Utilizing a learning health system to capture real-world patient data: Application of the reliable change index to evaluate and improve the outcome of a pain rehabilitation program.
Utilizing a learning health system to capture real-world patient data: Application of the reliable change index to evaluate and improve the outcome of a pain rehabilitation program.
复制标题
利用学习健康系统捕获真实世界的患者数据：应用可靠的变化指数来评估和改善疼痛康复计划的结果。
DOI：
10.1111/papr.13364
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发表时间：
2024
期刊：
影响因子：
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通讯作者：
Poupore-King,Heather
中科院分区：
文献类型：
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作者：
You,DokyoungS;Chong,JeanetteL;Mackey,SeanC;Poupore-King,Heather
背景和目标学习医疗保健系统 (LHS) 的开发旨在将患者的临床数据整合到临床决策中并改善治疗结果。在这个整合过程中几乎没有指导，我们的目标是解释（a）临床医生评估团体和个人水平临床结果的适用分析工具，以及（b）我们的质量改进（QI）项目，分析新的门诊疼痛康复计划（“Back-in-Action”：BIA）的结果，并应用分析结果来修改我们的临床实践。方法通过我们的 LHS（CHOIR；https://choir.stanford.edu），我们实施了疼痛灾难化BIA 前后的量表 (PCS)、慢性疼痛接受问卷 (CPAQ) 和患者报告结果测量 (PROMIS)®。在寻找合适的分析工具后，我们决定使用可靠变化指数 (RCI) 来确定观察到的向更好（改善）或更差（恶化）方向的变化是否会超出或在测量误差（无变化）之内。结果我们的 RCI 计算显示，PCS 分数至少下降 9 分，CPAQ 分数至少增加 10 分，表明有可靠的改善。 PROMIS 测量的 RCI 范围为 5 至 8T 分数（即 0.5-0.8 SD）。在评估 PCS、CPAQ 和 PROMIS 指标的变化分数时，我们发现 94% 的患者在 BIA 后至少在一个领域表现出改善，6% 的患者没有表现出可靠的改善。结论我们的 QI 项目表明 RCI 是评估团体和个人水平治疗结果的有用工具，RCI 可以纳入 LHS，为临床医生自动生成进度报告。我们进一步解释了临床医生如何使用 RCI 结果来修改临床实践、改善疼痛计划的结果以及制定个性化护理计划。最后，我们提出了未来的研究领域，以改进 LHS 在疼痛实践中的应用。
Background and ObjectivesThe learning healthcare system (LHS) has been developed to integrate patients' clinical data into clinical decisions and improve treatment outcomes. Having little guidance on this integration process, we aim to explain (a) an applicable analytic tool for clinicians to evaluate the clinical outcomes at a group and an individual level and (b) our quality improvement (QI) project, analyzing the outcomes of a new outpatient pain rehabilitation program (“Back‐in‐Action”: BIA) and applying the analysis results to modify our clinical practice.MethodsThrough our LHS (CHOIR; https://choir.stanford.edu), we administered the Pain Catastrophizing Scale (PCS), Chronic Pain Acceptance Questionnaire (CPAQ), and Patient‐Reported Outcomes Measures (PROMIS)® before and after BIA. After searching for appropriate analytic tools, we decided to use the Reliable Change Index (RCI) to determine if an observed change in the direction of better (improvement) or worse (deterioration) would be beyond or within the measurement error (no change).ResultsOur RCI calculations revealed that at least a 9‐point decrease in the PCS scores and 10‐point increase in the CPAQ scores would indicate reliable improvement. RCIs for the PROMIS measures ranged from 5 to 8T‐score points (i.e., 0.5–0.8 SD). When evaluating change scores of the PCS, CPAQ, and PROMIS measures, we found that 94% of patients showed improvement in at least one domain after BIA and 6% showed no reliable improvement.ConclusionsOur QI project revealed RCI as a useful tool to evaluate treatment outcomes at a group and an individual level, and RCI could be incorporated into the LHS to generate a progress report automatically for clinicians. We further explained how clinicians could use RCI results to modify a clinical practice, to improve the outcomes of a pain program, and to develop individualized care plans. Lastly, we suggested future research areas to improve the LHS application in pain practice.