Outcomes Based Appropriateness/Ronald Dale Hays

项目描述 本项目将在系统性综述核心的支持下进行系统性文献，以确定慢性颈椎疼痛治疗的脊椎按摩治疗变化与患者报告结局（PRO）之间相关性的既往工作。我们还将进行焦点小组，以评估标准化PRO的适用性，这些PRO评估患者的护理体验（医疗保健提供者和系统的消费者评估或CAHPS <$）和健康相关的生活质量（患者报告的结果测量和信息系统或PROMIS <$），以评估经历过颈椎疼痛M/M的脊椎按摩患者。这些信息将用于确定是否需要修改现有措施，以及是否存在需要新项目的差距。然后将起草现有项目和新项目的修订，并与经历过M/M颈椎疼痛的脊椎按摩患者进行认知访谈。修订后的项目和新项目将根据认知访谈最终确定，然后沿着CAHPS临床医生和成人团体访问调查以及PROMIS-57调查，纳入该卓越中心四个项目中的每一个共享的脊椎按摩患者的全国样本。 国家样本数据将从分布在美国各地的四个国家研究中心随机选择的从业人员及其患者中收集。项目1将评估慢性颈椎疼痛的治疗和M/M的次数。在研究方法评估和评价核心的帮助下，项目1将评估脊椎按摩疗法M/M护理的适当性。 我们将在慢性颈椎疼痛的脊椎指压治疗患者的全国样本中对这些PRO措施的心理测量特性进行全面评估，包括通过比较全国样本响应与在其他患者的大样本中收集的数据来评估测量等效性：CAHPS比较数据库和PROMIS波1样本。此外，我们还将评估国家样本中护理适当性（由项目1定义）与PRO之间的关联。我们使用的健康相关生活质量结局也将对项目4（基于经济的适当性）有用，特别是我们将根据PROMIS-57领域评分估计的基于EQ-5D偏好的单一汇总评分。 这项工作提供了一个重要的评估适用性的领先国家的科学病人为中心的结果措施CAM在接受脊椎治疗的患者和心理素质。此外，它提供了独特的信息，在何种程度上，目前的方法来评估适当的护理涉及到以病人为中心的护理结果。这项研究的结果将为今后评估CAM与美国其他医疗保健干预措施的比较有效性提供基础。

Project Description This project will conduct a systematic literature with the support of the Systematic Review Core to locate prior work on associations between variation in chiropractic care for chronic cervical pain care and patient-reported outcomes (PROs). We will also conduct focus groups to evaluate the applicability of standardized PROs that assess patient experiences of care (Consumer Assessment of Healthcare Providers and Systems or CAHPS¿) and health-related quality of life (Patient-Reported Outcomes Measurement and Information System or PROMIS¿) to chiropractic patients who have experienced M/M for cervical pain. This information will be used to determine if modifications to existing measures are needed and if there are gaps that require new items. Revisions to existing items and new items will then be drafted and subjected to cognitive interviews with chiropractic patients who have experienced M/M for cervical pain. The revised and new items will be finalized based on the cognitive interviews and then included along with the CAHPS Clinician and Group Adult Visit Survey and the PROMIS-57 Survey in the national sample of chiropractic patients shared by each of the four projects in this Center of Excellence. The national sample data will be collected from a random selection of practitioners and their patients in four national sites geographically distributed across the US. Project 1 will assess the treatment given chronic cervical pain and the number of times M/M is done. Project 1 with help from the Research Methods Assessment and Evaluation Core will estimate the appropriateness of chiropractic M/M care. We will conduct a thorough evaluation of the psychometric properties of these PRO measures in the national sample of chiropractic patients with chronic cervical pain, including an evaluation of measurement equivalence by comparing the national sample responses to data collected in large samples of other patients: the CAHPS comparative database and PROMIS wave 1 sample. In addition, we will estimate the associations between appropriateness of care (defined by Project 1) and PROs in the national sample. The health-related quality of life outcomes we use will also be useful to Project 4 (Economic Based Appropriateness), especially the EQ-5D preference-based single summary score we will estimate based on the PROMIS-57 domain scores. This work provides an essential assessment of the applicability of the leading state-of-the-science patient centered outcome measures to CAM in terms of acceptability to chiropractic patients and psychometric quality. In addition, it provides unique information about the extent to which the current approach tor evaluating appropriateness of care relates to patient-centered outcomes of care. The findings of this study will provide a basis for future evaluations of the comparative effectiveness of CAM versus other health care interventions in the United States.