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Wahl KJ, Brooks M, Trenaman L, Desjardins-Lorimer K, Bell CM, Chokmorova N, Segall R, Syring J, Williams A, Li LC, Norman WV, Munro S. User-Centered Development of a Patient Decision Aid for Choice of Early Abortion Method: Multi-Cycle Mixed Methods Study. J Med Internet Res 2024; 26:e48793. [PMID: 38625731 PMCID: PMC11061794 DOI: 10.2196/48793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 02/23/2024] [Accepted: 02/25/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND People seeking abortion in early pregnancy have the choice between medication and procedural options for care. The choice is preference-sensitive-there is no clinically superior option and the choice depends on what matters most to the individual patient. Patient decision aids (PtDAs) are shared decision-making tools that support people in making informed, values-aligned health care choices. OBJECTIVE We aimed to develop and evaluate the usability of a web-based PtDA for the Canadian context, where abortion care is publicly funded and available without legal restriction. METHODS We used a systematic, user-centered design approach guided by principles of integrated knowledge translation. We first developed a prototype using available evidence for abortion seekers' decisional needs and the risks, benefits, and consequences of each option. We then refined the prototype through think-aloud interviews with participants at risk of unintended pregnancy ("patient" participants). Interviews were audio-recorded and documented through field notes. Finally, we conducted a web-based survey of patients and health care professionals involved with abortion care, which included the System Usability Scale. We used content analysis to identify usability issues described in the field notes and open-ended survey questions, and descriptive statistics to summarize participant characteristics and close-ended survey responses. RESULTS A total of 61 individuals participated in this study. Further, 11 patients participated in think-aloud interviews. Overall, the response to the PtDA was positive; however, the content analysis identified issues related to the design, language, and information about the process and experience of obtaining abortion care. In response, we adapted the PtDA into an interactive website and revised it to include consistent and plain language, additional information (eg, pain experience narratives), and links to additional resources on how to find an abortion health care professional. In total, 25 patients and 25 health care professionals completed the survey. The mean System Usability Scale score met the threshold for good usability among both patient and health care professional participants. Most participants felt that the PtDA was user-friendly (patients: n=25, 100%; health care professionals: n=22, 88%), was not missing information (patients: n=21, 84%; health care professionals: n=18, 72%), and that it was appropriate for patients to complete the PtDA before a consultation (patients: n=23, 92%; health care professionals: n=23, 92%). Open-ended responses focused on improving usability by reducing the length of the PtDA and making the website more mobile-friendly. CONCLUSIONS We systematically designed the PtDA to address an unmet need to support informed, values-aligned decision-making about the method of abortion. The design process responded to a need identified by potential users and addressed unique sensitivities related to reproductive health decision-making.
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Affiliation(s)
- Kate J Wahl
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Melissa Brooks
- Department of Obstetrics and Gynecology, Dalhousie University, Halifax, NS, Canada
| | - Logan Trenaman
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, United States
| | | | - Carolyn M Bell
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Nazgul Chokmorova
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Romy Segall
- Department of Obstetrics and Gynecology, Dalhousie University, Halifax, NS, Canada
| | - Janelle Syring
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Aleyah Williams
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Linda C Li
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Wendy V Norman
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sarah Munro
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, United States
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Trenaman L, Guh D, Law MR, Cheng L, Harrison M. Effect of a Billing Code to Reimburse Nurse-Supported Rheumatology Care on Health Care Costs and Access: An Interrupted Time Series Analysis. Arthritis Care Res (Hoboken) 2024. [PMID: 38403453 DOI: 10.1002/acr.25317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/29/2024] [Accepted: 02/21/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVE This study was undertaken to evaluate the impact of a Multidisciplinary Care Assessment (MCA) billing code on health system costs and access to care in British Columbia (BC). METHODS Data on all people treated by rheumatologists in BC were obtained from five linked health administrative databases held by Population Data BC from April 1, 2006, to March 31, 2020. Rheumatologists were allocated to either the intervention (ever-billers) or control groups (never-billers). For the intervention group, the index date was the month of the first MCA code billing. For the control group the index dates were imputed from intervention index dates. Our analysis focused on a 48-month period (24 months before and after the index date). We evaluated the impact on two cost (costs related to rheumatoid arthritis [RA]; total health care costs) and access outcomes (rheumatology-related visits per rheumatologist; days between rheumatology visits for patients with RA) using an interrupted time series analysis. RESULTS A total of 46 rheumatologists (31 intervention and 15 control) met our inclusion criteria. Introduction of the MCA was associated with a small but significant increase in RA-related costs that, at 2 years, translates to a net absolute change of $9.66 per patient per month, but no statistically significant changes in total health care costs. There was no statistically significant change in the number of rheumatology-related visits, but at 2 years there was a net absolute reduction in the median days between rheumatologist visits for patients with RA (6.3 days). CONCLUSION The introduction of the MCA code was associated with a negligible increase in the RA-related costs and an improvement in access to ongoing care for patients.
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Affiliation(s)
| | - Daphne Guh
- Centre for Advancing Health Outcomes, Vancouver, British Columbia, Canada
| | - Michael R Law
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Lucy Cheng
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Mark Harrison
- Centre for Advancing Health Outcomes, University of British Columbia, and Arthritis Research Canada, Vancouver, British Columbia, Canada
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Trenaman L, Guh D, Bansback N, Sawatzky R, Sun H, Cuthbertson L, Whitehurst DGT. Quality of life of the Canadian population using the VR-12: population norms for health utility values, summary component scores and domain scores. Qual Life Res 2024; 33:453-465. [PMID: 37938404 PMCID: PMC10850034 DOI: 10.1007/s11136-023-03536-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVES To estimate Canadian population norms (health utility values, summary component scores and domain scores) for the VR-12. METHODS English and French speaking Canadians aged 18 and older completed an online survey that included sociodemographic questions and standardized health status instruments, including the VR-12. Responses to the VR-12 were summarized as: (i) a health utility value; (ii) mental and physical component summary scores (MCS and PCS, respectively), and (iii) eight domain scores. Norms were calculated for the full sample and by gender, age group, and province/territory (univariate), and for several multivariate stratifications (e.g., age group and gender). Results were summarized using descriptive statistics, including number of respondents, mean and standard deviation (SD), median and percentiles (25th and 75th), and minimum and maximum. RESULTS A total of 6761 people who clicked on the survey link completed the survey (83.4% completion rate), of whom 6741 (99.7%) were included in the analysis. The mean health utility score was 0.698 (SD = 0.216). Mean health utility scores tended to be higher in older age groups, ranging from 0.661 (SD = 0.214) in those aged 18-29 to 0.728 (SD = 0.310) in those aged 80+. Average MCS scores were higher in older age groups, while PCS scores were lower. Females consistently reported lower mean health utility values, summary component scores and domain scores compared with males. CONCLUSIONS This is the first study to present Canadian norms for the VR-12. Health utility norms can serve as a valuable input for Canadian economic models, while summary component and domain norms can help interpret routinely-collected data.
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Affiliation(s)
- Logan Trenaman
- Department of Health Systems and Population Health, School of Public Health, University of Washington, 3980 15th Ave NE, Fourth Floor, Box 351621, Seattle, WA, 98195, USA.
| | - Daphne Guh
- Centre for Advancing Health Outcomes, Vancouver, BC, Canada
| | - Nick Bansback
- Centre for Advancing Health Outcomes, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Richard Sawatzky
- Centre for Advancing Health Outcomes, Vancouver, BC, Canada
- School of Nursing, Trinity Western University, Vancouver, BC, Canada
| | - Huiying Sun
- Centre for Advancing Health Outcomes, Vancouver, BC, Canada
| | - Lena Cuthbertson
- British Columbia Office of Patient-Centred Measurement, Ministry of Health/Providence Health Care, Vancouver, BC, Canada
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Stacey D, Lewis KB, Smith M, Carley M, Volk R, Douglas EE, Pacheco-Brousseau L, Finderup J, Gunderson J, Barry MJ, Bennett CL, Bravo P, Steffensen K, Gogovor A, Graham ID, Kelly SE, Légaré F, Sondergaard H, Thomson R, Trenaman L, Trevena L. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2024; 1:CD001431. [PMID: 38284415 PMCID: PMC10823577 DOI: 10.1002/14651858.cd001431.pub6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
BACKGROUND Patient decision aids are interventions designed to support people making health decisions. At a minimum, patient decision aids make the decision explicit, provide evidence-based information about the options and associated benefits/harms, and help clarify personal values for features of options. This is an update of a Cochrane review that was first published in 2003 and last updated in 2017. OBJECTIVES To assess the effects of patient decision aids in adults considering treatment or screening decisions using an integrated knowledge translation approach. SEARCH METHODS We conducted the updated search for the period of 2015 (last search date) to March 2022 in CENTRAL, MEDLINE, Embase, PsycINFO, EBSCO, and grey literature. The cumulative search covers database origins to March 2022. SELECTION CRITERIA We included published randomized controlled trials comparing patient decision aids to usual care. Usual care was defined as general information, risk assessment, clinical practice guideline summaries for health consumers, placebo intervention (e.g. information on another topic), or no intervention. DATA COLLECTION AND ANALYSIS Two authors independently screened citations for inclusion, extracted intervention and outcome data, and assessed risk of bias using the Cochrane risk of bias tool. Primary outcomes, based on the International Patient Decision Aid Standards (IPDAS), were attributes related to the choice made (informed values-based choice congruence) and the decision-making process, such as knowledge, accurate risk perceptions, feeling informed, clear values, participation in decision-making, and adverse events. Secondary outcomes were choice, confidence in decision-making, adherence to the chosen option, preference-linked health outcomes, and impact on the healthcare system (e.g. consultation length). We pooled results using mean differences (MDs) and risk ratios (RRs) with 95% confidence intervals (CIs), applying a random-effects model. We conducted a subgroup analysis of 105 studies that were included in the previous review version compared to those published since that update (n = 104 studies). We used Grading of Recommendations Assessment, Development, and Evaluation (GRADE) to assess the certainty of the evidence. MAIN RESULTS This update added 104 new studies for a total of 209 studies involving 107,698 participants. The patient decision aids focused on 71 different decisions. The most common decisions were about cardiovascular treatments (n = 22 studies), cancer screening (n = 17 studies colorectal, 15 prostate, 12 breast), cancer treatments (e.g. 15 breast, 11 prostate), mental health treatments (n = 10 studies), and joint replacement surgery (n = 9 studies). When assessing risk of bias in the included studies, we rated two items as mostly unclear (selective reporting: 100 studies; blinding of participants/personnel: 161 studies), due to inadequate reporting. Of the 209 included studies, 34 had at least one item rated as high risk of bias. There was moderate-certainty evidence that patient decision aids probably increase the congruence between informed values and care choices compared to usual care (RR 1.75, 95% CI 1.44 to 2.13; 21 studies, 9377 participants). Regarding attributes related to the decision-making process and compared to usual care, there was high-certainty evidence that patient decision aids result in improved participants' knowledge (MD 11.90/100, 95% CI 10.60 to 13.19; 107 studies, 25,492 participants), accuracy of risk perceptions (RR 1.94, 95% CI 1.61 to 2.34; 25 studies, 7796 participants), and decreased decisional conflict related to feeling uninformed (MD -10.02, 95% CI -12.31 to -7.74; 58 studies, 12,104 participants), indecision about personal values (MD -7.86, 95% CI -9.69 to -6.02; 55 studies, 11,880 participants), and proportion of people who were passive in decision-making (clinician-controlled) (RR 0.72, 95% CI 0.59 to 0.88; 21 studies, 4348 participants). For adverse outcomes, there was high-certainty evidence that there was no difference in decision regret between the patient decision aid and usual care groups (MD -1.23, 95% CI -3.05 to 0.59; 22 studies, 3707 participants). Of note, there was no difference in the length of consultation when patient decision aids were used in preparation for the consultation (MD -2.97 minutes, 95% CI -7.84 to 1.90; 5 studies, 420 participants). When patient decision aids were used during the consultation with the clinician, the length of consultation was 1.5 minutes longer (MD 1.50 minutes, 95% CI 0.79 to 2.20; 8 studies, 2702 participants). We found the same direction of effect when we compared results for patient decision aid studies reported in the previous update compared to studies conducted since 2015. AUTHORS' CONCLUSIONS Compared to usual care, across a wide variety of decisions, patient decision aids probably helped more adults reach informed values-congruent choices. They led to large increases in knowledge, accurate risk perceptions, and an active role in decision-making. Our updated review also found that patient decision aids increased patients' feeling informed and clear about their personal values. There was no difference in decision regret between people using decision aids versus those receiving usual care. Further studies are needed to assess the impact of patient decision aids on adherence and downstream effects on cost and resource use.
