A proposed set of metrics for standardized outcome reporting in the management of low back pain.
A proposed set of metrics for standardized outcome reporting in the management of low back pain.
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DOI：
10.3109/17453674.2015.1036696
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发表时间：
2015
影响因子：
3.7
通讯作者：
Fritzell P
中科院分区：
文献类型：
--
作者：
Clement RC;Welander A;Stowell C;Cha TD;Chen JL;Davies M;Fairbank JC;Foley KT;Gehrchen M;Hagg O;Jacobs WC;Kahler R;Khan SN;Lieberman IH;Morisson B;Ohnmeiss DD;Peul WC;Shonnard NH;Smuck MW;Solberg TK;Stromqvist BH;Hooff ML;Wasan AD;Willems PC;Yeo W;Fritzell P
结果测量已被证明可以改善医疗保健的几个领域的性能。这种理解推动了人们对基于价值的医疗保健越来越感兴趣，其中价值被定义为每花费一笔钱所取得的成果。虽然腰痛（LBP）构成了巨大的疾病负担，但尚未接受一套通用的指标来衡量和比较结果。在这里，我们的目标是定义这样一个集合。 一个由22名脊柱护理领域专家组成的国际小组，通过6轮改良德尔菲法对文献进行回顾并选择LBP结果指标。结局集的范围是退行性腰椎疾病。 患者报告的指标包括数字疼痛量表、使用奥斯韦斯特里残疾指数的腰椎相关功能、使用EQ-5D-3L问卷的健康相关生活质量以及评估工作状态和镇痛剂使用的问题。包括特定的常见和严重并发症。建议的随访间隔包括开始治疗后6、12和24个月，可选的随访时间为3个月和5年。根据预先存在的工具选择用于风险分层的工具。 这里推荐的结果测量是围绕LBP的特定病因构建的，跨越患者的整个护理周期，并允许风险调整。因此，当实施时，可以预期该集合将促进有意义的比较，并最终提供连续的反馈回路，从而实现护理质量的持续改进。在实施、修订和验证这一套标准方面还有很多工作要做，但这是建立一个LBP提供者社区的重要第一步，该社区的重点是最大限度地提高我们提供的护理价值。
Outcome measurement has been shown to improve performance in several fields of healthcare. This understanding has driven a growing interest in value-based healthcare, where value is defined as outcomes achieved per money spent. While low back pain (LBP) constitutes an enormous burden of disease, no universal set of metrics has yet been accepted to measure and compare outcomes. Here, we aim to define such a set. An international group of 22 specialists in several disciplines of spine care was assembled to review literature and select LBP outcome metrics through a 6-round modified Delphi process. The scope of the outcome set was degenerative lumbar conditions. Patient-reported metrics include numerical pain scales, lumbar-related function using the Oswestry disability index, health-related quality of life using the EQ-5D-3L questionnaire, and questions assessing work status and analgesic use. Specific common and serious complications are included. Recommended follow-up intervals include 6, 12, and 24 months after initiating treatment, with optional follow-up at 3 months and 5 years. Metrics for risk stratification are selected based on pre-existing tools. The outcome measures recommended here are structured around specific etiologies of LBP, span a patient’s entire cycle of care, and allow for risk adjustment. Thus, when implemented, this set can be expected to facilitate meaningful comparisons and ultimately provide a continuous feedback loop, enabling ongoing improvements in quality of care. Much work lies ahead in implementation, revision, and validation of this set, but it is an essential first step toward establishing a community of LBP providers focused on maximizing the value of the care we deliver.