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Oehrlein EM, Schoch S, Majercak K, Gressler LE, Costantino RC, Love TR, Perfetto EM. Development and Testing of a Chronic-Disease Patient Experience Mapping Toolbox. Patient 2024; 17:263-274. [PMID: 38172406 DOI: 10.1007/s40271-023-00658-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Stakeholders increasingly expect research and care delivery to be guided by and to optimize patient experiences. However, standardized tools to engage patients to gather high-quality data about their experiences, priorities, and desired outcomes are not publicly available. The objective of this study was to develop and test a Toolbox with a disease-agnostic interview guide template and accompanying resources to assist researchers in engaging patients living with chronic disease in a dialogue about their experiences. METHODS Guided by a multidisciplinary workgroup, a targeted literature review (PubMed) was conducted, followed by group discussions to identify/thematically organize patient experience concepts, development of a conceptual model, and drafting of an interview guide template and patient-facing visual. Materials were tested/refined via cognitive (n = 5) and pilot (n = 30) interviews conducted virtually with US patients diagnosed with chronic/potentially disabling conditions from December 2020 to April 2021. Patient-facing tools were reviewed by health literacy experts for applicability/accessibility. English-speaking adults who self-reported receiving a chronic condition diagnosis at least 6 months prior participated in a 60-90 min interview. RESULTS Patient experience concepts were organized thematically under three domains: (1) life before a diagnosis, (2) experiences getting a diagnosis, and (3) experiences living with a diagnosis. A plain language consent sheet template, interview guide template, and patient experience conceptual model were developed and revised based on input from interviewees, interviewers, and the workgroup. CONCLUSIONS A disease-agnostic patient-engagement Toolbox was developed and tested to capture patient experience data. These materials can be customized based on study objectives and leveraged by various stakeholders to identify opportunities to enhance the patient centricity of healthcare delivery and research.
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Affiliation(s)
- Elisabeth M Oehrlein
- National Health Council, 1730 M St. NW Suite 650, Washington, DC, 20036, USA.
- Applied Patient Experience, LLC, 2201 Wisconsin Ave NW, Suite 200, Washington, DC, 20007, USA.
| | - Silke Schoch
- National Health Council, 1730 M St. NW Suite 650, Washington, DC, 20036, USA
| | - Kelsie Majercak
- National Health Council, 1730 M St. NW Suite 650, Washington, DC, 20036, USA
| | - Laura Elisabeth Gressler
- Division of Pharmaceutical Evaluation and Policy, College of Pharmacy, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR, 72205, USA
| | - Ryan C Costantino
- National Health Council, 1730 M St. NW Suite 650, Washington, DC, 20036, USA
- School of Pharmacy, University of Maryland, 20 N. Pine St, Baltimore, MD, 21201, USA
| | - T Rosie Love
- School of Pharmacy, University of Maryland, 20 N. Pine St, Baltimore, MD, 21201, USA
- Enterprise Intelligence and Data Solutions Program Management Office, Program Executive Office, Defense Healthcare Management Systems, 1700 North Moore Street, Suite 2300, Arlington, VA, 22209, USA
| | - Eleanor M Perfetto
- National Health Council, 1730 M St. NW Suite 650, Washington, DC, 20036, USA
- School of Pharmacy, University of Maryland, 20 N. Pine St, Baltimore, MD, 21201, USA
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Costantino RC, Gressler LE, Highland KB, Oehrlein EM, Villalonga-Olives E, Perfetto EM. Patient-centeredness and psychometric properties of the Defense and Veterans Pain Rating Scale 2.0 (DVPRS). Pain Med 2024; 25:57-62. [PMID: 37699011 DOI: 10.1093/pm/pnad125] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/24/2023] [Accepted: 08/31/2023] [Indexed: 09/14/2023]
Abstract
OBJECTIVE This study aims to assess the patient-centeredness and psychometric properties of the Defense and Veterans Pain Rating Scale 2.0 (DVPRS) as a patient-reported outcome measure (PROM) for pain assessment in a military population. DESIGN A critical evaluation of the DVPRS was conducted, considering its fit-for-purpose as a PROM and its patient-centeredness using the National Health Council's Rubric to Capture the Patient Voice. SETTING The study focused on the use of the DVPRS within the Department of Defense (DoD) and Veterans Health Administration (VA) healthcare settings. SUBJECTS The DVPRS was evaluated based on published studies and information provided by measure developers. The assessment included content validity, reliability, construct validity, and ability to detect change. Patient-centeredness and patient engagement were assessed across multiple domains. METHODS Two independent reviewers assessed the DVPRS using a tool/checklist/questionnaire, and any rating discrepancies were resolved through consensus. The assessment included an evaluation of psychometric properties and patient-centeredness based on established criteria. RESULTS The DVPRS lacked sufficient evidence of content validity, with no patient involvement in its development. Construct validity was not assessed adequately, and confirmatory factor analysis was not performed. Patient-centeredness and patient engagement were also limited, with only a few domains showing meaningful evidence of patient partnership. CONCLUSIONS The DVPRS as a PROM for pain assessment in the military population falls short in terms of content validity, construct validity, and patient-centeredness. It requires further development and validation, including meaningful patient engagement, to meet current standards and best practices for PROMs.