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Affiliation(s)
- Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, Canada
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | | | | | - Meg Carley
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Robert Volk
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elisa E Douglas
- Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Jeanette Finderup
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Michael J Barry
- Informed Medical Decisions Program, Massachusetts General Hospital, Boston, MA, USA
| | - Carol L Bennett
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Paulina Bravo
- Education and Cancer Prevention, Fundación Arturo López Pérez, Santiago, Chile
| | - Karina Steffensen
- Center for Shared Decision Making, IRS - Lillebælt Hospital, Vejle, Denmark
| | - Amédé Gogovor
- VITAM - Centre de recherche en santé durable, Université Laval, Quebec, Canada
| | - Ian D Graham
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, Canada
| | - Shannon E Kelly
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - France Légaré
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL), Université Laval, Quebec, Canada
| | | | - Richard Thomson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Logan Trenaman
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
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Trenaman L, Kaal KJ, Laba TL, Safari A, Aguiar M, Burch T, Beckett J, Munro S, Hudson M, Harrison M. The financial burden of accessing care for people with scleroderma in Canada: a patient-oriented, cross-sectional survey. CMAJ Open 2023; 11:E630-E636. [PMID: 37437955 PMCID: PMC10356003 DOI: 10.9778/cmajo.20220227] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Patients with scleroderma require a lifetime of treatment and frequent contacts with rheumatologists and other health care professionals. Although publicly funded health care systems in Canada cover many costs, patients may still face a substantial financial burden in accessing care. The purpose of this study was to quantify out-of-pocket costs borne by people with scleroderma in Canada and compare this burden for those living in large communities and smaller communities. METHODS We analyzed responses to a Web-based survey of people living in Canada with scleroderma. Respondents reported annual out-of-pocket medical, travel and accommodation and other nonmedical costs (2019 Canadian dollars). We used descriptive statistics to describe travel distance and out-of-pocket costs. We used a 2-part model to estimate the impact on out-of-pocket costs of living in a large urban centre (≥ 100 000 population), compared with smaller urban centres or rural areas (< 100 000 population). We generated combined mean estimates from the 2-part models using predictive margins. RESULTS The survey included 120 people in Canada with scleroderma. The mean, annual, total out-of-pocket costs were $3357 (standard deviation $5580). Respondents living in smaller urban centres and rural areas reported higher mean total costs ($4148, 95% confidence interval [CI] $3618-$4680) and travel or accommodation costs ($1084, 95% CI $804-$1364) than those in larger urban centres (total costs $2678, 95% CI $2252-$3104; travel or accommodation costs $332, 95% CI $207-$458). INTERPRETATION Many patients with scleroderma incur considerable out-of-pocket costs, and this burden is exacerbated for those living in smaller urban centres and rural areas. Health care systems and providers should consider ways to alleviate this burden and support equitable access to care.
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Affiliation(s)
- Logan Trenaman
- Centre for Health Evaluation and Outcome Sciences (Trenaman, Munro, Harrison), Vancouver, BC; Department of Community Health and Epidemiology (Kaal), Dalhousie University, Halifax, NS; Clinical and Health Sciences Unit (Laba), The University of South Australia, Adelaide, Australia; Centre for Health Economics Research and Evaluation (Laba), University of Technology, Sydney, Australia; College of Science (Safari), School of Mathematics, Statistics and Computer Science, University of Tehran, Tehran, Iran; Collaboration for Outcomes Research and Evaluation (Aguiar, Harrison), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC; Scleroderma Association of British Columbia (Burch), North Vancouver, BC; Patient partner (Burch), Vancouver, BC; Patient partner (Beckett), Kamloops, BC; Department of Obstetrics and Gynaecology (Munro), University of British Columbia, Vancouver, BC; Division of Rheumatology (Hudson), Jewish General Hospital and Lady Davis Institute; Department of Medicine (Hudson), McGill University, Montréal, Que.; Arthritis Research Canada (Hudson, Harrison), Vancouver, BC
| | - K Julia Kaal
- Centre for Health Evaluation and Outcome Sciences (Trenaman, Munro, Harrison), Vancouver, BC; Department of Community Health and Epidemiology (Kaal), Dalhousie University, Halifax, NS; Clinical and Health Sciences Unit (Laba), The University of South Australia, Adelaide, Australia; Centre for Health Economics Research and Evaluation (Laba), University of Technology, Sydney, Australia; College of Science (Safari), School of Mathematics, Statistics and Computer Science, University of Tehran, Tehran, Iran; Collaboration for Outcomes Research and Evaluation (Aguiar, Harrison), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC; Scleroderma Association of British Columbia (Burch), North Vancouver, BC; Patient partner (Burch), Vancouver, BC; Patient partner (Beckett), Kamloops, BC; Department of Obstetrics and Gynaecology (Munro), University of British Columbia, Vancouver, BC; Division of Rheumatology (Hudson), Jewish General Hospital and Lady Davis Institute; Department of Medicine (Hudson), McGill University, Montréal, Que.; Arthritis Research Canada (Hudson, Harrison), Vancouver, BC
| | - Tracey-Lea Laba
- Centre for Health Evaluation and Outcome Sciences (Trenaman, Munro, Harrison), Vancouver, BC; Department of Community Health and Epidemiology (Kaal), Dalhousie University, Halifax, NS; Clinical and Health Sciences Unit (Laba), The University of South Australia, Adelaide, Australia; Centre for Health Economics Research and Evaluation (Laba), University of Technology, Sydney, Australia; College of Science (Safari), School of Mathematics, Statistics and Computer Science, University of Tehran, Tehran, Iran; Collaboration for Outcomes Research and Evaluation (Aguiar, Harrison), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC; Scleroderma Association of British Columbia (Burch), North Vancouver, BC; Patient partner (Burch), Vancouver, BC; Patient partner (Beckett), Kamloops, BC; Department of Obstetrics and Gynaecology (Munro), University of British Columbia, Vancouver, BC; Division of Rheumatology (Hudson), Jewish General Hospital and Lady Davis Institute; Department of Medicine (Hudson), McGill University, Montréal, Que.; Arthritis Research Canada (Hudson, Harrison), Vancouver, BC
| | - Abdollah Safari
- Centre for Health Evaluation and Outcome Sciences (Trenaman, Munro, Harrison), Vancouver, BC; Department of Community Health and Epidemiology (Kaal), Dalhousie University, Halifax, NS; Clinical and Health Sciences Unit (Laba), The University of South Australia, Adelaide, Australia; Centre for Health Economics Research and Evaluation (Laba), University of Technology, Sydney, Australia; College of Science (Safari), School of Mathematics, Statistics and Computer Science, University of Tehran, Tehran, Iran; Collaboration for Outcomes Research and Evaluation (Aguiar, Harrison), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC; Scleroderma Association of British Columbia (Burch), North Vancouver, BC; Patient partner (Burch), Vancouver, BC; Patient partner (Beckett), Kamloops, BC; Department of Obstetrics and Gynaecology (Munro), University of British Columbia, Vancouver, BC; Division of Rheumatology (Hudson), Jewish General Hospital and Lady Davis Institute; Department of Medicine (Hudson), McGill University, Montréal, Que.; Arthritis Research Canada (Hudson, Harrison), Vancouver, BC
| | - Magda Aguiar
- Centre for Health Evaluation and Outcome Sciences (Trenaman, Munro, Harrison), Vancouver, BC; Department of Community Health and Epidemiology (Kaal), Dalhousie University, Halifax, NS; Clinical and Health Sciences Unit (Laba), The University of South Australia, Adelaide, Australia; Centre for Health Economics Research and Evaluation (Laba), University of Technology, Sydney, Australia; College of Science (Safari), School of Mathematics, Statistics and Computer Science, University of Tehran, Tehran, Iran; Collaboration for Outcomes Research and Evaluation (Aguiar, Harrison), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC; Scleroderma Association of British Columbia (Burch), North Vancouver, BC; Patient partner (Burch), Vancouver, BC; Patient partner (Beckett), Kamloops, BC; Department of Obstetrics and Gynaecology (Munro), University of British Columbia, Vancouver, BC; Division of Rheumatology (Hudson), Jewish General Hospital and Lady Davis Institute; Department of Medicine (Hudson), McGill University, Montréal, Que.; Arthritis Research Canada (Hudson, Harrison), Vancouver, BC
| | - Tiasha Burch
- Centre for Health Evaluation and Outcome Sciences (Trenaman, Munro, Harrison), Vancouver, BC; Department of Community Health and Epidemiology (Kaal), Dalhousie University, Halifax, NS; Clinical and Health Sciences Unit (Laba), The University of South Australia, Adelaide, Australia; Centre for Health Economics Research and Evaluation (Laba), University of Technology, Sydney, Australia; College of Science (Safari), School of Mathematics, Statistics and Computer Science, University of Tehran, Tehran, Iran; Collaboration for Outcomes Research and Evaluation (Aguiar, Harrison), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC; Scleroderma Association of British Columbia (Burch), North Vancouver, BC; Patient partner (Burch), Vancouver, BC; Patient partner (Beckett), Kamloops, BC; Department of Obstetrics and Gynaecology (Munro), University of British Columbia, Vancouver, BC; Division of Rheumatology (Hudson), Jewish General Hospital and Lady Davis Institute; Department of Medicine (Hudson), McGill University, Montréal, Que.; Arthritis Research Canada (Hudson, Harrison), Vancouver, BC
| | - Jennifer Beckett
- Centre for Health Evaluation and Outcome Sciences (Trenaman, Munro, Harrison), Vancouver, BC; Department of Community Health and Epidemiology (Kaal), Dalhousie University, Halifax, NS; Clinical and Health Sciences Unit (Laba), The University of South Australia, Adelaide, Australia; Centre for Health Economics Research and Evaluation (Laba), University of Technology, Sydney, Australia; College of Science (Safari), School of Mathematics, Statistics and Computer Science, University of Tehran, Tehran, Iran; Collaboration for Outcomes Research and Evaluation (Aguiar, Harrison), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC; Scleroderma Association of British Columbia (Burch), North Vancouver, BC; Patient partner (Burch), Vancouver, BC; Patient partner (Beckett), Kamloops, BC; Department of Obstetrics and Gynaecology (Munro), University of British Columbia, Vancouver, BC; Division of Rheumatology (Hudson), Jewish General Hospital and Lady Davis Institute; Department of Medicine (Hudson), McGill University, Montréal, Que.; Arthritis Research Canada (Hudson, Harrison), Vancouver, BC
| | - Sarah Munro
- Centre for Health Evaluation and Outcome Sciences (Trenaman, Munro, Harrison), Vancouver, BC; Department of Community Health and Epidemiology (Kaal), Dalhousie University, Halifax, NS; Clinical and Health Sciences Unit (Laba), The University of South Australia, Adelaide, Australia; Centre for Health Economics Research and Evaluation (Laba), University of Technology, Sydney, Australia; College of Science (Safari), School of Mathematics, Statistics and Computer Science, University of Tehran, Tehran, Iran; Collaboration for Outcomes Research and Evaluation (Aguiar, Harrison), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC; Scleroderma Association of British Columbia (Burch), North Vancouver, BC; Patient partner (Burch), Vancouver, BC; Patient partner (Beckett), Kamloops, BC; Department of Obstetrics and Gynaecology (Munro), University of British Columbia, Vancouver, BC; Division of Rheumatology (Hudson), Jewish General Hospital and Lady Davis Institute; Department of Medicine (Hudson), McGill University, Montréal, Que.; Arthritis Research Canada (Hudson, Harrison), Vancouver, BC
| | - Marie Hudson
- Centre for Health Evaluation and Outcome Sciences (Trenaman, Munro, Harrison), Vancouver, BC; Department of Community Health and Epidemiology (Kaal), Dalhousie University, Halifax, NS; Clinical and Health Sciences Unit (Laba), The University of South Australia, Adelaide, Australia; Centre for Health Economics Research and Evaluation (Laba), University of Technology, Sydney, Australia; College of Science (Safari), School of Mathematics, Statistics and Computer Science, University of Tehran, Tehran, Iran; Collaboration for Outcomes Research and Evaluation (Aguiar, Harrison), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC; Scleroderma Association of British Columbia (Burch), North Vancouver, BC; Patient partner (Burch), Vancouver, BC; Patient partner (Beckett), Kamloops, BC; Department of Obstetrics and Gynaecology (Munro), University of British Columbia, Vancouver, BC; Division of Rheumatology (Hudson), Jewish General Hospital and Lady Davis Institute; Department of Medicine (Hudson), McGill University, Montréal, Que.; Arthritis Research Canada (Hudson, Harrison), Vancouver, BC
| | - Mark Harrison
- Centre for Health Evaluation and Outcome Sciences (Trenaman, Munro, Harrison), Vancouver, BC; Department of Community Health and Epidemiology (Kaal), Dalhousie University, Halifax, NS; Clinical and Health Sciences Unit (Laba), The University of South Australia, Adelaide, Australia; Centre for Health Economics Research and Evaluation (Laba), University of Technology, Sydney, Australia; College of Science (Safari), School of Mathematics, Statistics and Computer Science, University of Tehran, Tehran, Iran; Collaboration for Outcomes Research and Evaluation (Aguiar, Harrison), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC; Scleroderma Association of British Columbia (Burch), North Vancouver, BC; Patient partner (Burch), Vancouver, BC; Patient partner (Beckett), Kamloops, BC; Department of Obstetrics and Gynaecology (Munro), University of British Columbia, Vancouver, BC; Division of Rheumatology (Hudson), Jewish General Hospital and Lady Davis Institute; Department of Medicine (Hudson), McGill University, Montréal, Que.; Arthritis Research Canada (Hudson, Harrison), Vancouver, BC
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Trenaman L, Harrison M, Hoch JS. Medicare Beneficiaries' Perspectives on the Quality of Hospital Care and Their Implications for Value-Based Payment. JAMA Netw Open 2023; 6:e2319047. [PMID: 37342041 DOI: 10.1001/jamanetworkopen.2023.19047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Abstract
Importance Medicare's Hospital Value-Based Purchasing (HVBP) program adjusts hospital payments according to performance on 4 equally weighted quality domains: clinical outcomes, safety, patient experience, and efficiency. The assumption that performance on each domain is equally important may not reflect the preferences of Medicare beneficiaries. Objective To estimate the relative importance (ie, weight) of the 4 quality domains in the HVBP program from the perspective of Medicare beneficiaries and the impact of using beneficiary value weights on incentive payments for hospitals enrolled in fiscal year 2019. Design, Setting, and Participants An online survey was conducted in March 2022. A nationally representative sample of Medicare beneficiaries was recruited through Ipsos KnowledgePanel. Value weights were estimated using a discrete choice experiment that asked respondents to choose between 2 hospitals and indicate which they preferred. Hospitals were described using 6 attributes, including (1) clinical outcomes, (2) patient experience, (3) safety, (4) Medicare spending per patient, (5) distance, and (6) out-of-pocket cost. Data analysis was performed from April to November 2022. Main Outcomes and Measures An effects-coded mixed logit regression model was used to estimate the relative importance of quality domains. HVBP program performance was linked to Medicare payment data in the Medicare Inpatient Hospitals by Provider and Service data set and hospital characteristics from the American Hospital Association Annual Survey data set, and the estimated impact of using beneficiary value weights on hospital payments was estimated. Results A total of 1025 Medicare beneficiaries (518 women [51%]; 879 individuals [86%] aged ≥65 years; 717 White individuals [70%]) responded to the survey. A hospital's performance on clinical outcomes was most highly valued by beneficiaries (49%), followed by safety (22%), patient experience (21%), and efficiency (8%). Nearly twice as many hospitals would see a payment reduction when using beneficiary value weights than would see an increase (1830 vs 922 hospitals); however, the average net decrease was smaller (mean [SD], -$46 978 [$71 211]; median [IQR], -$24 628 [-$53 507 to -$9562]) than the comparable increase (mean [SD], $93 243 [$190 654]; median [IQR], $35 358 [$9906 to $97 348]). Hospitals seeing a net reduction with beneficiary value weights were more likely to be smaller, lower volume, nonteaching, and non-safety-net hospitals located in more deprived areas that served less complex patients. Conclusions and Relevance This survey study of Medicare beneficiaries found that current HVBP program value weights do not reflect beneficiary preferences, suggesting that the use of beneficiary value weights may exacerbate disparities by rewarding larger, high-volume hospitals.
