Patient-reported outcome measures and patient-reported experience measures
TL;DR: There is an increasing support for the use of patient- reported outcome measures (PROMs) and patient-reported experience measures (PREMs) in measuring the quality of care across all three areas and to guide service improvement.
About: This article is published in BJA Education.The article was published on 2017-04-01 and is currently open access. It has received 334 citations till now. The article focuses on the topics: Patient-reported outcome.
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TL;DR: VerifyMed is the first proof-of-concept platform, built on Ethereum, for transparently validating the authorization and competence of medical professionals using blockchain technology and enables a healthcare professional to build a portfolio of real-life work experience and further validates the competence by storing outcome metrics reported by the patients.
Abstract: Patients living in a digitized world can now interact with medical professionals through online services such as chat applications, video conferencing or indirectly through consulting services. These applications need to tackle several fundamental trust issues: 1. Checking and confirming that the person they are interacting with is a real person; 2. Validating that the healthcare professional has competence within the field in question; and 3. Confirming that the healthcare professional has a valid license to practice. In this paper, we present VerifyMed -- the first proof-of-concept platform, built on Ethereum, for transparently validating the authorization and competence of medical professionals using blockchain technology. Our platform models trust relationships within the healthcare industry to validate professional clinical authorization. Furthermore, it enables a healthcare professional to build a portfolio of real-life work experience and further validates the competence by storing outcome metrics reported by the patients. The extensive realistic simulations show that with our platform, an average cost for creating a smart contract for a treatment and getting it approved is around 1 USD, and the cost for evaluating a treatment is around 50 cents.
109 citations
Cites methods from "Patient-reported outcome measures a..."
...There are two standardized manners to measure PROs: Patient Reported Outcome Measures (PROMs) and Patient Reported Experience Measures (PREMs) [11]....
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TL;DR: In cross-study comparisons, barriers to PROM/PREM implementation were consistent across patient populations and care settings, but enablers were context specific, suggesting the need for tailored implementation strategies based on clinic resources.
Abstract: Patient-reported outcome and experience measures (PROMs/PREMs) are well established in research for many health conditions, but barriers persist for implementing them in routine care. Implementation science (IS) offers a potential way forward, but its application has been limited for PROMs/PREMs. We compare similarities and differences for widely used IS frameworks and their applicability for implementing PROMs/PREMs through case studies. Three case studies implemented PROMs: (1) pain clinics in Canada; (2) oncology clinics in Australia; and (3) pediatric/adult clinics for chronic conditions in the Netherlands. The fourth case study is planning PREMs implementation in Canadian primary care clinics. We compare case studies on barriers, enablers, implementation strategies, and evaluation. Case studies used IS frameworks to systematize barriers, to develop implementation strategies for clinics, and to evaluate implementation effectiveness. Across case studies, consistent PROM/PREM implementation barriers were technology, uncertainty about how or why to use PROMs/PREMs, and competing demands from established clinical workflows. Enabling factors in clinics were context specific. Implementation support strategies changed during pre-implementation, implementation, and post-implementation stages. Evaluation approaches were inconsistent across case studies, and thus, we present example evaluation metrics specific to PROMs/PREMs. Multilevel IS frameworks are necessary for PROM/PREM implementation given the complexity. In cross-study comparisons, barriers to PROM/PREM implementation were consistent across patient populations and care settings, but enablers were context specific, suggesting the need for tailored implementation strategies based on clinic resources. Theoretically guided studies are needed to clarify how, why, and in what circumstances IS principles lead to successful PROM/PREM integration and sustainability.
107 citations
TL;DR: Careful consideration should be given when selecting PREMs, particularly as seven of the 10 validity and reliability criteria were not undertaken in ≥50 percent of the PREMs.
Abstract: OBJECTIVES: To identify patient-reported experience measures (PREMs), assess their validity and reliability, and assess any bias in the study design of PREM validity and reliability testing. DATA SOURCES/STUDY SETTING: Articles reporting on PREM development and testing sourced from MEDLINE, CINAHL and Scopus databases up to March 13, 2018. STUDY DESIGN: Systematic review. DATA COLLECTION/EXTRACTION METHODS: Critical appraisal of PREM study design was undertaken using the Appraisal tool for Cross-Sectional Studies (AXIS). Critical appraisal of PREM validity and reliability was undertaken using a revised version of the COSMIN checklist. PRINCIPAL FINDINGS: Eighty-eight PREMs were identified, spanning across four main health care contexts. PREM validity and reliability was supported by appropriate study designs. Internal consistency (n = 58, 65.2 percent), structural validity (n = 49, 55.1 percent), and content validity (n = 34, 38.2 percent) were the most frequently reported validity and reliability tests. CONCLUSIONS: Careful consideration should be given when selecting PREMs, particularly as seven of the 10 validity and reliability criteria were not undertaken in ≥50 percent of the PREMs. Testing PREM responsiveness should be prioritized for the application of PREMs where the end user is measuring change over time. Assessing measurement error/agreement of PREMs is important to understand the clinical relevancy of PREM scores used in a health care evaluation capacity.
101 citations
TL;DR: The quality of most SECT–ECT studies is so poor that the meta-analyses were wrong to conclude anything about efficacy, either during or beyond the treatment period, and its use should be immediately suspended.
