scholarly journals 4162 Improving Data Capacity and Predictive Capability of NSQIP-P Using Designed Sampling from Databases

2020 ◽  
Vol 4 (s1) ◽  
pp. 137-138
Author(s):  
Martha-Conley Ingram ◽  
Yao Tian ◽  
Sanjay Mehrotra ◽  
Dan Apley ◽  
Mehul V Raval
Keyword(s):  
Data Collection ◽  
Management Practices ◽  
Patient Reported Outcome Measures ◽  
Population Based ◽  
List Type ◽  
Statistical Regression ◽  
Surgical Quality ◽  
Improvement Project ◽  
Patient Reported ◽  
Study Population

OBJECTIVES/GOALS: Designed sampling from databases (DSD) methods have been used to cross-check electronic medical records for errors, structure study design, and, we hypothesize, can be used to make data collection for surgical quality metrics more efficient, particularly within national databases. We plan to apply statistical and DSD methods to accomplish the following aims: 1.Identify the most important elements in managing post-operative pain2.Identify the most informative procedure or population-based targets to focus collection of additional, labor-intense detail surrounding adequacy of pain control (i.e., Patient Reported Outcome Measures (PROMs)).METHODS/STUDY POPULATION: Our study population includes all children, ages 1-18 years, captured in the National Surgical Quality Improvement Project-Pediatric (NSQIP-P) from 2019 to 2021. We plan to apply statistical (regression modeling) and DSD methods to accomplish the aims listed above. RESULTS/ANTICIPATED RESULTS: For Aim 1, we expect to identify patient, procedure, and perioperative pain management practices that influence postoperative pain. For Aim 2, we will focus on outcomes such as PROMs that are challenging to obtain. By applying DSD methods, we will identify specific procedure and/or population-based cohorts to capture PROMs and decrease data collection burdens, while maintaining power, as the project is scaled nationally to all of NSQIP-P. DISCUSSION/SIGNIFICANCE OF IMPACT: Data from this study will inform expansion of NSQIP-P to collect novel outcomes of clinical and societal importance without prohibitively increasing data collection burden.

scholarly journals Minimal important difference and patient acceptable symptom state for PFDI-20 and POPDI-6 in POP surgery

2020 ◽  
Author(s):  
Päivi K. Karjalainen ◽  
Nina K. Mattsson ◽  
Jyrki T. Jalkanen ◽  
Kari Nieminen ◽  
Anna-Maija Tolppanen
Keyword(s):  
Pelvic Organ Prolapse ◽  
Roc Curve ◽  
Minimal Important Difference ◽  
Patient Reported Outcome Measures ◽  
Pelvic Organ ◽  
Population Based ◽  
Patient Reported Outcome ◽  
Pop Surgery ◽  
Patient Reported ◽  
Patient Acceptable Symptom State

Abstract Introduction and hypothesis Patient-reported outcome measures are fundamental tools when assessing effectiveness of treatments. The challenge lies in the interpretation: which magnitude of change in score is meaningful for the patients? The minimal important difference (MID) is defined as the smallest difference in score that patients perceive as important. The Patient Acceptable Symptom State (PASS) represents the value of score beyond which patients consider themselves well. We aimed to determine the MID and PASS for Pelvic Floor Distress Inventory-20 (PFDI-20) and Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6) in pelvic organ prolapse (POP) surgery. Methods We used data from 2704 POP surgeries from a prospective, population-based cohort. MID was determined with three anchor-based and one distribution-based method. PASS was defined using two different methods. Medians of the estimates were identified. Results The MID estimates with (1) mean change, (2) receiver-operating characteristic (ROC) curve, (3) 75th percentile, and (4) distribution-based method varied between 22.9–25.0 (median 24.2) points for PFDI-20 and 9.0–12.5 (median 11.3) for POPDI-6. The PASS cutoffs with (1) 75th percentile and (2) ROC curve method varied between 57.7–62.5 (median 60.0) for PFDI-20 and 16.7–17.7 (median 17.2) for POPDI-6. Conclusion A mean difference of 24 points in the PFDI-20 or 11 points in the POPDI-6 can be used as a clinically relevant difference between groups. Postoperative scores ≤ 60 for PFDI-20 and ≤ 17 for POPDI-6 signify acceptable symptom state.

scholarly journals Getting the measure of outcomes in clinical practice

2014 ◽  
Vol 20 (3) ◽  
pp. 165-171 ◽  
Author(s):  
Glyn Lewis ◽  
Helen Killaspy
Keyword(s):  
Outcome Measures ◽  
Outcome Measurement ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Quality Of Services ◽  
List Type ◽  
Regression To The Mean ◽  
Process Measures ◽  
Patient Reported

SummaryIt has been argued that the routine use of patient-reported outcome measures (PROMs) should be encouraged in order to improve the quality of services and even to determine payment. Clinician-rated outcome measures (CROMs), patient-reported experience measures (PREMs) and process measures also should be considered in evaluating healthcare quality. We discuss difficulties that the routine use of outcome measures might pose for psychiatric services. When outcome and experience measures are used to evaluate services they are difficult to interpret because of differences in case mix and regression to the mean. We conclude that PROMs and CROMs could be useful for monitoring the progress of individuals and that clinical audit still has an important role to play in improving the quality of services.LEARNING OBJECTIVESUnderstand the difference between process measurement and outcome measurement.Understand the limitation of using outcome measures to assess and promote quality of services.Understand the difficulties in assessing the psychometric properties and validity of outcome measures.

scholarly journals Minimal clinically important difference in idiopathic pulmonary fibrosis