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Affiliation(s)
- Logan Trenaman
- Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, British Columbia, Canada
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento
- Department of Public Health Sciences, University of California, Davis
| | - Mark Harrison
- Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, British Columbia, Canada
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeffrey S Hoch
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento
- Department of Public Health Sciences, University of California, Davis
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Marshall DA, Trenaman L, MacDonald KV, Johnson JA, Stacey D, Hawker G, Smith C, Durand D, Bansback N. Impact of an online, individualised, patient reported outcome measures based patient decision aid on patient expectations, decisional regret, satisfaction, and health-related quality-of-life for patients considering total knee arthroplasty: Results from a randomised controlled trial. J Eval Clin Pract 2023; 29:513-524. [PMID: 36575631 DOI: 10.1111/jep.13804] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/29/2022]
Abstract
RATIONALE Total knee arthroplasty is a common surgical procedure but not appropriate for all patients with knee osteoarthritis. Patient decision aids (PtDAs) can promote shared decision making and enhance understanding and expectations of procedures among patients, resulting in better discussions between patients and healthcare providers about whether total knee arthroplasty is the most appropriate option. AIMS AND OBJECTIVES Evaluate impact of an individualised PtDA for osteoarthritis patients considering total knee arthroplasty 1 year after baseline assessment. METHODS Prospective, randomised controlled trial comparing an intervention arm (IA) and routine care arm (RCA). The IA included an online individualised patient reported outcome measures (PROMs) based PtDA and one-page summary report for the surgeon. We report secondary outcomes from the final assessment: patient expectations, decisional regret, patient satisfaction with outcomes of knee replacement, health-related quality-of-life (HRQOL) and depression. We report changes in HRQOL between baseline and final assessments, study arms, and surgical versus non-surgical patients. Descriptive statistics were used to describe participant characteristics and continuous variables. Dichotomous outcomes (expectations, decisional regret, satisfaction) were analyzed using logistic regression and continuous outcomes (HRQOL, depression) were modelled using linear regression. RESULTS Overall, 140 participants completed all study assessments (IA: n = 69, RCA: n = 71); n = 108 underwent surgery (IA: n = 49, RCA: n = 59). Regardless of study arm, most participants reported expectations were met, minimal decisional regret, satisfaction with outcomes of knee replacement, and had improvements in HRQOL. While no significant differences in study outcomes were found between study arms, IA results were in the direction hypothesised in favour of the PtDA. CONCLUSIONS Although we were not able to detect statistically significant benefits associated with implementing this PROMs-based PtDA, there was no apparent negative effect on these outcomes 1 year after baseline. We anticipate there may be benefit to implementing this PtDA earlier in the osteoarthritis care pathway where patients have more opportunities to manage their disease non-surgically.
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Affiliation(s)
- Deborah A Marshall
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Logan Trenaman
- Arthritis Research Canada, Richmond, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada.,Centre for Clinical Epidemiology and Evaluation, Vancouver, British Columbia, Canada
| | - Karen V MacDonald
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jeffrey A Johnson
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Gillian Hawker
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - D'Arcy Durand
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.,Edmonton Bone and Joint Centre, Edmonton, Alberta, Canada
| | - Nick Bansback
- Arthritis Research Canada, Richmond, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada.,Centre for Clinical Epidemiology and Evaluation, Vancouver, British Columbia, Canada
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8
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Bansback N, Trenaman L, Mulhern BJ, Norman R, Metcalfe R, Sawatzky R, Brazier JE, Rowen D, Whitehurst DGT. Estimation of a Canadian preference-based scoring algorithm for the Veterans RAND 12-Item Health Survey: a population survey using a discrete-choice experiment. CMAJ Open 2022; 10:E589-E598. [PMID: 35790230 PMCID: PMC9262351 DOI: 10.9778/cmajo.20210113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The Veterans RAND 12-Item Health Survey (VR-12) is a generic patient-reported outcome measure derived from the widely used 36- and 12-item Short Form Health Surveys. We aimed to estimate a Canadian preference-based scoring algorithm for the VR-12, enabling the derivation of health utility values for generating quality-adjusted life years (QALYs). METHODS We conducted a discrete-choice experiment in a sample of the Canadian population in January and February 2019. Participants - recruited from a consumer research panel - completed an online survey, in English or French, that included 11 discrete-choice questions, each comprising 2 health profiles. We defined the health profiles using 8 VR-12 items and a duration attribute. Using conditional logit regressions, where each level of the respective VR-12 items was interacted with duration, we applied the coefficients to estimate health utility values interpretable on a scale of 0 (dead) to 1 (full health). Negative values reflect states considered worse than dead. RESULTS A total of 3380 individuals completed the survey. Of these, 1688 (49.9%) were females, and 3101 (91.7%) completed the English version of the survey. Across all models, "feel downhearted and blue all of the time" and "pain interferes with your normal work extremely" were associated with the largest decrements in health utility. Excluding the 685 respondents (20.3%) who provided inconsistent responses had a negligible effect on the results. The recommended model, weighted to match population demographics, had health utility values ranging from -0.589 to 1.000. INTERPRETATION Health utility values that reflect the preferences of the Canadian population can now be derived from responses to the VR-12. These values can be used to generate QALYs in future analyses.
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Affiliation(s)
- Nick Bansback
- School of Population and Public Health (Bansback), University of British Columbia; Centre for Health Evaluation and Outcome Sciences (Bansback, Trenaman, Metcalfe, Sawatzky), Vancouver, BC; Centre for Health Economics Research and Evaluation (Mulhern), University of Technology Sydney, Sydney, New South Wales, Australia; School of Health and Related Research (Mulhern, Brazier, Rowen), University of Sheffield, Sheffield, UK; School of Public Health (Norman), Curtin University, Perth, Western Australia, Australia; School of Nursing (Sawatzky), Trinity Western University, Langley, BC; Faculty of Health Sciences (Whitehurst), Simon Fraser University, Burnaby, BC
| | - Logan Trenaman
- School of Population and Public Health (Bansback), University of British Columbia; Centre for Health Evaluation and Outcome Sciences (Bansback, Trenaman, Metcalfe, Sawatzky), Vancouver, BC; Centre for Health Economics Research and Evaluation (Mulhern), University of Technology Sydney, Sydney, New South Wales, Australia; School of Health and Related Research (Mulhern, Brazier, Rowen), University of Sheffield, Sheffield, UK; School of Public Health (Norman), Curtin University, Perth, Western Australia, Australia; School of Nursing (Sawatzky), Trinity Western University, Langley, BC; Faculty of Health Sciences (Whitehurst), Simon Fraser University, Burnaby, BC
| | - Brendan J Mulhern
- School of Population and Public Health (Bansback), University of British Columbia; Centre for Health Evaluation and Outcome Sciences (Bansback, Trenaman, Metcalfe, Sawatzky), Vancouver, BC; Centre for Health Economics Research and Evaluation (Mulhern), University of Technology Sydney, Sydney, New South Wales, Australia; School of Health and Related Research (Mulhern, Brazier, Rowen), University of Sheffield, Sheffield, UK; School of Public Health (Norman), Curtin University, Perth, Western Australia, Australia; School of Nursing (Sawatzky), Trinity Western University, Langley, BC; Faculty of Health Sciences (Whitehurst), Simon Fraser University, Burnaby, BC
| | - Richard Norman
- School of Population and Public Health (Bansback), University of British Columbia; Centre for Health Evaluation and Outcome Sciences (Bansback, Trenaman, Metcalfe, Sawatzky), Vancouver, BC; Centre for Health Economics Research and Evaluation (Mulhern), University of Technology Sydney, Sydney, New South Wales, Australia; School of Health and Related Research (Mulhern, Brazier, Rowen), University of Sheffield, Sheffield, UK; School of Public Health (Norman), Curtin University, Perth, Western Australia, Australia; School of Nursing (Sawatzky), Trinity Western University, Langley, BC; Faculty of Health Sciences (Whitehurst), Simon Fraser University, Burnaby, BC
| | - Rebecca Metcalfe
- School of Population and Public Health (Bansback), University of British Columbia; Centre for Health Evaluation and Outcome Sciences (Bansback, Trenaman, Metcalfe, Sawatzky), Vancouver, BC; Centre for Health Economics Research and Evaluation (Mulhern), University of Technology Sydney, Sydney, New South Wales, Australia; School of Health and Related Research (Mulhern, Brazier, Rowen), University of Sheffield, Sheffield, UK; School of Public Health (Norman), Curtin University, Perth, Western Australia, Australia; School of Nursing (Sawatzky), Trinity Western University, Langley, BC; Faculty of Health Sciences (Whitehurst), Simon Fraser University, Burnaby, BC
| | - Richard Sawatzky
- School of Population and Public Health (Bansback), University of British Columbia; Centre for Health Evaluation and Outcome Sciences (Bansback, Trenaman, Metcalfe, Sawatzky), Vancouver, BC; Centre for Health Economics Research and Evaluation (Mulhern), University of Technology Sydney, Sydney, New South Wales, Australia; School of Health and Related Research (Mulhern, Brazier, Rowen), University of Sheffield, Sheffield, UK; School of Public Health (Norman), Curtin University, Perth, Western Australia, Australia; School of Nursing (Sawatzky), Trinity Western University, Langley, BC; Faculty of Health Sciences (Whitehurst), Simon Fraser University, Burnaby, BC
| | - John E Brazier
- School of Population and Public Health (Bansback), University of British Columbia; Centre for Health Evaluation and Outcome Sciences (Bansback, Trenaman, Metcalfe, Sawatzky), Vancouver, BC; Centre for Health Economics Research and Evaluation (Mulhern), University of Technology Sydney, Sydney, New South Wales, Australia; School of Health and Related Research (Mulhern, Brazier, Rowen), University of Sheffield, Sheffield, UK; School of Public Health (Norman), Curtin University, Perth, Western Australia, Australia; School of Nursing (Sawatzky), Trinity Western University, Langley, BC; Faculty of Health Sciences (Whitehurst), Simon Fraser University, Burnaby, BC
| | - Donna Rowen
- School of Population and Public Health (Bansback), University of British Columbia; Centre for Health Evaluation and Outcome Sciences (Bansback, Trenaman, Metcalfe, Sawatzky), Vancouver, BC; Centre for Health Economics Research and Evaluation (Mulhern), University of Technology Sydney, Sydney, New South Wales, Australia; School of Health and Related Research (Mulhern, Brazier, Rowen), University of Sheffield, Sheffield, UK; School of Public Health (Norman), Curtin University, Perth, Western Australia, Australia; School of Nursing (Sawatzky), Trinity Western University, Langley, BC; Faculty of Health Sciences (Whitehurst), Simon Fraser University, Burnaby, BC
| | - David G T Whitehurst
- School of Population and Public Health (Bansback), University of British Columbia; Centre for Health Evaluation and Outcome Sciences (Bansback, Trenaman, Metcalfe, Sawatzky), Vancouver, BC; Centre for Health Economics Research and Evaluation (Mulhern), University of Technology Sydney, Sydney, New South Wales, Australia; School of Health and Related Research (Mulhern, Brazier, Rowen), University of Sheffield, Sheffield, UK; School of Public Health (Norman), Curtin University, Perth, Western Australia, Australia; School of Nursing (Sawatzky), Trinity Western University, Langley, BC; Faculty of Health Sciences (Whitehurst), Simon Fraser University, Burnaby, BC
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9
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Hoch JS, Trenaman L, Hearney SM, Dewa CS. How Economic Decision Modeling Can Facilitate Health Equity. AMA J Ethics 2021; 23:E624-630. [PMID: 34459730 DOI: 10.1001/amajethics.2021.624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This article offers examples of how modeling can motivate health equity inquiry and research. This article also considers how equity fits into cost-effectiveness frameworks, how economic modeling can broaden the range of options for improving health equity, and how information other than results of cost-effectiveness analyses can inform health technology assessment.