Abstract: Background Electroconvulsive therapy (ECT) is still being administered to approximately a million people annually. There have been no ECT versus simulated ECT (SECT) studies since 1985. The five meta-analyses of ECT versus SECT studies all claim that ECT is more effective than SECT for its primary target, severe depression. This review assesses the quality of those meta-analyses and of the 11 studies on which they are based. Methods The meta-analyses were evaluated primarily in terms of whether they considered the quality of the studies they included, but also in terms of whether they addressed efficacy beyond end of treatment. The methodological rigor of the 11 studies included by one or more of the meta-analyses was assessed using a 24-point Quality scale developed for this review. Results The five meta-analyses include between 1 and 7 of the 11 studies. The meta-analyses pay little or no attention to the multiple limitations of the studies they include. The 11 studies have a mean Quality score of 12.3 out of 24. Eight scored 13 or less. Only four studies describe their processes of randomization and testing the blinding. None convincingly demonstrate that they are double-blind. Five selectively report their findings. Only four report any ratings by patients. None assess Quality of Life. The studies are small, involving an average of 37 people. Four of the 11 found ECT significantly superior to SECT at the end of treatment, five found no significant difference and two found mixed results (including one where the psychiatrists reported a difference but patients did not). Only two higher Quality studies report follow-up data, one produced a near-zero effect size (.065) in the direction of ECT, and the other a small effect size (.299) in favor of SECT. Conclusions The quality of most SECT-ECT studies is so poor that the meta-analyses were wrong to conclude anything about efficacy, either during or beyond the treatment period. There is no evidence that ECT is effective for its target demographic - older women, or its target diagnostic group - severely depressed people, or for suicidal people, people who have unsuccessfully tried other treatments first, involuntary patients, or children and adolescents. Given the high risk of permanent memory loss and the small mortality risk, this longstanding failure to determine whether or not ECT works means that its use should be immediately suspended until a series of well designed, randomized, placebo-controlled studies have investigated whether there really are any significant benefits against which the proven significant risks can be weighed.
33 citations
Cites background from "Patient-reported outcome measures a..."
...We agree with Kingsley and Patel (2017) that patient-reported outcome measures should be included in clinical trials and meta-analyses of psychiatric conditions....
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TL;DR: An overview of key PROMs in Urology now include USSQ, WISQOL, CUSP, CReSP and USIQOL is provided to help delineate their role in current practice.
32 citations
References
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Journal Article•
TL;DR: This research highlights the need to understand more fully the rationale behind the continued use of these devices, as well as the barriers to their adoption.
Abstract: s. Outcome research 249 Questionnaire 63,152 Would pick up refer-
1,638 citations
Additional excerpts
...The target patient group, content, reliability, and validity of the questionnaire should be considered, in addition to its prior use in a similar patient demographic.(11) A pilot of the questionnaire prior to commencing the PROMs or PREMs data collection is vital to identify inappropriate questions for the population....
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TL;DR: To use evidence regarding both costs and outcomes of primary THR to model how much more effective newer prostheses must be to justify higher costs.
Abstract: Objectives- T identify the literature on primary total hip replacement(THR) surgery that is relevant to the question of whether prostheses differ in their medium to longer term outcomes, and to synthesise this evidence. To use evidence regarding both costs and outcomes of primary THR to model how much more effective newer prostheses must be to justify higher costs
1,057 citations
TL;DR: It is believed that the QoR-40 is a good objective measure of quality of recovery after anaesthesia and surgery and would be a useful end-point in perioperative clinical studies.
Abstract: Quality of recovery after anaesthesia is an important measure of the early postoperative health status of patients. We attempted to develop a valid, reliable and responsive measure of quality of recovery after anaesthesia and surgery. We studied 160 patients and asked them to rate postoperative recovery using three methods: a 100-mm visual analogue scale (VAS), a nine-item questionnaire and a 50-item questionnaire; the questionnaires were repeated later on the same day. From these results, we developed a 40-item questionnaire as a measure of quality of recovery (QoR-40; maximum score 200). We found good convergent validity between QoR-40 and VAS (r = 0.68, P
650 citations
04 Aug 2013
TL;DR: In this article, the authors provide an overview of patients' involvement in clinical research and service evaluation along with its benefits and limitations, including patient-reported outcomes (PROs) and patientreported outcome measures (PROMs), including the trends in current research.
Abstract: In recent years, there has been an increased focus on placing patients at the center of health care research and evaluating clinical care in order to improve their experience and ensure that research is both robust and of maximum value for the use of medicinal products, therapy, or health services. This paper provides an overview of patients’ involvement in clinical research and service evaluation along with its benefits and limitations. We describe and discuss patient-reported outcomes (PROs) and patient-reported outcome measures (PROMs), including the trends in current research. Both the patient-reported experiences measures (PREMs) and patient and public involvement (PPI) initiative for including patients in the research processes are also outlined. PROs provide reports from patients about their own health, quality of life, or functional status associated with the health care or treatment they have received. PROMs are tools and/or instruments used to report PROs. Patient report experiences through the use of PREMs, such as satisfaction scales, providing insight into the patients’ experience with their care or a health service. There is increasing international attention regarding the use of PREMS as a quality indicator of patient care and safety. This reflects the ongoing health service commitment of involving patients and the public within the wider context of the development and evaluation of health care service delivery and quality improvement.
594 citations
TL;DR: In this article, the authors provide a guide for individuals who are interested in using patient reported outcome measures at a local level, however, a number of pitfalls await clinicians with limited expertise.
Abstract: The use of patient reported outcome measures might seem to be quite straightforward; however, a number of pitfalls await clinicians with limited expertise. Jill Dawson and colleagues provide a guide for individuals keen to use patient reported outcome measures at a local level.
518 citations