Development of a Patient-centered Outcome Measure for Emergency Department Asthma Patients.
Development of a Patient-centered Outcome Measure for Emergency Department Asthma Patients.
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DOI：
10.1111/acem.13165
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发表时间：
2017-05
期刊：
影响因子：
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通讯作者：
Mollen C
中科院分区：
文献类型：
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作者：
Samuels-Kalow ME;Rhodes KV;Henien M;Hardy E;Moore T;Wong F;Camargo CA Jr;Rizzo CT;Mollen C
衡量急诊护理的结果至关重要，但目前的指标，如72小时回访率，存在确定偏差，在初次就诊时激励过度检测和过度治疗，并且不能反映急诊科护理后家中经历的疾病和发病率的全部负担。越来越多的人强调纳入患者报告的结果，但现有的患者报告措施对急诊护理的适用性有限。确定纳入患者报告的ED护理结果测量的概念，并通过健康素养评估潜在概念的差异。采用自由列表法和半结构化访谈法进行概念识别，成员检验法进行概念排序，认知访谈法进行问题开发，完成了三个阶段的定性研究。参与者来自三个三级医疗急诊科。哮喘患者（儿童）或患者（成人）的父母完成了一项人口统计调查和健康素养评估。第一阶段的参与者还完成了关于ED出院后成功定义的自由列表练习和定性访谈。阶段2的参与者完成了基于阶段1中确定的概念的成员检查调查。第三阶段是基于第二阶段中排名最高的概念的试验问题的试点。第一阶段招募了22名成年患者和37名儿科患者的父母。第二阶段招募了41名成年患者和200名家长。第三阶段涉及15名家长。在所有人口统计学/识字组中，第一阶段的参与者报告说，恢复正常活动和没有哮喘症状是成功的最重要标志。在第2阶段，症状改善，药物使用和获取以及哮喘知识被确定为ed后出院成功定义的最重要组成部分。第三阶段针对提议的措施提出了5个问题。阶梯式定性过程可以根据患者确定的概念识别、排序和制定问题，以便纳入患者报告的ED出院结果测量。确定纳入的4个关键概念：症状改善、药物可及性、正确用药和哮喘知识没有通过现有质量指标加以衡量。
Measuring outcomes of emergency care is of key importance, but current metrics, such as 72-hour return visit rates, are subject to ascertainment bias, incentivize over-testing and over-treatment at initial visit, and do not reflect the full burden of disease and morbidity experienced at home following ED care. There is increasing emphasis on including patient-reported outcomes, but the existing patient-reported measures have limited applicability to emergency care. To identify concepts for inclusion in a patient-reported outcome measure for ED care, and assess differences in potential concepts by health literacy. A three-phase qualitative study was completed using freelisting and semi-structured interviewing for concept identification, member checking for concept ranking and cognitive interviewing for question development. Participants were drawn from three tertiary care EDs. Parents of patients (pediatric) or patients (adult) with asthma completed a demographic survey and an assessment of health literacy. Phase 1 participants also completed a freelisting exercise and qualitative interview regarding the definition of success following ED discharge. Phase 2 participants completed a member checking survey based on concepts identified in Phase 1. Phase 3 was a pilot of trial questions based on the highest-ranked concepts from Phase 2. Phase 1 enrolled 22 adult patients and 37 parents of pediatric patients. Phase 2 enrolled 41 adult patients and 200 parents. Phase 3 involved 15 parents. Across all demographic / literacy groups, Phase 1 participants reported return to usual activity and lack of asthma symptoms as the most important markers of success. In Phase 2, symptom improvement, medication use and access and asthma knowledge were identified as the most important components of the definition of post-ED discharge success. Phase 3 resulted in 5 questions for the proposed measure. A step-wise qualitative process can identify, rank, and formulate questions based on patient-identified concepts for inclusion in a patient-reported outcome measure for ED discharge. The 4 key concepts identified for inclusion: symptom improvement, medication access, correct medication use and asthma knowledge are not measured by existing quality metrics.