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Affiliation(s)
- Ryan C Costantino
- Enterprise Intelligence and Data Solutions Program Management Office, Program Executive Office, Defense Healthcare Management Systems, Rosslyn, VA 22209, United States
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD 21201, United States
| | - Laura E Gressler
- Division of Pharmaceutical Evaluation and Policy, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
| | - Krista B Highland
- Department of Military and Emergency Medicine, Uniformed Services University, Bethesda, MD 20814, United States
- Department of Anesthesiology, Uniformed Services University, Bethesda, MD 20814, United States
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD 20817, United States
| | | | - Ester Villalonga-Olives
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD 21201, United States
| | - Eleanor M Perfetto
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD 21201, United States
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Oehrlein EM. An Interview With the Food and Drug Administration About Draft Patient-Focused Drug Development Guidance 3: Selecting, Developing, or Modifying Fit-for-Purpose Clinical Outcome Assessments. Value Health 2023; 26:791-795. [PMID: 37116698 DOI: 10.1016/j.jval.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 06/04/2023]
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Perfetto EM, Love TR, Oehrlein EM, Schoch SC, Schrandt S. A Foundation for Patient-Centered Core Impact Sets: Key Learnings from Past and Existing Approaches. Patient 2023:10.1007/s40271-023-00630-1. [PMID: 37204700 DOI: 10.1007/s40271-023-00630-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Accepted: 04/08/2023] [Indexed: 05/20/2023]
Abstract
Despite growing commitment to patient centricity, challenges persist in consistently identifying the impacts of disease and/or treatment that patients report as most important to them, especially across myriad potential downstream uses. Patient-centered core impact sets (PC-CIS), disease-specific lists of impacts that patients report as most important, are proposed as a solution. But, PC-CIS is a new concept, currently in the pilot stage with patient advocacy groups. We conducted an environmental scan to explore PC-CIS conceptual overlap with past/existing efforts [e.g., core outcome sets (COS)] and to inform general feasibility for further development and operationalization. With guidance and advice from an expert advisory committee, we conducted a search of the literature and relevant websites. Identified resources were reviewed for alignment with the PC-CIS definition, and key insights were gleaned. We identified 51 existing resources and five key insights: (1) no existing efforts identified meet the definition of PC-CIS as we have specified it in terms of patient centricity, (2) existing COS-development efforts are a valuable source of foundational resources for PC-CIS, (3) existing health-outcome taxonomies can be augmented with patient-prioritized impacts to create a comprehensive impact taxonomy, (4) current approaches/methods can inadvertently exclude patient priorities from core lists/sets and will need to be modified to protect the patient voice, and (5) there is need for clarity and transparency on how patients were engaged in individual past/existing efforts. PC-CIS is conceptually unique from past/existing efforts in its explicit emphasis on patient leadership and being patient driven. However, PC-CIS development can leverage many resources from the past/existing related work.
