Quality improvements of healthcare trajectories by learning from aggregated patient-reported outcomes: a mixed-methods systematic literature review
Tóm tắt
In healthcare, analysing patient-reported outcome measures (PROMs) on an aggregated level can improve and regulate healthcare for specific patient populations (meso level). This mixed-methods systematic review aimed to summarize and describe the effectiveness of quality improvement methods based on aggregated PROMs. Additionally, it aimed to describe barriers, facilitators and lessons learned when using these quality improvement methods.
A mixed-methods systematic review was conducted. Embase, MEDLINE, CINAHL and the Cochrane Library were searched for studies that described, implemented or evaluated a quality improvement method based on aggregated PROMs in the curative hospital setting. Quality assessment was conducted via the Mixed Methods Appraisal Tool. Quantitative data were synthesized into a narrative summary of the characteristics and findings. For the qualitative analysis, a thematic synthesis was conducted.
From 2360 unique search records, 13 quantitative and three qualitative studies were included. Four quality improvement methods were identified: benchmarking, plan-do-study-act cycle, dashboards and internal statistical analysis. Five studies reported on the effectiveness of the use of aggregated PROMs, of which four identified no effect and one a positive effect. The qualitative analysis identified the following themes for facilitators and barriers: (1) conceptual (i.e. stakeholders, subjectivity of PROMs, aligning PROMs with clinical data, PROMs versus patient-reported experience measures [PREMs]); (2a) methodological—data collection (i.e. choice, timing, response rate and focus); (2b) methodological—data processing (i.e. representativeness, responsibility, case-mix control, interpretation); (3) practical (i.e. resources).
The results showed little to no effect of quality improvement methods based on aggregated PROMs, but more empirical research is needed to investigate different quality improvement methods. A shared stakeholder vision, selection of PROMs, timing of measurement and feedback, information on interpretation of data, reduction of missing data, and resources for data collection and feedback infrastructure are important to consider when implementing and evaluating quality improvement methods in future research.
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Tài liệu tham khảo
Williams K, Sansoni J, Morris D, Grootemaat P, Thompson C. Patient-reported outcome measures. Lit Rev. 2016.
Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard‐Jensen J, French SD, O'Brien MA, Johansen M, Grimshaw J, Oxman AD. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2012.
Howell D, Molloy S, Wilkinson K, Green E, Orchard K, Wang K, Liberty J. Patient-reported outcomes in routine cancer clinical practice: a scoping review of use, impact on health outcomes, and implementation factors. Ann Oncol. 2015;26:1846–58.
Valderas JM, Kotzeva A, Espallargues M, Guyatt G, Ferrans CE, Halyard MY, Revicki DA, Symonds T, Parada A, Alonso J. The impact of measuring patient-reported outcomes in clinical practice: a systematic review of the literature. Qual Life Res. 2008;17:179–93.
Boyce MB, Browne JP. Does providing feedback on patient-reported outcomes to healthcare professionals result in better outcomes for patients? A systematic review. Qual Life Res. 2013;22:2265–78.
Damman OC, Jani A, Jong BA, Becker A, Metz MJ, Bruijne MC, Timmermans DR, Cornel MC, Ubbink DT, Steen M, et al. The use of PROMs and shared decision-making in medical encounters with patients: an opportunity to deliver value-based health care to patients. J Eval Clin Pract. 2020;26:524–40.
Prodinger B, Taylor P. Improving quality of care through patient-reported outcome measures (PROMs): expert interviews using the NHS PROMs Programme and the Swedish quality registers for knee and hip arthroplasty as examples. BMC Health Serv Res. 2018;18:87.
Van Der Wees PJ, Der Nijhuis-Van S, En MWG, Ayanian JZ, Black N, Westert GP, Schneider EC. Integrating the use of patient-reported outcomes for both clinical practice and performance measurement: views of experts from 3 countries. Milbank Q. 2014;92:754–75.
Wu AW, Kharrazi H, Boulware LE, Snyder CF. Measure once, cut twice–adding patient-reported outcome measures to the electronic health record for comparative effectiveness research. J Clin Epidemiol. 2013;66:S12-20.
Sutherland HJ, Till JE. Quality of life assessments and levels of decision making: differentiating objectives. Qual Life Res. 1993;2:297–303.
Krawczyk M, Sawatzky R, Schick-Makaroff K, Stajduhar K, Öhlen J, Reimer-Kirkham S, Mercedes Laforest E, Cohen R. Micro-meso-macro practice tensions in using patient-reported outcome and experience measures in hospital palliative care. Qual Health Res. 2019;29:510–21.
Nilsson E, Orwelius L, Kristenson M. Patient-reported outcomes in the Swedish National Quality Registers. J Intern Med (GBR). 2016;279:141–53.
Selby JV, Beal AC, Frank L. The Patient-Centered Outcomes Research Institute (PCORI) national priorities for research and initial research agenda. JAMA. 2012;307:1583–4.
OECD. Recommendations to OECD Ministers of Health from the high level reflection group on the future of health statistics: strengthening the international comparison of health system performance through patient-reported indicators. 2017.