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Affiliation(s)
- Jeffrey S Hoch
- Professor and the chief of the Division of Health Policy and Management in the Department of Public Health Sciences at the University of California, Davis
| | - Logan Trenaman
- Postdoctoral fellow in the Department of Public Health Sciences and the Center for Healthcare Policy and Research at the University of California, Davis
| | - Shannon M Hearney
- Second-year student in the public health sciences doctoral degree program at the University of California, Davis
| | - Carolyn S Dewa
- Professor in the Department of Psychiatry and Behavioral Health and the Department of Public Health Sciences at the University of California, Davis
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10
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Munro S, Benipal S, Williams A, Wahl K, Trenaman L, Begun S. Access experiences and attitudes toward abortion among youth experiencing homelessness in the United States: A systematic review. PLoS One 2021; 16:e0252434. [PMID: 34197477 PMCID: PMC8248724 DOI: 10.1371/journal.pone.0252434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 05/17/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives We sought to review the literature on the access experiences and attitudes toward abortion among youth experiencing homelessness in the United States. Methods We conducted a systematic review of peer‐reviewed literature published from 2001 to 2019. We included qualitative studies involving US participants that focused on access experiences, views, or accounts of unintended pregnancy and/or abortion among youth experiencing homelessness. We excluded studies published before 2001 as that was the year mifepristone medication abortion was made available in the US and we aimed to investigate experiences of access to both medical and surgical abortion options. Results Our thematic analysis of the data resulted in five key themes that characterize the abortion attitudes and access experiences of youth experiencing homelessness: (1) engaging in survival sex and forced sex, (2) balancing relationships and autonomy, (3) availability does not equal access, (4) attempting self-induced abortions using harmful methods, and (5) feeling resilient despite traumatic unplanned pregnancy experiences. Conclusions Youth experiencing homelessness experience barriers to abortion access across the US, including in states with a supportive policy context and publicly funded abortion services. In the absence of accessible services, youth may consider harmful methods of self-induced abortion. Improved services should be designed to offer low-barrier abortion care with the qualities that youth identified as important to them, including privacy and autonomy.
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Affiliation(s)
- Sarah Munro
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, BC, Canada
- * E-mail:
| | - Savvy Benipal
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Aleyah Williams
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, BC, Canada
| | - Kate Wahl
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Logan Trenaman
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, BC, Canada
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver BC, Canada
| | - Stephanie Begun
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
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11
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Trenaman L, Bryan S, Cuthbertson L, Sawatzky R, Stacey D, Bansback N. An economic valuation technique identified different inpatient care experience as priorities for older Canadians than a traditional approach. J Clin Epidemiol 2021; 139:1-11. [PMID: 34182147 DOI: 10.1016/j.jclinepi.2021.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 05/25/2021] [Accepted: 06/22/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To (1) estimate the relative value of older adults' healthcare experiences based on the Canadian Patient Experience Survey for Inpatient Care (CPES-IC) using an economic valuation technique, and (2) compare the results with those of a conventional key-driver analysis of healthcare experiences based on bivariate correlations. STUDY DESIGN AND SETTING An online survey of 1,074 Canadians aged 60 and older who had been hospitalized within five years. Participants completed the CPES-IC and a best-worst scaling (BWS) valuation task. BWS data were analyzed using a conditional logit model. These results were compared to a conventional key-driver analysis that estimates importance through Spearman's correlations between experiences and a global rating of overall experience. RESULTS The valuation approach found that the three experiences most valued by patients were: that staff seemed informed and up-to-date about their hospital care, doctors explained things in a way that they could understand, and that they got all the information they needed about their care and treatment. Three of the top five most valued experiences from the valuation approach were among the top five in the key driver analysis. However, there were noteworthy differences in rank order. CONCLUSION The results of the valuation exercise can inform local and/or system level quality improvement efforts by identifying priorities from an economic evaluation point of view, which are different than those based on a conventional key-driver analysis. Given the degree of uncertainty in estimates both the rank order and confidence intervals should be used to guide decision-making.
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Affiliation(s)
- Logan Trenaman
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver, British Columbia, Canada
| | - Stirling Bryan
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver, British Columbia, Canada
| | - Lena Cuthbertson
- British Columbia Office of Patient-Centred Measurement, Ministry of Health/Providence Health Care, Vancouver, British Columbia, Canada
| | - Rick Sawatzky
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada; School of Nursing, Trinity Western University, Vancouver, British Columbia, Canada
| | - Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada; Centre for Practice Changing Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Nick Bansback
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver, British Columbia, Canada.
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12
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Trenaman L, Jansen J, Blumenthal-Barby J, Körner M, Lally J, Matlock DD, Perestelo-Perez L, Ropka M, Stirling C, Valentine K, Vo H, Wills CE, Thomson R, Sepucha K. Are We Improving? Update and Critical Appraisal of the Reporting of Decision Process and Quality Measures in Trials Evaluating Patient Decision Aids. Med Decis Making 2021; 41:954-959. [PMID: 33966534 PMCID: PMC8474325 DOI: 10.1177/0272989x211011120] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background In 2014, a systematic review found large gaps in the quality of reporting of
measures used in 86 published trials evaluating the effectiveness of patient
decision aids (PtDAs). The purpose of this study was to update that
review. Methods We examined measures of decision making used in 49 randomized controlled
trials included in the 2014 and 2017 Cochrane Collaboration systematic
review of PtDAs. Data on development of the measures, reliability, validity,
responsiveness, precision, interpretability, feasibility, and acceptability
were independently abstracted by 2 paired reviewers. Results Information from 273 measures was abstracted, and 109 of these covered the
core domains of decision processes (n = 55) and decision
quality including informed choice/knowledge (n = 48) and
values-choice concordance (n = 12). Very few studies
reported data on the performance and clinical sensibility of measures, with
reliability (23%) and validity (6%) being the most common. Studies using new
measures were less likely to include information about their psychometric
performance compared with previously published measures. Limitations The review was limited to reporting of measures in studies included in the
Cochrane review and did not consult prior publications. Conclusion There continues to be very little reported about the development or
performance of measures used to evaluate the effectiveness of PtDAs in
published trials. Minimum reporting standards have been published, and
efforts to require investigators to use them are needed.
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Affiliation(s)
- Logan Trenaman
- University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcome Sciences, Vancouver, Canada
| | - Jesse Jansen
- Maastricht University, Maastricht, The Netherlands
| | | | - Mirjam Körner
- Institute of Medical Psychology and Medical Sociology, Medical Faculty, Albert-Ludwigs- University, Freiburg, Baden-Wurttemberg, Germany
| | - Joanne Lally
- Population Health Sciences Institute, Baddiley Clark Building, Newcastle University, Newcastle upon Tyne, UK
| | - Daniel D Matlock
- University of Colorado, Aurora, CO, USA.,VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, CO, USA
| | | | - Mary Ropka
- University of Virginia, Charlottesville, VA, USA
| | | | - Kathrene Valentine
- Harvard Medical School, Boston, MA, USA.,Massachusetts General Hospital, Boston, MA, USA
| | - Ha Vo
- Massachusetts General Hospital, Boston, MA, USA
| | | | - Richard Thomson
- Population Health Sciences Institute, Baddiley Clark Building, Newcastle University, Newcastle upon Tyne, UK
| | - Karen Sepucha
- Harvard Medical School, Boston, MA, USA.,Massachusetts General Hospital, Boston, MA, USA
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13
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Trenaman L, Sutherland JM. Moving from Volume to Value with Hospital Funding Policies in Canada. Healthc Pap 2020; 19:24-35. [PMID: 32687469 DOI: 10.12927/hcpap.2020.26261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Canada's two most populous provinces are moving toward activity-based funding (ABF) of hospitals. Although ABF may encourage greater value by improving cost-efficiency, it may decrease value in other respects. To address this trade-off, many jurisdictions have implemented value-based payment programs that modify ABF payments based on hospital performance on other aspects of value, such as outcomes and patient experience. In this article, the design and implementation of two value-based programs are reviewed: Australia's Pricing for Safety and Quality Program and Medicare's Hospital Value-Based Purchasing Program. The contrasts of these programs highlight key questions facing provincial payers in Canada to increase value from hospital spending.
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Affiliation(s)
- Logan Trenaman
- Postdoctoral Fellow, Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Postdoctoral Fellow, Department of Public Health Sciences, University of California, Davis, CA
| | - Jason M Sutherland
- Faculty, Centre for Health Services and Policy Research, Professor, UBC School of Population and Public Health, University of British Columbia, Vancouver, BC
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Trenaman L, Stacey D, Bryan S, Payne K, Hawker G, Bansback N. Long-term effect of patient decision aids on use of joint replacement and health care costs. Osteoarthritis Cartilage 2020; 28:819-823. [PMID: 32173628 DOI: 10.1016/j.joca.2020.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 12/19/2019] [Accepted: 01/06/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Shared decision-making supported by patient decisions aids may improve care and reduce healthcare costs for persons considering total joint replacement. Observational studies and randomized controlled trials (RCTs) have evaluated the short-term impact of decision aids on uptake of surgery and costs, however the long-term effects are unclear. This analysis aimed to evaluate the effect of patient decision aids on 1) use of joint replacement up to 7-years of follow-up, and 2) osteoarthritis-related health system costs. METHODS 324 participants in a Canadian RCT with 2-years follow-up who were randomized to either a decision aid (n = 161) or usual care (n = 163) had their trial and health administrative data linked. The proportion undergoing surgery up to 7-years were compared using cumulative incidence plots and competing risk regression. Mean per-patient costs were compared using two sample t-tests. RESULTS At 2-years, 119 of 161 (73.9%) patients in the decision aid arm and 129 of 163 (79.1%) patients in the usual care arm had surgery. Between two and 7-years, 17 additional patients in both the decision aid (of 42, 40.4%) and usual care (of 34, 50.0%) arms underwent surgery. At 7-years, patients exposed to decision aids had a similar likelihood of undergoing surgery (HR = 0.92, 95% CI:0.73 to 1.17, p = 0.49) and mean per-patient costs ($21,965 vs $23,681, incremental cost: -$1,717, 95% CI:-$5,631 to $2,198) compared to those in usual care. CONCLUSIONS This is the first study to assess the long-term impact of decision aids on use of joint replacement and healthcare costs. These results are not conclusive but can inform future trial design. CLINICAL TRIAL REGISTRATION The full trial protocol is available at ClinicalTrials.Gov (NCT00911638).