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Affiliation(s)
| | - T Rosie Love
- School of Pharmacy, University of Maryland, Baltimore, MD, USA
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Oehrlein EM, Burcu M, Schoch S, Gressler LE. Enhancing Patient Centricity of Real-World Data Research: An Exploratory Analysis Using the Patient Experience Mapping Toolbox. Value Health 2023; 26:10-17. [PMID: 36494301 DOI: 10.1016/j.jval.2022.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 09/27/2022] [Accepted: 10/04/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES There is an increasing expectation that medical product development and assessment be guided by patient input captured through patient engagement. Recently published consensus guidelines describe how qualitative patient experience data (PED) can guide the design, conduct, and translation of real-world research that reflects patients' lived experience. The objective of this exploratory analysis is to examine how researchers could leverage PED captured through the Patient Experience Mapping Toolbox (PEMT) to guide real-world data (RWD) research designs. METHODS This exploratory analysis included a thematic analysis of interview transcripts collected while pilot testing the PEMT followed by a qualitative analysis of the emerging themes aligned with stages listed in the patient-centered real-world evidence, Real-World Research Design Framework. RESULTS PED collected using the PEMT include information about symptomology, interactions with the healthcare system, information-seeking behavior, misdiagnoses, lifestyle changes, treatments, side effects, and comorbidities. This information can be leveraged at key study design decisions, including (1) identifying study cohorts and subgroups, (2) identifying exposures, (3) informing covariates and potential confounders; and (4) refining study periods. Additionally, participants described where they seek information about treatments and diseases, which should inform dissemination strategies. CONCLUSIONS We identified opportunities for PED collected using the PEMT to inform RWD study designs. The PED described in this exploratory analysis stem from pilot testing of the PEMT across a variety of conditions. In the next phase of development in this area, researchers should evaluate how data collected using the PEMT can be applied to RWD research for a specific disease.
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Affiliation(s)
- Elisabeth M Oehrlein
- National Health Council, Washington, DC, USA; Applied Patient Experience, LLC, Washington, DC, USA.
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Oehrlein EM, Schoch S, Burcu M, McBeth JF, Bright J, Pashos CL, Willke R, Love TR, Mattingly TJ, Perfetto EM. Developing Patient-Centered Real-World Evidence: Emerging Methods Recommendations From a Consensus Process. Value Health 2023; 26:28-38. [PMID: 35863944 DOI: 10.1016/j.jval.2022.04.1738] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 04/13/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES The Joint ISPOR-ISPE Special Task Force on Real-World Evidence included patient/stakeholder engagement as a recommended good procedural practice when designing, conducting, and disseminating real-world evidence (RWE). However, there are no guidelines describing how patient experience data (PED) can be applied when designing real-world data (RWD) studies. This article describes development of consensus recommendations to guide researchers in applying PED to develop patient-centered RWE. METHODS A multidisciplinary advisory board, identified through recommendations of collaborators, was established to guide development of recommendations. Semistructured interviews were conducted to identify how experienced RWD researchers (n = 15) would apply PED when designing a hypothetical RWD study. Transcripts were analyzed and emerging themes developed into preliminary methods recommendations. An eDelphi survey (n = 26) was conducted to refine/develop consensus on the draft recommendations. RESULTS We identified 13 recommendations for incorporating PED throughout the design, conduct, and translation of RWE. The recommendations encompass themes related to the development of a patient-centered research question, designing a study, disseminating RWE, and general considerations. For example, consider how patient input can inform population/subgroups, comparators, and study period. Researchers can leverage existing information describing PED and may be able to apply those insights to studies relying on traditional RWD sources and/or patient registries. CONCLUSIONS Applying these emerging recommendations may improve the patient centricity of RWE through improved relevance of RWE to patient communities of interest and foster greater multidisciplinary participation and transparency in RWD research. As researchers gather experience by applying the methods recommendations, further refinement of these consensus recommendations may lead to "best practices."
