representatives) ranked the 81 QI with a validated evaluation tool which contained four dimensions: Importance, Scientific acceptability, Feasibility, and Usability. (4) Development of a consensus on a final selection. Based on a structured voting process (Delphi method, two rounds), the hospital panel selected a comprehensive set of 42 QI among the 81.

RESULTS

(1) Eight national priorities were defined: pain management, continuity of care, management of nutritional disorders, Iatrogenic risks (including nosocomial infections), patient satisfaction, follow-up of practice guidelines, management of human resources, accessibility. (2) A set of 42 QI were selected: a set of 6 core QI and 7 to 18 specific QI according to the hospital type.

CONCLUSION

Such a set of QI provides a foundation for developing a quality measurement system in French hospitals. It requires a pragmatic view for implementing them and a coherence between the different objectives of use (internal and external use).

Carcase characteristics of a heavy Japanese quail line under introgression with the roux gene

1. The roux plumage sex-linked recessive gene may be used for early sexing of Japanese quail in crossbreeding production systems with wild-type and roux lines. However, associated effects of the gene on carcase and meat composition need to be assessed. 2. Quail carcases from pure Line K males and females (100% K), a heavy meat line which was used as the recipient line for the introgression of the roux gene, and from same-age roux or wild-type females from the second generation of introgression (75% K) were dissected. The effects of sex, line and plumage colour on carcase components and on protein and lipid contents of various tissues were estimated. 3. Expected sex differences in carcase weights were obtained, with marginally higher values for females. However, weights of parts and carcase yield (ratio of empty carcase weight without head, neck and feet over live body weight) were similar for both sexes in pure Line K which had a 68% carcase yield. Lipid contents in leg meat were higher in males (3.1%) than in females (2.7%). 4. The roux gene did not seem to have any major impact on carcase parts or composition. However, in roux birds, leg skin was marginally higher in lipids and pectoralis major lower in proteins than in wild-type ones.

Beyond quality management methods: meeting the challenges of health care reform

Over the last 20 years, the increasing complexity and technical intensiveness of health care in French hospitals have increased the level of uncertainty in the process of care. This paper argues that beyond quality management approaches, the most important issue in health care management is the need to implement new organizational methods in response to the dynamic changes that are transforming the care process. Uncertainty, complexity and speed can all be managed by standardizing operating procedures, but when quality management is applied to a complex system such as health care, a different approach is needed. One alternative to standardization can be found in new theories of organization that emphasize the flexibility of an organization, i.e. its capacity to adapt to uncertainty. Building on empirical work, this paper integrates these different theoretical perspectives and tries to provide insight into the kind of quality management methods that will allow hospitals to deal with the new constraints being placed on the process of care.

[Managing of an innovation in health care: the case of polyvalent intravenous immunoglobulins at the Assistance-Publique-Hôpitaux de Paris]

Managing new innovations in medicine is a particularly timely subject. There is an abundant history concerning over expectations resulting from the development of new treatments or diagnostic procedures, some shown to be less effective than promised, others even found to be dangerous. A new aspect to the question is the importance of economic pressures which require rational investment decisions when diffusing innovating technologies. In 1991, the Commission for the evaluation and diffusion of innovating technologies (CEDIT) at the University Hospitals of Paris (Assistance Publique-Hôpitaux de Paris) developed a programme aimed at better managing the distribution and use of polyvalent intravenous immunoglobulins (IgIV), a new promising therapeutic tool with both a high cost and a certain number of risks. The programme was designed to assist prescribers in elaborating better therapeutic strategies and to help hospital managers rationalize expenditures for IgIV. The results of this experience are presented here together with certain conclusions concerning the way management decisions can be applied to the diffusion of an innovation in health care.