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Affiliation(s)
- L Trenaman
- University of British Columbia, Vancouver, Canada; Centre for Health Evaluation and Outcome Sciences, Vancouver, Canada
| | - D Stacey
- University of Ottawa, Ottawa, Canada
| | - S Bryan
- University of British Columbia, Vancouver, Canada
| | - K Payne
- The University of Manchester, Manchester, UK
| | - G Hawker
- The University of Toronto, Toronto, Canada
| | - N Bansback
- University of British Columbia, Vancouver, Canada; Centre for Health Evaluation and Outcome Sciences, Vancouver, Canada.
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Trenaman L, Pearson SD, Hoch JS. How Are Incremental Cost-Effectiveness, Contextual Considerations, and Other Benefits Viewed in Health Technology Assessment Recommendations in the United States? Value Health 2020; 23:576-584. [PMID: 32389223 DOI: 10.1016/j.jval.2020.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 09/16/2019] [Revised: 01/24/2020] [Accepted: 01/30/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To review assessments from the Institute for Clinical and Economic Review (ICER) and describe how cost-effectiveness, other benefits or disadvantages, and contextual considerations affect Council members' assessments of value. METHODS Assessments published by the ICER between December 2014 and April 2019 were reviewed. Data on the assessment, intervention, results from cost-effectiveness analyses, and Council members' votes were extracted. Voting data were examined using bar charts and radar plots. Spearman's correlations between the number of votes for other benefits and contextual considerations were estimated. Two case studies (tisagenlecleucel and voretigene neparvovec) explored the relationship between different aspects of value and the vote. RESULTS Thirty-one ICER assessments were reviewed, which included 51 value votes and 17 votes on other benefits and contextual considerations. On average, interventions with lower cost-effectiveness ratios received a higher proportion of high and intermediate value votes; however, there was heterogeneity across assessments. Of other benefits or disadvantages, having a novel mechanism of action received the most votes (n = 138), and reducing health disparities received the fewest (n = 24). Of contextual considerations, treating a condition that has a severe impact on length and quality of life received the most votes (n = 164). There was a strong positive correlation between votes for reduced caregiver/family burden and improving return to work/productivity (ρ = 0.88, P < .05). Two case studies highlighted that factors beyond cost-effectiveness can lead to lower (tisagenlecleucel) or higher (voretigene neparvovec) assessments of value. CONCLUSION Council members' judgments about the value of interventions are influenced by other benefits or disadvantages and contextual considerations but anchored by cost-effectiveness.
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Affiliation(s)
- Logan Trenaman
- Division of Health Policy and Management, Department of Public Sciences, University of California, Davis, Davis, CA, USA; Center for Healthcare Policy and Research, University of California, Davis, Davis, CA, USA.
| | | | - Jeffrey S Hoch
- Division of Health Policy and Management, Department of Public Sciences, University of California, Davis, Davis, CA, USA; Center for Healthcare Policy and Research, University of California, Davis, Davis, CA, USA
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Munro S, Sou J, Zhang W, Mohammadi T, Trenaman L, Langlois S, Anis AH. Attitudes toward prenatal screening for chromosomal abnormalities: A focus group study. Women Birth 2019; 32:364-371. [DOI: 10.1016/j.wombi.2018.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 09/17/2018] [Accepted: 09/18/2018] [Indexed: 11/16/2022]
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Hoch JS, Hay A, Isaranuwatchai W, Thavorn K, Leighl NB, Tu D, Trenaman L, Dewa CS, O'Callaghan C, Pater J, Jonker D, Chen BE, Mittmann N. Advantages of the net benefit regression framework for trial-based economic evaluations of cancer treatments: an example from the Canadian Cancer Trials Group CO.17 trial. BMC Cancer 2019; 19:552. [PMID: 31174497 PMCID: PMC6555934 DOI: 10.1186/s12885-019-5779-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 05/31/2019] [Indexed: 11/18/2022] Open
Abstract
Background Economic evaluations commonly accompany trials of new treatments or interventions; however, regression methods and their corresponding advantages for the analysis of cost-effectiveness data are not widely appreciated. Methods To illustrate regression-based economic evaluation, we review a cost-effectiveness analysis conducted by the Canadian Cancer Trials Group’s Committee on Economic Analysis and implement net benefit regression. Results Net benefit regression offers a simple option for cost-effectiveness analyses of person-level data. By placing economic evaluation in a regression framework, regression-based techniques can facilitate the analysis and provide simple solutions to commonly encountered challenges (e.g., the need to adjust for potential confounders, identify key patient subgroups, and/or summarize “challenging” findings, like when a more effective regimen has the potential to be cost-saving). Conclusions Economic evaluations of patient-level data (e.g., from a clinical trial) can use net benefit regression to facilitate analysis and enhance results.
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Affiliation(s)
- Jeffrey S Hoch
- Division of Health Policy and Management, Department of Public Health Sciences and Associate Director, Center for Healthcare Policy and Research, 2103 Stockton Blvd, Sacramento, CA, 95817, USA.
| | - Annette Hay
- Division of Health Policy and Management, Department of Public Health Sciences and Associate Director, Center for Healthcare Policy and Research, 2103 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Wanrudee Isaranuwatchai
- Division of Health Policy and Management, Department of Public Health Sciences and Associate Director, Center for Healthcare Policy and Research, 2103 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Kednapa Thavorn
- Division of Health Policy and Management, Department of Public Health Sciences and Associate Director, Center for Healthcare Policy and Research, 2103 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Natasha B Leighl
- Division of Health Policy and Management, Department of Public Health Sciences and Associate Director, Center for Healthcare Policy and Research, 2103 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Dongsheng Tu
- Division of Health Policy and Management, Department of Public Health Sciences and Associate Director, Center for Healthcare Policy and Research, 2103 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Logan Trenaman
- Division of Health Policy and Management, Department of Public Health Sciences and Associate Director, Center for Healthcare Policy and Research, 2103 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Carolyn S Dewa
- Division of Health Policy and Management, Department of Public Health Sciences and Associate Director, Center for Healthcare Policy and Research, 2103 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Chris O'Callaghan
- Division of Health Policy and Management, Department of Public Health Sciences and Associate Director, Center for Healthcare Policy and Research, 2103 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Joseph Pater
- Division of Health Policy and Management, Department of Public Health Sciences and Associate Director, Center for Healthcare Policy and Research, 2103 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Derek Jonker
- Division of Health Policy and Management, Department of Public Health Sciences and Associate Director, Center for Healthcare Policy and Research, 2103 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Bingshu E Chen
- Division of Health Policy and Management, Department of Public Health Sciences and Associate Director, Center for Healthcare Policy and Research, 2103 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Nicole Mittmann
- Division of Health Policy and Management, Department of Public Health Sciences and Associate Director, Center for Healthcare Policy and Research, 2103 Stockton Blvd, Sacramento, CA, 95817, USA
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Bansback N, Trenaman L, MacDonald KV, Hawker G, Johnson JA, Stacey D, Marshall DA. An individualized patient-reported outcome measure (PROM) based patient decision aid and surgeon report for patients considering total knee arthroplasty: protocol for a pragmatic randomized controlled trial. BMC Musculoskelet Disord 2019; 20:89. [PMID: 30797238 PMCID: PMC6387514 DOI: 10.1186/s12891-019-2434-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 01/28/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While the rates of total knee arthroplasty (TKA) continue to rise worldwide, there are concerns about whether all surgeries are appropriate. Guidelines for appropriateness suggest that patients should have realistic expectations for total knee arthroplasty (TKA), and that the patient and their surgeon should agree that the potential benefits outweigh the potential harms. The objective of this study is to evaluate whether routinely collected pre- and post-TKA patient-reported outcome measures (PROMs) could be integrated into a patient decision aid to better inform these appropriateness criteria. This randomised trial will evaluate the preliminary efficacy of a tailored PROM-based patient decision aid and surgeon report (compared to usual care) for patients considering TKA on decision quality. METHODS This is a pragmatic, randomised controlled trial conducted at one site in Alberta, Canada. Adults over the age of 30 years, who have been scheduled for a TKA consultation at the Edmonton Bone and Joint Centre with a participating surgeon, who understand, speak, and read English, and can provide informed consent, are eligible to participate. Participants will be randomised to receive a PROM-based patient decision aid and surgeon report before their surgical consultation or usual care. The decision aid will provide patients with information on their expected outcomes based on the EQ-5D-5L PROM, and these estimates are individualized based on clinical and demographic characteristics. The primary outcome of this trial is decision quality. Analysis will consider outcomes intention to treat, and feasibility outcomes for implementing the trial to routine practise. DISCUSSION This patient decision aid and surgeon report intervention could contribute to improved treatment decision-making for patients considering total knee arthroplasty. TRIAL REGISTRATION (REGISTRY AND NUMBER) ClinicalTrials.gov : NCT03240913. Registered on August 1, 2017.
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Affiliation(s)
- Nick Bansback
- School of Population and Public Health, University of British Columbia, Vancouver, BC Canada
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC Canada
- Arthritis Research Canada, Richmond, BC Canada
| | - Logan Trenaman
- School of Population and Public Health, University of British Columbia, Vancouver, BC Canada
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC Canada
- Arthritis Research Canada, Richmond, BC Canada
| | - Karen V. MacDonald
- Department of Community Health Sciences, University of Calgary, Calgary, AB Canada
| | - Gillian Hawker
- Department of Medicine, University of Toronto, Toronto, ON Canada
| | | | - Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, ON Canada
- Centre for Practice Changing Research, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Deborah A. Marshall
- Arthritis Research Canada, Richmond, BC Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB Canada
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Boland L, Taljaard M, Dervin G, Trenaman L, Tugwell P, Pomey MP, Stacey D. Effect of patient decision aid was influenced by presurgical evaluation among patients with osteoarthritis of the knee. Can J Surg 2017; 61:28-33. [PMID: 29171829 DOI: 10.1503/cjs.003316] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Decision aids help patients make total joint arthroplasty decisions, but presurgical evaluation might influence the effects of a decision aid. We compared the effects of a decision aid among patients considering total knee arthroplasty at 2 surgical screening clinics with different evaluation processes. METHODS We performed a subgroup analysis of a randomized controlled trial. Patients were recruited from 2 surgical screening clinics: an academic clinic providing 20-minute physician consultations and a community clinic providing 45-minute physiotherapist/nurse consultations with education. We compared the effects of decision quality, decisional conflict and surgery rate using Cochran-Mantel-Haenszel χ2 tests and the Breslow-Day test. RESULTS We evaluated 242 patients: 123 from the academic clinic (61 who used the decision aid and 62 controls) and 119 from the community clinic (59 who used the decision aid and 60 controls). Results suggested a between-site difference in the effect of the decision aid on the patients' decision quality (p = 0.09): at the academic site, patients who used the decision were more likely to make better-quality decisions than controls (54% v. 35%, p = 0.044), but not at the community site (47% v. 51%, p = 0.71). Fewer patients who used decision aids at the academic site than at the community site experienced decisional conflict (p = 0.007) (33% v. 52%, p = 0.05 at the academic site and 40% v. 24%, p = 0.08 at the community site). The effect of the decision aid on surgery rates did not differ between sites (p = 0.65). CONCLUSION The decision aid had a greater effect at the academic site than at the community site, which provided longer consultations with more verbal education. Hence, decision aids might be of greater value when more extensive total knee arthroplasty presurgical assessment and counselling are either impractical or unavailable.