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Affiliation(s)
| | | | | | | | | | | | - Richard Willke
- International Society for Pharmacoeconomics and Outcomes Research (ISPOR), Lawrenceville, NJ, USA
| | - T Rosie Love
- Department of Pharmaceutical Health Services Research, University of Maryland Baltimore, Baltimore, MD, USA
| | - T Joseph Mattingly
- Department of Pharmaceutical Health Services Research, University of Maryland Baltimore, Baltimore, MD, USA
| | - Eleanor M Perfetto
- National Health Council, Washington, DC, USA; Merck & Co, Inc, Rahway, NJ, USA; Department of Pharmaceutical Health Services Research, University of Maryland Baltimore, Baltimore, MD, USA
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Oehrlein EM, Luo X, Savone M, Lobban T, Kang A, Lee B, Gale R, Schoch S, Perfetto E. Engaging Patients in Real-World Evidence: An Atrial Fibrillation Patient Advisory Board Case Example. Patient 2020; 14:295-300. [PMID: 33355917 PMCID: PMC7884300 DOI: 10.1007/s40271-020-00479-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 10/29/2020] [Indexed: 10/31/2022]
Affiliation(s)
| | - Xuemei Luo
- Pfizer, Inc, Health Economics and Outcomes Research, Groton, CT, USA
| | | | - Trudie Lobban
- Heart Rhythm Alliance, Arrhythmia Alliance, PO Box 5507, Hilton Head Island, SC, 29938, USA
| | - Amiee Kang
- Bristol-Myers Squibb Company, 3401 Princeton Pike, Lawrence Township, NJ, 08648, USA
| | - Brian Lee
- Bristol-Myers Squibb Company, 3401 Princeton Pike, Lawrence Township, NJ, 08648, USA
| | - Rex Gale
- Board Member-Arrhythmia Alliance, P O Box 5507, Hilton Head Island, SC, 29938, USA
| | - Silke Schoch
- National Health Council, 1730 M St, Suite 500, Washington, DC, USA
| | - Eleanor Perfetto
- National Health Council, 1730 M St, Suite 500, Washington, DC, USA.,Department Pharmaceutical Health Services Research, University of Maryland Baltimore, 220 Arch Street 12th floor, Baltimore, MD, 21201, USA
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Oehrlein EM, Harris J, Balch A, Furlong P, Hargis E, Woolley M, Perfetto E. Improving Access and Quality of Health Care in the United States: Shared Goals Among Patient Advocates. Patient 2020; 14:687-690. [PMID: 33083996 PMCID: PMC8357644 DOI: 10.1007/s40271-020-00453-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
| | - Jason Harris
- National Health Council, 1730 M St, Suite 500, Washington, DC, USA.,Lupus Foundation of America, Inc., 2121 K Street NW, Suite 200, Washington, DC, USA
| | - Alan Balch
- Patient Advocate Foundation, 1100 H St NW, Washington, DC, USA
| | - Pat Furlong
- Parent Project Muscular Dystrophy, 401 Hackensack Avenue, 9th Floor, Hackensack, NJ, USA
| | - Eric Hargis
- Colon Cancer Alliance, 1025 Vermont Ave NW Suite 1066, Washington, DC, USA
| | - Mary Woolley
- Research!America, 241 18th St S, Arlington, VA, USA
| | - Eleanor Perfetto
- National Health Council, 1730 M St, Suite 500, Washington, DC, USA.,Department of Pharmaceutical Health Services Research, University of Maryland Baltimore, 220 Arch Street 12th floor, Baltimore, MD, 21201, USA
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Marsh K, van Til JA, Molsen-David E, Juhnke C, Hawken N, Oehrlein EM, Choi YC, Duenas A, Greiner W, Haas K, Hiligsmann M, Hockley KS, Ivlev I, Liu F, Ostermann J, Poder T, Poon JL, Muehlbacher A. Health Preference Research in Europe: A Review of Its Use in Marketing Authorization, Reimbursement, and Pricing Decisions-Report of the ISPOR Stated Preference Research Special Interest Group. Value Health 2020; 23:831-841. [PMID: 32762984 DOI: 10.1016/j.jval.2019.11.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 11/07/2019] [Accepted: 11/27/2019] [Indexed: 06/11/2023]
Abstract
OBJECTIVE This study examines European decision makers' consideration and use of quantitative preference data. METHODS The study reviewed quantitative preference data usage in 31 European countries to support marketing authorization, reimbursement, or pricing decisions. Use was defined as: agency guidance on preference data use, sponsor submission of preference data, or decision-maker collection of preference data. The data could be collected from any stakeholder using any method that generated quantitative estimates of preferences. Data were collected through: (1) documentary evidence identified through a literature and regulatory websites review, and via key opinion leader outreach; and (2) a survey of staff working for agencies that support or make healthcare technology decisions. RESULTS Preference data utilization was identified in 22 countries and at a European level. The most prevalent use (19 countries) was citizen preferences, collected using time-trade off or standard gamble methods to inform health state utility estimation. Preference data was also used to: (1) value other impact on patients, (2) incorporate non-health factors into reimbursement decisions, and (3) estimate opportunity cost. Pilot projects were identified (6 countries and at a European level), with a focus on multi-criteria decision analysis methods and choice-based methods to elicit patient preferences. CONCLUSION While quantitative preference data support reimbursement and pricing decisions in most European countries, there was no utilization evidence in European-level marketing authorization decisions. While there are commonalities, a diversity of usage was identified between jurisdictions. Pilots suggest the potential for greater use of preference data, and for alignment between decision makers.
