Improve the Meaning of Patient Reported Outcomes to Evaluate Effectiveness for Cardiac Care" (IMPROVE-Cardiac Care)

项目总结 心脏疾病是全球发病率和死亡率的主要原因。超过4亿人生活在 心脏疾病，每年有1800万人死亡。在美国，冠心病影响着18.2 超过650万成年人和心力衰竭患者，其中超过30%的人因急性心肌梗死住院。 每年都在恶化。患者报告的结果为医疗专业人员和患者提供了洞察力 无论是在常规治疗期间还是在从疾病中恢复的过程中，都可以了解患者在疾病轨迹上的位置 重大临床事件。总体目标是改善患者报告结果的意义以进行评估 心脏护理的有效性“(改善：心脏护理)研究是为了建立人群和个人 最小临床重要差异(MCID)，这是对以下方面有意义的最小改善 有心脏疾病的患者。在目标1中，研究人员将在患者报告的结果中建立MCID 适用于冠状动脉搭桥术后康复的冠心病患者或心力衰竭患者 住院后正在恢复中。在目标2中，研究人员将在患者报告的结果中建立MCID 对射血分数保留的心力衰竭患者在门诊接受疾病治疗 布景。对于目标1和目标2，我们将使用三种统计方法，包括：1)基于锚点的方法 (PRO和临床指标的相关变化，平均值变化，接收器操作特征)，以及2) 基于条件锚点的方法(使用多变量Logistic回归)。在目标3中，调查人员将确定 患者报告的心脏疾病患者的结果如何为临床决策提供信息。引导式 根据感觉生成的数据框架理论，我们将对60名患者和医疗保健专业人员进行评估 使用患者报告的结果健康信息做出临床决策，包括：1)视频人种学 测量沟通行为；以及2)基于视频临床会面的反身性访谈 描述如何将患者报告的结果纳入到感觉制造过程中。总体而言，改进的方面： 心脏护理研究将建立可用于识别患者的最低临床重要性差异 那些没有从心脏事件中最佳恢复的人，并使用MCID来针对早期干预。这个 研究人员还将开发一种新的框架，说明患者报告的结果如何具有意义 结合到临床实践中。

PROJECT SUMMARY Cardiac conditions are the leading cause of morbidity and mortality globally. Over 400 million people are living with cardiac conditions, and 18 million people die annually. In the U.S., coronary heart disease affects 18.2 million adults and heart failure affects over 6.5 million people, of whom over 30% are hospitalized for acute exacerbations annually. Patient-reported outcomes provide healthcare professionals and patients with insight into where patients are on the disease trajectory, both during routine management and during recovery from a major clinical event. The overall goal of the Improve the Meaning of Patient-Reported Outcomes to eValuate Effectiveness for Cardiac Care” (IMPROVE: Cardiac Care) study is to establish population and individual minimally clinically important differences (MCIDS), which are the smallest improvement that is meaningful to patients with cardiac conditions. In Aim 1, the investigators will establish MCIDs in patient-reported outcomes for patients with coronary heart disease recovering from coronary artery bypass surgery, or with heart failure recovering from a hospitalization. In Aim 2, the investigators will establish MCIDs in patient-reported outcomes for patients with heart failure with preserved ejection fraction undergoing disease management in the ambulatory setting. For both Aims 1 and 2, we will use three statistical approaches including: 1) anchor-based methods (associated changes in PROs and clinical indicators, mean changes, receiver operating characteristics), and 2) conditional anchor-based methods (using multivariate logistic regression). In Aim 3, investigators will determine how patient-reported outcomes from patients with cardiac condition can inform clinical decision-making. Guided by the Data-Frame Theory of Sensemaking, we will evaluate 60 patient and healthcare professional dyads making clinical decisions using patient-reported outcome health information with: 1) video ethnography to measure communication behaviors; and 2) reflexive interviewing based on videoed clinical encounters to describe how patient-reported outcomes are incorporated into the sensemaking process. Overall, the IMPROVE: Cardiac Care study will establish minimally clinically important differences that can be used to identify patients who are not optimally recovering from a cardiac event, and use the MCIDs to target early interventions. The investigators will also develop a novel framework for how patient-reported outcomes can be meaningfully incorporated into clinical practice.