Greenhalgh J, Dalkin S, Gibbons E, Wright J, Valderas JM, Meads D, Black N. How do aggregated patient-reported outcome measures data stimulate health care improvement? A realist synthesis. J Health Serv Res Policy. 2018;23:57–65.
Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ Br Med J. 2015;349: g7647.
Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan—a web and mobile app for systematic reviews. Syst Rev. 2016;5:210.
Sandelowski M, Voils CI, Barroso J. Defining and designing mixed research synthesis studies. Research in the schools: a nationally refereed journal sponsored by the Mid-South Educational Research Association and the University of Alabama 2006; 13:29–29.
Thomas J, Harden A. Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med Res Methodol. 2008;8:45.
Hong QN, Gonzalez-Reyes A, Pluye P. Improving the usefulness of a tool for appraising the quality of qualitative, quantitative and mixed methods studies, the Mixed Methods Appraisal Tool (MMAT). J Eval Clin Pract. 2018;24:459–67.
Weingarten SR, Kim CS, Stone EG, Kristopaitis RJ, Pelter M, Sandhu M. Can peer-comparison feedback improve patient functional status? Am J Manag Care. 2000;6:35–9.
van Zijl F, Lohuis P, Datema FR. The Rhinoplasty Health Care Monitor: using validated questionnaires and a web-based outcome dashboard to evaluate personal surgical performance. Facial Plast Surg Aesthet Med. 2021.
Reilly CA, Doughty HP, Werth PM, Rockwell CW, Sparks MB, Jevsevar DS. Creating a value dashboard for orthopaedic surgical procedures. J Bone Joint Surg Am. 2020;102:1849–56.
Lucas SM, Kim TK, Ghani KR, Miller DC, Linsell S, Starr J, Peabody JO, Hurley P, Montie J, Cher ML. Establishment of a web-based system for collection of patient-reported outcomes after radical prostatectomy in a Statewide quality improvement collaborative. Urology. 2017;107:96–102.
Boyce MB, Browne JP. The effectiveness of providing peer benchmarked feedback to hip replacement surgeons based on patient-reported outcome measures–results from the PROFILE (Patient-Reported Outcomes: Feedback Interpretation and Learning Experiment) trial: a cluster randomised controlled study. BMJ Open. 2015;5: e008325.
Brønserud M, Iachina M, Green A, Grønvold M, Jakobsen E. P3.15-05 patient reported outcomes (PROs) as performance measures after surgery for lung cancer. J Thorac Oncol. 2018; 13:S992–S993.
Gutacker N, Bojke C, Daidone S, Devlin N, Street A. Hospital variation in patient-reported outcomes at the level of EQ-5D dimensions: evidence from England. Med Decis Making. 2013;33:804–18.
Lundström M, Stenevi U. Analyzing patient-reported outcomes to improve cataract care. Optom Vis Sci. 2013;90:754–9.
Partridge T, Carluke I, Emmerson K, Partington P, Reed M. Improving patient reported outcome measures (PROMs) in total knee replacement by changing implant and preserving the infrapatella fatpad: a quality improvement project. 2016.
van Veghel D, Marteijn M, de Mol B. First results of a national initiative to enable quality improvement of cardiovascular care by transparently reporting on patient-relevant outcomes. Eur J Cardio Thorac Surg. 2016;49:1660–9.
Varagunam M, Hutchings A, Neuburger J, Black N. Impact on hospital performance of introducing routine patient reported outcome measures in surgery. J Health Serv Res Policy. 2014;19:77–84.
Zheng H, Li W, Harrold L, Ayers DC, Franklin PD. Web-based comparative patient-reported outcome feedback to support quality improvement and comparative effectiveness research in total joint replacement. EGEMS (Wash DC). 2014;2:1130.
Kumar RM, Fergusson DA, Lavallée LT, Cagiannos I, Morash C, Horrigan M, Mallick R, Stacey D, Fung-Kee Fung M, Sands D, Breau RH. Performance feedback may not improve radical prostatectomy outcomes: the surgical report card (SuRep) study. J Urol. 2021:101097JU0000000000001764.
Boyce MB, Browne JP, Greenhalgh J. Surgeon’s experiences of receiving peer benchmarked feedback using patient-reported outcome measures: a qualitative study. Implement Sci. 2014;9:84.
Kaplan HC, Brady PW, Dritz MC, Hooper DK, Linam WM, Froehle CM, Margolis P. The influence of context on quality improvement success in health care: a systematic review of the literature. Milbank Q. 2010;88:500–59.
Gleeson H, Calderon A, Swami V, Deighton J, Wolpert M, Edbrooke-Childs J. Systematic review of approaches to using patient experience data for quality improvement in healthcare settings. BMJ Open. 2016;6: e011907.
Bastemeijer CM, Boosman H, van Ewijk H, Verweij LM, Voogt L, Hazelzet JA. Patient experiences: a systematic review of quality improvement interventions in a hospital setting. Patient Relat Outcome Meas. 2019;10:157–69.
Haugum M, Danielsen K, Iversen HH, Bjertnaes O. The use of data from national and other large-scale user experience surveys in local quality work: a systematic review. Int J Qual Health Care. 2014;26:592–605.