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Affiliation(s)
| | - Janine A van Til
- Health Technology and Services Research, University of Twente, Enschede, The Netherlands
| | | | | | | | | | - Y Christy Choi
- University of Minnesota College of Pharmacy, Minneapolis, Minnesota
| | | | - Wolfgang Greiner
- Department of Health Economics, Bielefeld University, Bielefeld, Germany
| | | | - Mickael Hiligsmann
- Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | | | - Ilya Ivlev
- Center for Health Research, Kaiser Permanente, Portland, OR, USA
| | | | - Jan Ostermann
- Department of Health Services Policy and Management, University of South Carolina, Columbia, SC, USA
| | | | - Jiat L Poon
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Axel Muehlbacher
- Hochschule Neubrandenburg, Neubrandenburg, Germany; Department of Population Health Sciences, Duke University, Durham, NC, USA
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Harrington RL, Hanna ML, Oehrlein EM, Camp R, Wheeler R, Cooblall C, Tesoro T, Scott AM, von Gizycki R, Nguyen F, Hareendran A, Patrick DL, Perfetto EM. Defining Patient Engagement in Research: Results of a Systematic Review and Analysis: Report of the ISPOR Patient-Centered Special Interest Group. Value Health 2020; 23:677-688. [PMID: 32540224 DOI: 10.1016/j.jval.2020.01.019] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 01/17/2020] [Accepted: 01/30/2020] [Indexed: 05/13/2023]
Abstract
OBJECTIVES Lack of clarity on the definition of "patient engagement" has been highlighted as a barrier to fully implementing patient engagement in research. This study identified themes within existing definitions related to patient engagement and proposes a consensus definition of "patient engagement in research." METHODS A systematic review was conducted to identify definitions of patient engagement and related terms in published literature (2006-2018). Definitions were extracted and qualitatively analyzed to identify themes and characteristics. A multistakeholder approach, including academia, industry, and patient representation, was taken at all stages. A proposed definition is offered based on a synthesis of the findings. RESULTS Of 1821 abstracts identified and screened for eligibility, 317 were selected for full-text review. Of these, 169 articles met inclusion criteria, from which 244 distinct definitions were extracted for analysis. The most frequently defined terms were: "patient-centered" (30.5%), "patient engagement" (15.5%), and "patient participation" (13.4%). The majority of definitions were specific to the healthcare delivery setting (70.5%); 11.9% were specific to research. Among the definitions of "patient engagement," the most common themes were "active process," "patient involvement," and "patient as participant." In the research setting, the top themes were "patient as partner," "patient involvement," and "active process"; these did not appear in the top 3 themes of nonresearch definitions. CONCLUSION Distinct themes are associated with the term "patient engagement" and with engagement in the "research" setting. Based on an analysis of existing literature and review by patient, industry, and academic stakeholders, we propose a scalable consensus definition of "patient engagement in research."