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Affiliation(s)
- Laura Boland
- From the University of Ottawa, Ottawa, Ont. (Boland, Tugwell, Stacey); the Patient Decision Aid Research Group, Ottawa Hospital Research Institute, Ottawa, Ont. (Boland, Dervin, Trenaman, Stacey); the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Taljaard); the School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ont. (Taljaard); the Ottawa Hospital Research Institute, Ottawa, Ont. (Dervin, Tugwell); the University of British Columbia, Vancouver, BC (Trenaman); and the School of Public Health, University of Montréal, Montréal, Que. (Pomey)
| | - Monica Taljaard
- From the University of Ottawa, Ottawa, Ont. (Boland, Tugwell, Stacey); the Patient Decision Aid Research Group, Ottawa Hospital Research Institute, Ottawa, Ont. (Boland, Dervin, Trenaman, Stacey); the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Taljaard); the School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ont. (Taljaard); the Ottawa Hospital Research Institute, Ottawa, Ont. (Dervin, Tugwell); the University of British Columbia, Vancouver, BC (Trenaman); and the School of Public Health, University of Montréal, Montréal, Que. (Pomey)
| | - Geoffrey Dervin
- From the University of Ottawa, Ottawa, Ont. (Boland, Tugwell, Stacey); the Patient Decision Aid Research Group, Ottawa Hospital Research Institute, Ottawa, Ont. (Boland, Dervin, Trenaman, Stacey); the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Taljaard); the School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ont. (Taljaard); the Ottawa Hospital Research Institute, Ottawa, Ont. (Dervin, Tugwell); the University of British Columbia, Vancouver, BC (Trenaman); and the School of Public Health, University of Montréal, Montréal, Que. (Pomey)
| | - Logan Trenaman
- From the University of Ottawa, Ottawa, Ont. (Boland, Tugwell, Stacey); the Patient Decision Aid Research Group, Ottawa Hospital Research Institute, Ottawa, Ont. (Boland, Dervin, Trenaman, Stacey); the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Taljaard); the School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ont. (Taljaard); the Ottawa Hospital Research Institute, Ottawa, Ont. (Dervin, Tugwell); the University of British Columbia, Vancouver, BC (Trenaman); and the School of Public Health, University of Montréal, Montréal, Que. (Pomey)
| | - Peter Tugwell
- From the University of Ottawa, Ottawa, Ont. (Boland, Tugwell, Stacey); the Patient Decision Aid Research Group, Ottawa Hospital Research Institute, Ottawa, Ont. (Boland, Dervin, Trenaman, Stacey); the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Taljaard); the School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ont. (Taljaard); the Ottawa Hospital Research Institute, Ottawa, Ont. (Dervin, Tugwell); the University of British Columbia, Vancouver, BC (Trenaman); and the School of Public Health, University of Montréal, Montréal, Que. (Pomey)
| | - Marie-Pascale Pomey
- From the University of Ottawa, Ottawa, Ont. (Boland, Tugwell, Stacey); the Patient Decision Aid Research Group, Ottawa Hospital Research Institute, Ottawa, Ont. (Boland, Dervin, Trenaman, Stacey); the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Taljaard); the School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ont. (Taljaard); the Ottawa Hospital Research Institute, Ottawa, Ont. (Dervin, Tugwell); the University of British Columbia, Vancouver, BC (Trenaman); and the School of Public Health, University of Montréal, Montréal, Que. (Pomey)
| | - Dawn Stacey
- From the University of Ottawa, Ottawa, Ont. (Boland, Tugwell, Stacey); the Patient Decision Aid Research Group, Ottawa Hospital Research Institute, Ottawa, Ont. (Boland, Dervin, Trenaman, Stacey); the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Taljaard); the School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ont. (Taljaard); the Ottawa Hospital Research Institute, Ottawa, Ont. (Dervin, Tugwell); the University of British Columbia, Vancouver, BC (Trenaman); and the School of Public Health, University of Montréal, Montréal, Que. (Pomey)
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Bansback N, Trenaman L, Almeida F, Lynd L, Pendharkar S, Ayas N. Adherence to treatment is associated with initial informed treatment preference in patients with obstructive sleep apnea. Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Trenaman L, Stacey D, Bryan S, Taljaard M, Hawker G, Dervin G, Tugwell P, Bansback N. Decision aids for patients considering total joint replacement: a cost-effectiveness analysis alongside a randomised controlled trial. Osteoarthritis Cartilage 2017. [PMID: 28624294 DOI: 10.1016/j.joca.2017.05.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Shared decision-making (SDM) is a key priority to improve patient-centred care, and can play an important role in helping patients decide whether to undergo total joint arthroplasty (TJA). Patient decision aids can support SDM; however, they may incur an upfront cost. We aimed to estimate the health and economic effects of patient decision aids for TJA. METHODS A cost-effectiveness analysis of a randomised controlled trial (RCT) with 2-year follow-up. 343 patients were recruited from two orthopedic screening clinics in Ottawa, Canada. Patients were randomized to either a patient decision aid plus surgeon preference report (decision aid) or usual care. Primary outcomes were costs (in 2014 CAD$), quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio (ICER). Costs were calculated by multiplying self-reported resource use by unit costs. QALYs were calculated by mapping the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) to EuroQol 5-Dimension (EQ-5D) health utilities. Costs and QALYs were discounted at 5%. Multiple imputation was used to handle missing data, and bootstrapping was used to estimate uncertainty. RESULTS The sample comprised 167 intervention and 167 control group patients. The decision aid arm had fewer surgeries over the 2-year period thereby incurring a negative incremental cost of -$560 (95% CI: -$1358 to $426) per patient while providing 0.05 (95% CI: -0.04 to 0.13) additional QALYs per patient. Consequently, the decision aid arm was dominant. CONCLUSION The use of a patient decision aid was associated with fewer health care costs, while producing similar health outcomes. CLINICAL TRIAL REGISTRATION NUMBER CT00911638 (clinicaltrials.gov).
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Affiliation(s)
- L Trenaman
- University of British Columbia, Vancouver, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver, Canada; Centre for Health Evaluation and Outcome Sciences, Vancouver, Canada; Arthritis Research Canada, Richmond, Canada
| | - D Stacey
- University of Ottawa, Ottawa, Canada; Ottawa Hospital Research Institute, Ottawa, Canada
| | - S Bryan
- University of British Columbia, Vancouver, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver, Canada
| | - M Taljaard
- University of Ottawa, Ottawa, Canada; Ottawa Hospital Research Institute, Ottawa, Canada
| | - G Hawker
- University of Toronto, Toronto, Canada; Women's College Hospital, Toronto, Canada
| | - G Dervin
- University of Ottawa, Ottawa, Canada; Ottawa Hospital Research Institute, Ottawa, Canada
| | - P Tugwell
- University of Ottawa, Ottawa, Canada; Ottawa Hospital Research Institute, Ottawa, Canada
| | - N Bansback
- University of British Columbia, Vancouver, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver, Canada; Centre for Health Evaluation and Outcome Sciences, Vancouver, Canada; Arthritis Research Canada, Richmond, Canada.
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Trenaman L, Boonen A, Guillemin F, Hiligsmann M, Hoens A, Marra C, Taylor W, Barton J, Tugwell P, Wells G, Bansback N. OMERACT Quality-adjusted Life-years (QALY) Working Group: Do Current QALY Measures Capture What Matters to Patients? J Rheumatol 2017; 44:1899-1903. [PMID: 28298567 DOI: 10.3899/jrheum.161112] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To understand the limitations with current patient-reported outcome measures (PROM) used to generate quality-adjusted life-years (QALY) in rheumatology, and set a research agenda. METHODS Two activities were undertaken. The first was a scoping review of published studies that have used PROM to generate QALY in rheumatology between 2011 and 2016. The second was an interactive "eyeball test" exercise at Outcome Measures in Rheumatology 13 that compared subdomains of widely used generic PROM, as identified through the scoping review, to subdomains of the Assessment of SpondyloArthritis Health Index (ASAS-HI) condition-specific PROM for ankylosing spondylitis. RESULTS The scoping review included 39 studies. Five different PROM have been used to generate QALY in rheumatology; however, the EQ-5D and Short Form 6 Dimensions (SF-6D) were used most frequently (in 32 and 9 of included studies, respectively). Special interest group participants identified energy/drive and sleep as 2 key subdomains of the ASAS-HI instrument that may be missed by the EQ-5D, and sexual function as potentially missed by the SF-6D. Participants also expressed concerns that aspects of the process of care and non-health outcomes may be missed. Three ways of incorporating additional subdomains were discussed, including using an alternative generic PROM, modifying an existing generic PROM with "bolt-on" subdomain(s), and generating societal weights for a condition-specific PROM. CONCLUSION Three priorities for future research were identified: understanding whether the EQ-5D and SF-6D identify what matters to patients with different rheumatic conditions, analyzing how much patients value process or non-health outcomes, and identifying which approaches to incorporating a greater number of subdomains into the QALY are being undertaken in other disease areas.
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Affiliation(s)
- Logan Trenaman
- From the School of Population and Public Health, and Department of Physical Therapy, University of British Columbia; Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital; Arthritis Patient Advisory Board, Arthritis Research Canada, Vancouver, British Columbia; School of Pharmacy, Memorial University, St. John's, Newfoundland; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Graduate School, Care and Public Health Research Institute (CAPHRI), Maastricht University; Department of Health Services Research, CAPHRI, Maastricht University, Maastricht, the Netherlands; Université de Lorraine, Université Paris Descartes, EA 4360 APEMAC, Nancy, France; Department of Medicine, University of Otago Wellington, Wellington, New Zealand; School of Medicine, Oregon Health and Science University, Portland, Oregon, USA.,L. Trenaman, MSc, School of Population and Public Health, University of British Columbia, and the Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital; A. Boonen, MD, PhD, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Graduate School, CAPHRI, Maastricht University; F. Guillemin, MD, PhD, Université de Lorraine, Université Paris Descartes, EA 4360 APEMAC; M. Hiligsmann, PhD, Department of Health Services Research, Maastricht University, CAPHRI; A. Hoens, BScPT, MSc, Department of Physical Therapy, University of British Columbia, and Arthritis Patient Advisory Board, Arthritis Research Canada; C. Marra, PharmD, PhD, School of Pharmacy, Memorial University; W. Taylor, MBChB, PhD, FRACP, FAFRM, Department of Medicine, University of Otago; J. Barton, MD, School of Medicine, Oregon Health and Science University; P. Tugwell, MD, MSc, FRCPC, Department of Medicine, University of Ottawa; G. Wells, PhD, Department of Medicine, University of Ottawa; N. Bansback, PhD, School of Population and Public Health, University of British Columbia, and Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital
| | - Annelies Boonen
- From the School of Population and Public Health, and Department of Physical Therapy, University of British Columbia; Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital; Arthritis Patient Advisory Board, Arthritis Research Canada, Vancouver, British Columbia; School of Pharmacy, Memorial University, St. John's, Newfoundland; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Graduate School, Care and Public Health Research Institute (CAPHRI), Maastricht University; Department of Health Services Research, CAPHRI, Maastricht University, Maastricht, the Netherlands; Université de Lorraine, Université Paris Descartes, EA 4360 APEMAC, Nancy, France; Department of Medicine, University of Otago Wellington, Wellington, New Zealand; School of Medicine, Oregon Health and Science University, Portland, Oregon, USA.,L. Trenaman, MSc, School of Population and Public Health, University of British Columbia, and the Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital; A. Boonen, MD, PhD, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Graduate School, CAPHRI, Maastricht University; F. Guillemin, MD, PhD, Université de Lorraine, Université Paris Descartes, EA 4360 APEMAC; M. Hiligsmann, PhD, Department of Health Services Research, Maastricht University, CAPHRI; A. Hoens, BScPT, MSc, Department of Physical Therapy, University of British Columbia, and Arthritis Patient Advisory Board, Arthritis Research Canada; C. Marra, PharmD, PhD, School of Pharmacy, Memorial University; W. Taylor, MBChB, PhD, FRACP, FAFRM, Department of Medicine, University of Otago; J. Barton, MD, School of Medicine, Oregon Health and Science University; P. Tugwell, MD, MSc, FRCPC, Department of Medicine, University of Ottawa; G. Wells, PhD, Department of Medicine, University of Ottawa; N. Bansback, PhD, School of Population and Public Health, University of British Columbia, and Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital
| | - Francis Guillemin
- From the School of Population and Public Health, and Department of Physical Therapy, University of British Columbia; Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital; Arthritis Patient Advisory Board, Arthritis Research Canada, Vancouver, British Columbia; School of Pharmacy, Memorial University, St. John's, Newfoundland; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Graduate School, Care and Public Health Research Institute (CAPHRI), Maastricht University; Department of Health Services Research, CAPHRI, Maastricht University, Maastricht, the Netherlands; Université de Lorraine, Université Paris Descartes, EA 4360 APEMAC, Nancy, France; Department of Medicine, University of Otago Wellington, Wellington, New Zealand; School of Medicine, Oregon Health and Science University, Portland, Oregon, USA.,L. Trenaman, MSc, School of Population and Public Health, University of British Columbia, and the Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital; A. Boonen, MD, PhD, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Graduate School, CAPHRI, Maastricht University; F. Guillemin, MD, PhD, Université de Lorraine, Université Paris Descartes, EA 4360 APEMAC; M. Hiligsmann, PhD, Department of Health Services Research, Maastricht University, CAPHRI; A. Hoens, BScPT, MSc, Department of Physical Therapy, University of British Columbia, and Arthritis Patient Advisory Board, Arthritis Research Canada; C. Marra, PharmD, PhD, School of Pharmacy, Memorial University; W. Taylor, MBChB, PhD, FRACP, FAFRM, Department of Medicine, University of Otago; J. Barton, MD, School of Medicine, Oregon Health and Science University; P. Tugwell, MD, MSc, FRCPC, Department of Medicine, University of Ottawa; G. Wells, PhD, Department of Medicine, University of Ottawa; N. Bansback, PhD, School of Population and Public Health, University of British Columbia, and Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital
