Montreal Accord on Patient-Reported Outcomes (PROs) use series - Paper 4: patient-reported outcomes can inform clinical decision making in chronic care
Montreal Accord on Patient-Reported Outcomes (PROs) use series - Paper 4: patient-reported outcomes can inform clinical decision making in chronic care
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DOI：
10.1016/j.jclinepi.2017.04.014
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发表时间：
2017-09-01
影响因子：
7.2
通讯作者：
Bartlett, Susan J.
中科院分区：
文献类型：
--
作者：
Bingham, Clifton O., III;Noonan, Vanessa K.;Bartlett, Susan J.
背景资料：提供以患者为中心的医疗保健要求患者的需求，偏好和有价值的结果更充分地融入所有决策。患者自报结局（PRO）指标从患者的角度提供关于整体健康、症状、负担和治疗反应的独特信息。目的：我们试图从PRO研究人员、临床医生、管理人员、政策制定者和参加多学科会议的患者的角度描述PRO在临床环境中的应用和实施考虑。PRO的临床应用包括用于医疗决策的个体水平使用和用于比较有效性研究、项目评估、质量改进和性能评估的聚合使用。考虑工作流程影响和患者负担、结果显示和给药频率的可行性非常重要。应选择具有较强心理测量特性、可操作阈值和可解释结果的PRO。我们提供了PRO在各种临床应用中使用的当前范例，初步经验教训，并强调PRO数据收集的概念，后勤和后续考虑。提出了一个研究议程，以解决关键的知识差距。总之，PRO可用于临床环境，以支持以患者为中心的护理。这需要评估预期使用环境中的可行性、测量考虑因素和过程措施，以优化整合和使用。(C)2017爱思唯尔公司All rights reserved.
Background: Providing patient-centered health care requires that patient needs, preferences, and valued outcomes are more fully integrated into all decisions. Patient-reported outcome (PRO) measures provide unique information from the patient perspective on overall health, symptoms, burden, and treatment response.Objective: We sought to describe applications of PROs in clinical settings and considerations for implementation from the perspectives of PRO researchers, clinicians, administrators, policy makers, and patients attending a multidisciplinary meeting.Discussion: Clinical applications of PROs include individual level use for medical decision making and aggregate use for comparative effectiveness research, program evaluation, quality improvement, and performance assessments. Considerations of feasibility on workflow impact and patient burden, display of results, and administration frequency are important. PROs with strong psychometric properties, actionable thresholds, and interpretable results should be selected. We provide current exemplars of PRO use in various clinical applications, initial lessons learned, and highlight conceptual, logistical, and consequential considerations of PRO data collection. A research agenda is proposed to address critical knowledge gaps. In conclusion, PROs can be used in clinical settings to support patient-centered care. This requires an assessment of feasibility in the intended setting of use, measurement considerations, and process measures to optimize integration and use. (C) 2017 Elsevier Inc. All rights reserved.