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Affiliation(s)
| | - Maya L Hanna
- Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT USA
| | | | - Rob Camp
- Community Advisory Board Programme, EURORDIS, Barcelona, Spain
| | | | - Clarissa Cooblall
- Scientific & Health Policy Initiatives, ISPOR, Lawrenceville, NJ, USA
| | - Theresa Tesoro
- Scientific & Health Policy Initiatives, ISPOR, Lawrenceville, NJ, USA
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Oehrlein EM, Graff JS, Harris J, Perfetto EM. Patient-Community Perspectives on Real-World Evidence: Enhancing Engagement, Understanding, and Trust. Patient 2019; 12:375-381. [PMID: 30666526 PMCID: PMC6598955 DOI: 10.1007/s40271-019-00356-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Healthcare stakeholders have pronounced both enthusiasm and apprehension over the expanding use of real-world evidence (RWE). The patient community-those who benefit from new treatments but are vulnerable to potential safety risks and whose routine medical encounters are used to generate RWE-has been less vocal. Understanding patient perspectives on the use of RWE to guide clinical decision making and inform regulatory decisions and value assessments is imperative. METHODS We convened a day-long, multi-stakeholder roundtable in Washington D.C., USA, on 31 July 2017 to gather patient-community views on RWE and related concerns and the communications, information and tools needed by patients to understand, trust, and use RWE. Participants included a convenience sample of National Health Council (NHC) members primarily representing patient groups as well as non-patient members with an interest in RWE. Participants were organized into small, pre-assigned groups, ensuring representativeness across stakeholders and patient leadership. Discussions, including storyboards, notes, and illustrative examples were captured and later analyzed thematically by NHC staff. RESULTS Ten RWE themes emerged: (1) most patients were unaware of RWE and its actual or potential uses, (2) common definitions for real-world data and RWE are needed, (3) patient organizations need RWE skills and tools, (4) patient-scientist partnerships can help differentiate high-quality RWE, (5) RWE should inform decision making, (6) clinician support is needed for RWE uptake in patient decision making, (7) communications to patients should be balanced and empowering, (8) context of use impacts RWE acceptability/trust, (9) privacy/data ownership require clarity, and (10) patient-generated data are also real-world data (RWD). CONCLUSION Patients see great possibility in using RWE to understand how a treatment works-to find someone that "looks like me" as assurance of how a treatment might benefit them personally. Patient groups will play a critical role in helping to educate constituents on understanding, contributing to, and using RWE. To maximize patient uptake and the co-development and application of RWE, patient groups require education and tools.
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Affiliation(s)
| | - Jennifer S Graff
- National Pharmaceutical Council, 1717 Pennsylvania Ave NW #800, Washington, DC, 20006, USA
| | - Jason Harris
- National Health Council, 1730 M Street #500, Washington, DC, 20036, USA
| | - Eleanor M Perfetto
- National Health Council, 1730 M Street #500, Washington, DC, 20036, USA
- Department Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, 12th floor, Baltimore, MD, 21201, USA
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Oehrlein EM, Perfetto EM, Love TR, Chung Y, Ghafoori P. Patient-Reported Outcome Measures in the Food and Drug Administration Pilot Compendium: Meeting Today's Standards for Patient Engagement in Development? Value Health 2018; 21:967-972. [PMID: 30098675 DOI: 10.1016/j.jval.2018.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 12/05/2017] [Accepted: 01/14/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND In 2016, the Food and Drug Administration (FDA) released a Pilot Clinical Outcome Assessment Compendium (COA Compendium) intended to foster patient-focused drug development (PFDD). However, it is unclear whether patient perspectives were solicited during development or validation of the included patient-reported outcome (PRO) measures. OBJECTIVE To examine the pedigree of a sample of measures included in the COA Compendium. METHODS PROs included in chapters 1 or 2 of the COA Compendium were extracted and three reviewers independently searched PubMed and Google to identify information on measure pedigree. Data on method and stage of measure development where patient engagement took place were documented. RESULTS Among the 26 evaluated PRO measures, we were unable to identify information on development or validation on nearly half the sample (n = 12). Among the remaining 14 measures, 5 did not include any evidence of patient engagement; 2 engaged patients during concept elicitation only; 1 engaged patients during psychometric validation only; and 6 engaged patients during both concept elicitation and cognitive interviewing. Measures either previously qualified or submitted for qualification were more likely to include patient engagement. CONCLUSIONS For the FDA Pilot COA Compendium to fulfill its purpose of fostering PFDD, it needs fine-tuning to reflect today's standards, improving transparency and facilitating clear identification of included measures so that the level of patient engagement, among other factors, can be properly assessed. Suggested improvements include identifying clinical trials that correspond to the COA Compendium's use in drug development; more clearly identifying which measure is referred to; and including only those measures that already qualified or undergoing qualification.