| | - Mickael Hiligsmann
- From the School of Population and Public Health, and Department of Physical Therapy, University of British Columbia; Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital; Arthritis Patient Advisory Board, Arthritis Research Canada, Vancouver, British Columbia; School of Pharmacy, Memorial University, St. John's, Newfoundland; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Graduate School, Care and Public Health Research Institute (CAPHRI), Maastricht University; Department of Health Services Research, CAPHRI, Maastricht University, Maastricht, the Netherlands; Université de Lorraine, Université Paris Descartes, EA 4360 APEMAC, Nancy, France; Department of Medicine, University of Otago Wellington, Wellington, New Zealand; School of Medicine, Oregon Health and Science University, Portland, Oregon, USA.,L. Trenaman, MSc, School of Population and Public Health, University of British Columbia, and the Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital; A. Boonen, MD, PhD, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Graduate School, CAPHRI, Maastricht University; F. Guillemin, MD, PhD, Université de Lorraine, Université Paris Descartes, EA 4360 APEMAC; M. Hiligsmann, PhD, Department of Health Services Research, Maastricht University, CAPHRI; A. Hoens, BScPT, MSc, Department of Physical Therapy, University of British Columbia, and Arthritis Patient Advisory Board, Arthritis Research Canada; C. Marra, PharmD, PhD, School of Pharmacy, Memorial University; W. Taylor, MBChB, PhD, FRACP, FAFRM, Department of Medicine, University of Otago; J. Barton, MD, School of Medicine, Oregon Health and Science University; P. Tugwell, MD, MSc, FRCPC, Department of Medicine, University of Ottawa; G. Wells, PhD, Department of Medicine, University of Ottawa; N. Bansback, PhD, School of Population and Public Health, University of British Columbia, and Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital
| | - Alison Hoens
- From the School of Population and Public Health, and Department of Physical Therapy, University of British Columbia; Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital; Arthritis Patient Advisory Board, Arthritis Research Canada, Vancouver, British Columbia; School of Pharmacy, Memorial University, St. John's, Newfoundland; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Graduate School, Care and Public Health Research Institute (CAPHRI), Maastricht University; Department of Health Services Research, CAPHRI, Maastricht University, Maastricht, the Netherlands; Université de Lorraine, Université Paris Descartes, EA 4360 APEMAC, Nancy, France; Department of Medicine, University of Otago Wellington, Wellington, New Zealand; School of Medicine, Oregon Health and Science University, Portland, Oregon, USA.,L. Trenaman, MSc, School of Population and Public Health, University of British Columbia, and the Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital; A. Boonen, MD, PhD, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Graduate School, CAPHRI, Maastricht University; F. Guillemin, MD, PhD, Université de Lorraine, Université Paris Descartes, EA 4360 APEMAC; M. Hiligsmann, PhD, Department of Health Services Research, Maastricht University, CAPHRI; A. Hoens, BScPT, MSc, Department of Physical Therapy, University of British Columbia, and Arthritis Patient Advisory Board, Arthritis Research Canada; C. Marra, PharmD, PhD, School of Pharmacy, Memorial University; W. Taylor, MBChB, PhD, FRACP, FAFRM, Department of Medicine, University of Otago; J. Barton, MD, School of Medicine, Oregon Health and Science University; P. Tugwell, MD, MSc, FRCPC, Department of Medicine, University of Ottawa; G. Wells, PhD, Department of Medicine, University of Ottawa; N. Bansback, PhD, School of Population and Public Health, University of British Columbia, and Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital
| | - Carlo Marra
- From the School of Population and Public Health, and Department of Physical Therapy, University of British Columbia; Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital; Arthritis Patient Advisory Board, Arthritis Research Canada, Vancouver, British Columbia; School of Pharmacy, Memorial University, St. John's, Newfoundland; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Graduate School, Care and Public Health Research Institute (CAPHRI), Maastricht University; Department of Health Services Research, CAPHRI, Maastricht University, Maastricht, the Netherlands; Université de Lorraine, Université Paris Descartes, EA 4360 APEMAC, Nancy, France; Department of Medicine, University of Otago Wellington, Wellington, New Zealand; School of Medicine, Oregon Health and Science University, Portland, Oregon, USA.,L. Trenaman, MSc, School of Population and Public Health, University of British Columbia, and the Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital; A. Boonen, MD, PhD, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Graduate School, CAPHRI, Maastricht University; F. Guillemin, MD, PhD, Université de Lorraine, Université Paris Descartes, EA 4360 APEMAC; M. Hiligsmann, PhD, Department of Health Services Research, Maastricht University, CAPHRI; A. Hoens, BScPT, MSc, Department of Physical Therapy, University of British Columbia, and Arthritis Patient Advisory Board, Arthritis Research Canada; C. Marra, PharmD, PhD, School of Pharmacy, Memorial University; W. Taylor, MBChB, PhD, FRACP, FAFRM, Department of Medicine, University of Otago; J. Barton, MD, School of Medicine, Oregon Health and Science University; P. Tugwell, MD, MSc, FRCPC, Department of Medicine, University of Ottawa; G. Wells, PhD, Department of Medicine, University of Ottawa; N. Bansback, PhD, School of Population and Public Health, University of British Columbia, and Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital
| | - Will Taylor
- From the School of Population and Public Health, and Department of Physical Therapy, University of British Columbia; Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital; Arthritis Patient Advisory Board, Arthritis Research Canada, Vancouver, British Columbia; School of Pharmacy, Memorial University, St. John's, Newfoundland; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Graduate School, Care and Public Health Research Institute (CAPHRI), Maastricht University; Department of Health Services Research, CAPHRI, Maastricht University, Maastricht, the Netherlands; Université de Lorraine, Université Paris Descartes, EA 4360 APEMAC, Nancy, France; Department of Medicine, University of Otago Wellington, Wellington, New Zealand; School of Medicine, Oregon Health and Science University, Portland, Oregon, USA.,L. Trenaman, MSc, School of Population and Public Health, University of British Columbia, and the Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital; A. Boonen, MD, PhD, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Graduate School, CAPHRI, Maastricht University; F. Guillemin, MD, PhD, Université de Lorraine, Université Paris Descartes, EA 4360 APEMAC; M. Hiligsmann, PhD, Department of Health Services Research, Maastricht University, CAPHRI; A. Hoens, BScPT, MSc, Department of Physical Therapy, University of British Columbia, and Arthritis Patient Advisory Board, Arthritis Research Canada; C. Marra, PharmD, PhD, School of Pharmacy, Memorial University; W. Taylor, MBChB, PhD, FRACP, FAFRM, Department of Medicine, University of Otago; J. Barton, MD, School of Medicine, Oregon Health and Science University; P. Tugwell, MD, MSc, FRCPC, Department of Medicine, University of Ottawa; G. Wells, PhD, Department of Medicine, University of Ottawa; N. Bansback, PhD, School of Population and Public Health, University of British Columbia, and Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital
| | - Jennifer Barton
- From the School of Population and Public Health, and Department of Physical Therapy, University of British Columbia; Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital; Arthritis Patient Advisory Board, Arthritis Research Canada, Vancouver, British Columbia; School of Pharmacy, Memorial University, St. John's, Newfoundland; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Graduate School, Care and Public Health Research Institute (CAPHRI), Maastricht University; Department of Health Services Research, CAPHRI, Maastricht University, Maastricht, the Netherlands; Université de Lorraine, Université Paris Descartes, EA 4360 APEMAC, Nancy, France; Department of Medicine, University of Otago Wellington, Wellington, New Zealand; School of Medicine, Oregon Health and Science University, Portland, Oregon, USA.,L. Trenaman, MSc, School of Population and Public Health, University of British Columbia, and the Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital; A. Boonen, MD, PhD, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Graduate School, CAPHRI, Maastricht University; F. Guillemin, MD, PhD, Université de Lorraine, Université Paris Descartes, EA 4360 APEMAC; M. Hiligsmann, PhD, Department of Health Services Research, Maastricht University, CAPHRI; A. Hoens, BScPT, MSc, Department of Physical Therapy, University of British Columbia, and Arthritis Patient Advisory Board, Arthritis Research Canada; C. Marra, PharmD, PhD, School of Pharmacy, Memorial University; W. Taylor, MBChB, PhD, FRACP, FAFRM, Department of Medicine, University of Otago; J. Barton, MD, School of Medicine, Oregon Health and Science University; P. Tugwell, MD, MSc, FRCPC, Department of Medicine, University of Ottawa; G. Wells, PhD, Department of Medicine, University of Ottawa; N. Bansback, PhD, School of Population and Public Health, University of British Columbia, and Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital
| | - Peter Tugwell
- From the School of Population and Public Health, and Department of Physical Therapy, University of British Columbia; Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital; Arthritis Patient Advisory Board, Arthritis Research Canada, Vancouver, British Columbia; School of Pharmacy, Memorial University, St. John's, Newfoundland; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Graduate School, Care and Public Health Research Institute (CAPHRI), Maastricht University; Department of Health Services Research, CAPHRI, Maastricht University, Maastricht, the Netherlands; Université de Lorraine, Université Paris Descartes, EA 4360 APEMAC, Nancy, France; Department of Medicine, University of Otago Wellington, Wellington, New Zealand; School of Medicine, Oregon Health and Science University, Portland, Oregon, USA.,L. Trenaman, MSc, School of Population and Public Health, University of British Columbia, and the Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital; A. Boonen, MD, PhD, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Graduate School, CAPHRI, Maastricht University; F. Guillemin, MD, PhD, Université de Lorraine, Université Paris Descartes, EA 4360 APEMAC; M. Hiligsmann, PhD, Department of Health Services Research, Maastricht University, CAPHRI; A. Hoens, BScPT, MSc, Department of Physical Therapy, University of British Columbia, and Arthritis Patient Advisory Board, Arthritis Research Canada; C. Marra, PharmD, PhD, School of Pharmacy, Memorial University; W. Taylor, MBChB, PhD, FRACP, FAFRM, Department of Medicine, University of Otago; J. Barton, MD, School of Medicine, Oregon Health and Science University; P. Tugwell, MD, MSc, FRCPC, Department of Medicine, University of Ottawa; G. Wells, PhD, Department of Medicine, University of Ottawa; N. Bansback, PhD, School of Population and Public Health, University of British Columbia, and Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital
| | - George Wells
- From the School of Population and Public Health, and Department of Physical Therapy, University of British Columbia; Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital; Arthritis Patient Advisory Board, Arthritis Research Canada, Vancouver, British Columbia; School of Pharmacy, Memorial University, St. John's, Newfoundland; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Graduate School, Care and Public Health Research Institute (CAPHRI), Maastricht University; Department of Health Services Research, CAPHRI, Maastricht University, Maastricht, the Netherlands; Université de Lorraine, Université Paris Descartes, EA 4360 APEMAC, Nancy, France; Department of Medicine, University of Otago Wellington, Wellington, New Zealand; School of Medicine, Oregon Health and Science University, Portland, Oregon, USA.,L. Trenaman, MSc, School of Population and Public Health, University of British Columbia, and the Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital; A. Boonen, MD, PhD, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Graduate School, CAPHRI, Maastricht University; F. Guillemin, MD, PhD, Université de Lorraine, Université Paris Descartes, EA 4360 APEMAC; M. Hiligsmann, PhD, Department of Health Services Research, Maastricht University, CAPHRI; A. Hoens, BScPT, MSc, Department of Physical Therapy, University of British Columbia, and Arthritis Patient Advisory Board, Arthritis Research Canada; C. Marra, PharmD, PhD, School of Pharmacy, Memorial University; W. Taylor, MBChB, PhD, FRACP, FAFRM, Department of Medicine, University of Otago; J. Barton, MD, School of Medicine, Oregon Health and Science University; P. Tugwell, MD, MSc, FRCPC, Department of Medicine, University of Ottawa; G. Wells, PhD, Department of Medicine, University of Ottawa; N. Bansback, PhD, School of Population and Public Health, University of British Columbia, and Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital
| | - Nick Bansback
- From the School of Population and Public Health, and Department of Physical Therapy, University of British Columbia; Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital; Arthritis Patient Advisory Board, Arthritis Research Canada, Vancouver, British Columbia; School of Pharmacy, Memorial University, St. John's, Newfoundland; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Graduate School, Care and Public Health Research Institute (CAPHRI), Maastricht University; Department of Health Services Research, CAPHRI, Maastricht University, Maastricht, the Netherlands; Université de Lorraine, Université Paris Descartes, EA 4360 APEMAC, Nancy, France; Department of Medicine, University of Otago Wellington, Wellington, New Zealand; School of Medicine, Oregon Health and Science University, Portland, Oregon, USA. .,L. Trenaman, MSc, School of Population and Public Health, University of British Columbia, and the Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital; A. Boonen, MD, PhD, Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and Graduate School, CAPHRI, Maastricht University; F. Guillemin, MD, PhD, Université de Lorraine, Université Paris Descartes, EA 4360 APEMAC; M. Hiligsmann, PhD, Department of Health Services Research, Maastricht University, CAPHRI; A. Hoens, BScPT, MSc, Department of Physical Therapy, University of British Columbia, and Arthritis Patient Advisory Board, Arthritis Research Canada; C. Marra, PharmD, PhD, School of Pharmacy, Memorial University; W. Taylor, MBChB, PhD, FRACP, FAFRM, Department of Medicine, University of Otago; J. Barton, MD, School of Medicine, Oregon Health and Science University; P. Tugwell, MD, MSc, FRCPC, Department of Medicine, University of Ottawa; G. Wells, PhD, Department of Medicine, University of Ottawa; N. Bansback, PhD, School of Population and Public Health, University of British Columbia, and Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital.