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Affiliation(s)
- Elisabeth M Oehrlein
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA.
| | - Eleanor M Perfetto
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA; National Health Council, Washington, DC, USA
| | - T Rose Love
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Yujin Chung
- University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Parima Ghafoori
- University of Maryland School of Pharmacy, Baltimore, MD, USA
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Asche CV, Seal B, Kahler KH, Oehrlein EM, Baumgartner MG. Evaluation of Healthcare Interventions and Big Data: Review of Associated Data Issues. Pharmacoeconomics 2017; 35:759-765. [PMID: 28474299 DOI: 10.1007/s40273-017-0513-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Although the analysis of 'big data' holds tremendous potential to improve patient care, there remain significant challenges before it can be realized. Accuracy and completeness of data, linkage of disparate data sources, and access to data are areas that require particular focus. This article discusses these areas and shares strategies to promote progress. Improvement in clinical coding, innovative matching methodologies, and investment in data standardization are potential solutions to data validation and linkage problems. Challenges to data access still require significant attention with data ownership, security needs, and costs representing significant barriers to access.
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Affiliation(s)
- Carl V Asche
- Center for Outcomes Research, University of Illinois College of Medicine at Peoria, 1 Illini Dr, Peoria, IL, 61605, USA.
| | - Brian Seal
- Global Health Outcomes, Takeda, Bedford, MA, USA
| | - Kristijan H Kahler
- Novartis Pharmaceuticals Corporation, 1 Health Plaza, East Hanover, NJ, 07936, USA
| | - Elisabeth M Oehrlein
- Pharmaceutical Heath Services Research, University of Maryland, Baltimore, MD, USA
| | - Meredith Greer Baumgartner
- Center for Outcomes Research, University of Illinois College of Medicine at Peoria, 1 Illini Dr, Peoria, IL, 61605, USA
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Perfetto EM, Oehrlein EM, Boutin M, Reid S, Gascho E. Value to Whom? The Patient Voice in the Value Discussion. Value Health 2017; 20:286-291. [PMID: 28237211 DOI: 10.1016/j.jval.2016.11.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 11/10/2016] [Accepted: 11/13/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Professional societies and other organizations have recently taken a visible role trying to define treatment value via value frameworks and assessments, providing payer or provider recommendations, and potentially impacting patient access. Patient perspectives routinely differ from those of other stakeholders. Yet, it is not always apparent that patients were engaged in value framework development or assessment. OBJECTIVES To describe the development and content of the National Health Council's (NHC's) Rubric, a tool that includes criteria for evaluation of value frameworks specifically with regard to patient-centeredness and meaningful patient engagement. METHODS The NHC held a multistakeholder, invitational roundtable in Washington, DC, in 2016. Participants reviewed existing patient-engagement rubrics, discussed experiences with value frameworks, debated and thematically grouped hallmark patient-centeredness characteristics, and developed illustrative examples of the characteristics. These materials were organized into the rubric, and subsequently vetted via multistakeholder peer review. RESULTS The resulting rubric describes six domains of patient-centered value frameworks: partnership, transparency, inclusiveness, diversity, outcomes, and data sources. Each domain includes specific examples illustrating how patient engagement and patient-centeredness can be operationalized in value framework processes. CONCLUSIONS The NHC multistakeholder roundtable's recommendations are captured in the NHC's Rubric to assess value framework and model patient-centeredness and patient engagement. The Rubric is a tool that will be refined over time on the basis of feedback from patient, patient group, framework developer, and other stakeholder-use experiences.
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Affiliation(s)
- Eleanor M Perfetto
- National Health Council, Washington, DC, USA; University of Maryland, Baltimore, MD, USA.