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Trenaman L, Bansback N. Moving from outcomes to values to deliver high-quality health care-A new checklist for valuation studies. J Clin Epidemiol 2017; 83:3-5. [PMID: 28104463 DOI: 10.1016/j.jclinepi.2016.11.020] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 11/08/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Logan Trenaman
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nick Bansback
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
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Trenaman L, Selva A, Desroches S, Singh K, Bissonnette J, Bansback N, Stacey D. A measurement framework for adherence in patient decision aid trials applied in a systematic review subanalysis. J Clin Epidemiol 2016; 77:15-23. [DOI: 10.1016/j.jclinepi.2016.03.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 03/24/2016] [Accepted: 03/31/2016] [Indexed: 10/21/2022]
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Bansback N, Trenaman L, Harrison M. How important is mode of administration in treatments for rheumatic diseases and related conditions? Curr Rheumatol Rep 2016; 17:514. [PMID: 25903666 DOI: 10.1007/s11926-015-0514-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Many new drugs do not offer clinical benefits over existing treatments but provide potentially more convenient modes of administration. These include how frequently a treatment is given, how it is delivered, who gives the treatment, and whether there are any associated local adverse reactions. We reviewed studies in rheumatology that ask patients and society the value they assign to these aspects of treatment in comparison to the benefits and side effects and costs. We find that mode of administration is generally valued by both patients and society, but the extent depends on the context of the disease and the study participants. Respondents with a more severe disease seem to assign less value to mode and frequency of administration, and prioritize improvement in pain and function. However, patients with chronic, but less severe, disease seem to place greater value on mode of administration. Furthermore, respondents with experience of the treatments perceived to be more inconvenient assigned lower value to more convenient treatments. Unfortunately, we found few examples of studies that reported values in a format that could easily be incorporated into resource allocation decisions by payers.
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Affiliation(s)
- Nick Bansback
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada,
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Trenaman L, Munro S, Almeida F, Ayas N, Hicklin J, Bansback N. Development of a patient decision aid prototype for adults with obstructive sleep apnea. Sleep Breath 2015; 20:653-61. [DOI: 10.1007/s11325-015-1269-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 09/07/2015] [Accepted: 09/25/2015] [Indexed: 11/28/2022]
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Trenaman L, Miller WC, Querée M, Escorpizo R. Modifiable and non-modifiable factors associated with employment outcomes following spinal cord injury: A systematic review. J Spinal Cord Med 2015; 38:422-31. [PMID: 25989899 PMCID: PMC4612197 DOI: 10.1179/2045772315y.0000000031] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
CONTEXT Employment rates in individuals with spinal cord injury (SCI) are approximately 35%, which is considerably lower than that of the general population. In order to improve employment outcomes a clear understanding of what factors influence employment outcomes is needed. OBJECTIVE To systematically review factors that are consistently and independently associated with employment outcomes in individuals with SCI, and to understand the magnitude of their influence. METHODS Through an electronic search of MEDLINE/PubMed, EMBASE, CINAHL, PsycINFO, Social Science Abstracts and Social Work databases, we identified studies published between 1952-2014 that investigated factors associated with employment outcomes following SCI. Exclusion criteria included: (1) reviews (2) studies not published in English (3) studies not controlling for potential confounders through a regression analysis, or (4) studies not providing an effect measure in the form of OR, RR, or HR. Data were categorized based on the International Classification of Functioning, Disability and Health framework, with each domain sub-categorized by modifiability. First author, year of publication, sample size, explanatory and outcome variables, and effect measures were extracted. RESULTS Thirty-nine studies met the inclusion criteria. Twenty modifiable and twelve non-modifiable factors have been investigated in the context of employment following SCI. Education, vocational rehabilitation, functional independence, social support, and financial disincentives were modifiable factors that have been consistently and independently associated with employment outcomes. CONCLUSION A number of key modifiable factors have been identified and can inform interventions aimed at improving employment outcomes for individuals with SCI. Future research should focus on determining which factors have the greatest effect on employment outcomes, in addition to developing and evaluating interventions targeted at these factors.
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Affiliation(s)
| | - William C Miller
- Correspondence to: William C Miller, FCAOT, Department of Occupational Science and Occupational Therapy, University of British Columbia, T325–2211 Wesbrook Mall, Vancouver, BC, Canada V6 T 2B5. E-mail:
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Trenaman L, Ayas N, Bansback N. The patient's or society's: whose quality of life is it anyway? Sleep 2014; 37:1885-6. [PMID: 25406114 DOI: 10.5665/sleep.4234] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 04/25/2014] [Indexed: 11/03/2022] Open
Affiliation(s)
- Logan Trenaman
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada: Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, BC, Canada: Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Research Institute, Vancouver, BC, Canada
| | - Najib Ayas
- Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, BC, Canada: Department of Medicine and Sleep Disorders Program, University of British Columbia, Vancouver, BC, Canada
| | - Nick Bansback
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada: Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, BC, Canada: Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Research Institute, Vancouver, BC, Canada
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Trenaman L, Sadatsafavi M, Almeida F, Ayas N, Lynd L, Marra C, Stacey D, Bansback N. Exploring the Potential Cost-Effectiveness of Patient Decision Aids for Use in Adults with Obstructive Sleep Apnea. Med Decis Making 2014; 35:671-82. [DOI: 10.1177/0272989x14556676] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 09/26/2014] [Indexed: 11/16/2022]
Abstract
Background. There is increasing evidence highlighting the effectiveness of patient decision aids (PtDAs), but evidence supporting their cost-effectiveness is lacking. We consider patients with obstructive sleep apnea (OSA), in whom a PtDA may decrease nonadherence to treatment by empowering patients to receive the option that is most congruent with their own values. Objective. To determine the potential costs and benefits of delivering a PtDA to patients with moderate OSA. Methods. A Markov cohort decision-analytic model was developed for patients with moderate OSA, comparing a PtDA to usual care over 5 years from a societal perspective. Data for patient preference for treatment options was taken from a recent randomized crossover trial, event data (cardiovascular, motor vehicle accidents) came from national databases and published literature. Potential improvements in adherence are unknown, so we considered a realistic range of values. Outcome measures were 5-year costs (in 2010 Canadian dollars), quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER). Results. When adherence to treatment was unchanged, the PtDA strategy was dominated by incurring lower QALYs and higher costs. When nonadherence was decreased by 20% in the PtDA arm (corresponding to an increase in adherence from 63% to 70% for continuous positive airway pressure and from 77% to 82% for mandibular advancement splints in year 1), the ICER fell to $62,414/QALY. Costs associated with the treatment devices and delivering the PtDA had the greatest effect on cost-effectiveness. Limitations. The model relies on surrogate measures and opinions for key parameters. Conclusions: The cost-effectiveness of PtDAs will depend on contextual factors, but a framework is described for properly considering their long-term cost-effectiveness. A number of important questions around the appropriateness of benefit measurement for PtDA trials are highlighted.
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Affiliation(s)
- Logan Trenaman
- School of Population and Public Health, University of British Columbia, Vancouver, Canada (LT,NB)
- Center for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada (LT, MS, NA, NB)
- Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, University of British Columbia, Vancouver, Canada (LT, NA, LL, CM, NB)
- Ottawa Hospital Research Institute, Ottawa, Canada (LT, DS)
- Collaboration for Outcomes Research and Evaluations, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada (MS, LL, CM)
| | - Mohsen Sadatsafavi
- School of Population and Public Health, University of British Columbia, Vancouver, Canada (LT,NB)
- Center for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada (LT, MS, NA, NB)
- Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, University of British Columbia, Vancouver, Canada (LT, NA, LL, CM, NB)
- Ottawa Hospital Research Institute, Ottawa, Canada (LT, DS)
- Collaboration for Outcomes Research and Evaluations, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada (MS, LL, CM)
| | - Fernanda Almeida
- School of Population and Public Health, University of British Columbia, Vancouver, Canada (LT,NB)
- Center for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada (LT, MS, NA, NB)
- Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, University of British Columbia, Vancouver, Canada (LT, NA, LL, CM, NB)
- Ottawa Hospital Research Institute, Ottawa, Canada (LT, DS)
- Collaboration for Outcomes Research and Evaluations, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada (MS, LL, CM)
| | - Najib Ayas
- School of Population and Public Health, University of British Columbia, Vancouver, Canada (LT,NB)
- Center for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada (LT, MS, NA, NB)
- Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, University of British Columbia, Vancouver, Canada (LT, NA, LL, CM, NB)
- Ottawa Hospital Research Institute, Ottawa, Canada (LT, DS)
- Collaboration for Outcomes Research and Evaluations, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada (MS, LL, CM)
| | - Larry Lynd
- School of Population and Public Health, University of British Columbia, Vancouver, Canada (LT,NB)
- Center for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada (LT, MS, NA, NB)
- Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, University of British Columbia, Vancouver, Canada (LT, NA, LL, CM, NB)
- Ottawa Hospital Research Institute, Ottawa, Canada (LT, DS)
- Collaboration for Outcomes Research and Evaluations, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada (MS, LL, CM)
| | - Carlo Marra
- School of Population and Public Health, University of British Columbia, Vancouver, Canada (LT,NB)
- Center for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada (LT, MS, NA, NB)
- Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, University of British Columbia, Vancouver, Canada (LT, NA, LL, CM, NB)
- Ottawa Hospital Research Institute, Ottawa, Canada (LT, DS)
- Collaboration for Outcomes Research and Evaluations, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada (MS, LL, CM)
| | - Dawn Stacey
- School of Population and Public Health, University of British Columbia, Vancouver, Canada (LT,NB)
- Center for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada (LT, MS, NA, NB)
- Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, University of British Columbia, Vancouver, Canada (LT, NA, LL, CM, NB)
- Ottawa Hospital Research Institute, Ottawa, Canada (LT, DS)
- Collaboration for Outcomes Research and Evaluations, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada (MS, LL, CM)
| | - Nick Bansback
- School of Population and Public Health, University of British Columbia, Vancouver, Canada (LT,NB)
- Center for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada (LT, MS, NA, NB)
- Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, University of British Columbia, Vancouver, Canada (LT, NA, LL, CM, NB)
- Ottawa Hospital Research Institute, Ottawa, Canada (LT, DS)
- Collaboration for Outcomes Research and Evaluations, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada (MS, LL, CM)
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Krueger H, Williams D, Ready AE, Trenaman L, Turner D. Improved estimation of the health and economic burden of chronic disease risk factors in Manitoba. Chronic Dis Inj Can 2013; 33:236-246. [PMID: 23987220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION There are analytic challenges involved with estimating the aggregate burden of multiple risk factors (RFs) in a population. We describe a methodology to account for overlapping RFs in some sub-populations, a phenomenon that leads to "double-counting" the diseases and economic burden generated by those factors. METHODS Our method uses an efficient approach to accurately analyze the aggregate economic burden of chronic disease across a multifactorial system. In addition, it involves considering the effect of body weight as a continuous or polytomous exposure that ranges from no excess weight through overweight to obesity. We then apply this method to smoking, physical inactivity and overweight/obesity in Manitoba, a province of Canada. RESULTS The annual aggregate economic burden of the RFs in Manitoba in 2008 is about $1.6 billion ($557 million for smoking, $299 million for physical inactivity and $747 million for overweight/obesity). The total burden represents a 12.6% downward adjustment to account for the effect of multiple RFs in some individuals in the population. CONCLUSION An improved estimate of the aggregate economic burden of multiple RFs in a given population can assist in prioritizing and gaining support for primary prevention initiatives.
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Affiliation(s)
- H Krueger
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
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