| | - Elisabeth M Oehrlein
- National Health Council, Washington, DC, USA; University of Maryland, Baltimore, MD, USA
| | - Marc Boutin
- National Health Council, Washington, DC, USA
| | - Sarah Reid
- National Health Council, Washington, DC, USA
| | - Eric Gascho
- National Health Council, Washington, DC, USA
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Abstract
OBJECTIVES The study objective was to assess national trends in the diagnosis of attention-deficit hyperactivity disorder (ADHD) in outpatient visits by comparing adults and youths. Also examined were recent stimulant prescribing patterns for ADHD visits by youths and adults. METHODS Databases from the 1999-2010 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey were used in this cross-sectional study to analyze outpatient visit data of youths (ages two to 17 years; unweighted N=112,404) and adults (ages 18-64; unweighted N=426,209). The 12-year trends in ADHD visits were assessed as a proportion of youth and adult visits. The interaction of time period and age group was added to multivariable and weighted logistic regression models to assess whether trends in ADHD diagnosis differed by age group. RESULTS As a percentage of total visits, those involving an ADHD diagnosis were more common among youths than adults. However, from 1999 through 2010, the percentage of total visits involving a diagnosis of ADHD increased proportionally more among adult visits (from .3%, unweighted N=363 of 132,065, to .7%, unweighted N=1,015 of 154,764; adjusted odds ratio [AOR]=2.7, 95% confidence interval [CI]=2.1-3.7) than among youth visits (from 3.9%, unweighted N=2,033 of 36,263, to 5.2%, unweighted N=2,609 of 37,906; AOR=1.3, CI=1.1-1.6; p<.001). ADHD visits by adults compared with those by youths represented significantly greater proportions of females, Caucasians, patients with private insurance, and visits with a psychiatrist. Stimulant prescribing was common in ADHD visits regardless of age group (>70%). CONCLUSIONS As a percentage of total office-based visits, those at which ADHD was diagnosed increased more among adults than among youths from 1999 to 2010. Further research is warranted on the appropriateness, benefit-risk, and policy implications of stimulant use among adults with ADHD.
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Affiliation(s)
- Elisabeth M Oehrlein
- Ms. Oehrlein, Mr. Burcu, and Dr. Zito are with the Department of Pharmaceutical Health Services Research, University of Maryland, Baltimore. Dr. Zito is also with the Department of Psychiatry at the university. Dr. Safer is with the Department of Psychiatry and the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore
| | - Mehmet Burcu
- Ms. Oehrlein, Mr. Burcu, and Dr. Zito are with the Department of Pharmaceutical Health Services Research, University of Maryland, Baltimore. Dr. Zito is also with the Department of Psychiatry at the university. Dr. Safer is with the Department of Psychiatry and the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore
| | - Daniel J Safer
- Ms. Oehrlein, Mr. Burcu, and Dr. Zito are with the Department of Pharmaceutical Health Services Research, University of Maryland, Baltimore. Dr. Zito is also with the Department of Psychiatry at the university. Dr. Safer is with the Department of Psychiatry and the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore
| | - Julie Magno Zito
- Ms. Oehrlein, Mr. Burcu, and Dr. Zito are with the Department of Pharmaceutical Health Services Research, University of Maryland, Baltimore. Dr. Zito is also with the Department of Psychiatry at the university. Dr. Safer is with the Department of Psychiatry and the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore
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Abstract
The FDA regulates the use of information by biopharmaceutical companies in their promotional activities. Section 114 of the Food and Drug Administration Modernization Act of 1997 (FDAMA) was specifically designed to allow companies to more readily disseminate health care economic information (HCEI) to those who need it for formulary decision making. However, very little HCEI has been distributed promotionally under this provision over the past 17 years. There are recent discussions by stakeholders regarding the need for updates, revisions, or guidance regarding Section 114.In light of recent renewed interest in Section 114 of the FDAMA, the purpose of this commentary is to equip managed care decision makers with the information they need to understand and respond to industry communications that are governed by Section 114. This commentary reviews and synthesizes the regulatory history and language of the statute and changes to the promotion regulation generated by Section 114. It explores the reasons for the section's limited use to date, for recent renewed interest, and why changes by various stakeholders are suggested at this time. Also discussed is what managed care pharmacists need to know about Section 114, and suggestions are included regarding the active role pharmacists can play in this change process. Renewed interest in FDAMA Section 114 appears to stem largely from the increasingly visible and growing interest in comparative effectiveness research, the emergence of "big data," the expanding range of data sources available for deriving HCEI, and recent court decisions that might indicate a change in the regulatory environment. Various stakeholders are proposing recommendations regarding changes to FDAMA Section 114. Managed care pharmacists should be aware that companies are restricted when communicating HCEI promotional messages; this may mean seeing the use of FDAMA Section 114 as the "competent and reliable" effectiveness standard in promotion. If the managed care pharmacy community communicates clearly about what information it needs and the format in which it wants to receive that information, companies, policymakers, and regulatory bodies can work collaboratively with managed care pharmacy to create a regulatory environment that supports transparent communication of desired information.
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Affiliation(s)
- Eleanor M Perfetto
- University of Maryland School of Pharmacy, 220 Arch St., 12th Fl., Baltimore, MD 21201.
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