Breathe ◽  
2021 ◽  
Vol 17 (2) ◽  
pp. 200345
Author(s):  
Mohleen Kang ◽  
Lucian Marts ◽  
Jordan A. Kempker ◽  
Srihari Veeraraghavan
Keyword(s):  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Outcome Measures ◽  
Minimal Clinically Important Difference ◽  
Pulmonary Function Tests ◽  
Threshold Value ◽  
Patient Reported Outcome Measures ◽  
List Type ◽  
Clinically Important Difference ◽  
Patient Reported

Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive fibrosing lung disease with an estimated median survival of 2–5 years and a significant impact on quality of life (QoL). Current approved medications, pirfenidone and nintedanib, have shown a reduction in annual decline of forced vital capacity but no impact on QoL. The minimal clinically important difference (MCID) is a threshold value for a change in a parameter that is considered meaningful by the patient rather than solely relying on statistically significant change in the parameter. This review provides a brief overview of the MCID methodology along with detailed discussion of reported MCID values for commonly used physiological measures and patient-reported outcome measures in IPF. While there is no gold standard methodology for determining MCID, there are certain limitations in the MCID literature in IPF, mainly the choice of death, hospitalisation and pulmonary function tests as sole anchors, and pervasive use of distribution-based methods which do not take into account the patient's input. There is a critical need to identify accurate thresholds of outcome measures that reflect patient's QoL over time in order to more precisely design and evaluate future clinical trials and to develop algorithms for patient-oriented management of IPF in outpatient clinics.Educational aimsTo understand the concept of MCID and the methods used to determine these values.To understand the indications and limitations of MCID values in IPF.

scholarly journals UNICORNS: Uveitis in childhood prospective national cohort study protocol

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 1196
Author(s):  
Salomey Kellett ◽  
Jugnoo S Rahi ◽  
Andrew D. Dick ◽  
Rachel Knowles ◽  
Valerija Tadić ◽  
...  
Keyword(s):  
Cohort Study ◽  
Structural Damage ◽  
Patient Reported Outcome Measures ◽  
Population Based ◽  
Term Outcome ◽  
Prospective Longitudinal Study ◽  
Long Term Outcome ◽  
Patient Reported ◽  
Prospective Longitudinal ◽  
The Impact

Background: Childhood uveitis is a rare inflammatory eye disease which is typically chronic, relapsing-remitting in nature, with an uncertain aetiology (idiopathic). Visual loss occurs due to structural damage caused by uncontrolled inflammation. Understanding of the determinants of long term outcome is lacking, including the predictors of therapeutic response or how to define disease control. Aims: To describe disease natural history and outcomes amongst a nationally representative group of children with non-infectious uveitis, describe the impact of disease course on quality of life for both child and family, and identify determinants of adverse visual, structural and developmental outcomes. Methods: UNICORNS is a prospective longitudinal multicentre cohort study of children newly diagnosed with uveitis about whom a core minimum clinical dataset will be collected systematically. Participants and their families will also complete patient-reported outcome measures annually from recruitment. The association of patient (child- and treatment- dependent) characteristics with outcome will be investigated using logistic and ordinal regression models which incorporate adjustment for within-child correspondence between eyes for those with bilateral disease and repeated outcomes measurement.  Discussion: Through this population based, prospective longitudinal study of childhood uveitis, we will describe the characteristics of childhood onset disease. Early (1-2 years following diagnosis) outcomes will be described in the first instance, and through the creation of a national inception cohort, longer term studies will be enabled of outcome for affected children and families.

National Implementation of an Electronic Patient Reported Outcome Measures Program for Joint Replacement Surgery (Preprint)

2021 ◽  
Author(s):  
Emma L. Heath ◽  
Ilana I. Ackerman ◽  
Michelle F. Lorimer ◽  
Sophia Rainbird ◽  
Grace O’Donohue ◽  
...  
Keyword(s):  
Data Collection ◽  
Outcome Measures ◽  
Joint Replacement ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Successful Implementation ◽  
Replacement Surgery ◽  
Patient Registration ◽  
National Implementation ◽  
Patient Reported

BACKGROUND There is a global emphasis on expanding data collection for joint replacement procedures beyond implant attributes and progression to revision surgery. Patient reported outcome measures (PROMs) are increasingly considered as an important measure of surgical outcomes from a patient’s perspective. However, a major limitation preventing wider use of PROMs data in national data collection has been the inability to systematically collect and share electronic information with relevant stakeholders in a comprehensive and financially sustainable manner. OBJECTIVE We aim to report on the development of an electronic data capture and reporting system by a national registry for the collection of PROMs and the processes used to identify and overcome barriers to implementation and uptake. We also aim to provide a cost breakdown of establishing and maintaining a nationwide electronic PROMs program. METHODS Between 2018 and 2020 three governance and advisory committees were established to develop and implement a PROMs pilot program nested within a nationwide joint replacement registry. The program involved electronic collection of pre- and 6-month post-operative data for hip, knee or shoulder replacement surgery from 44 Australian hospitals. Resource requirements for the program included a Project Manager, Software Developers, Data Manager and Statistician. An online platform was tested, refined, and implemented for electronic PROMs collection with scalability considered for future expansion to all Australian hospitals and additional data fields. Technical capabilities included different access for multiple user types, patient registration, automatic reminders via SMS and email, online consent and patient outcome real-time dashboards accessible for different user groups (surgeons, patients, hospitals and project stakeholders). RESULTS During the PROMs pilot period, there were 14,890 procedures registered in the electronic system. This equated to 60% of people who had a joint replacement at participating hospitals during this period. Patient registration and data collection were efficient (20-30 seconds and 10-12 minutes, respectively). Engagement with the reporting dashboards (proportion of those who viewed their dashboard) varied by user group: 197 (71.1%) hospital administrators, 68 (52.7%) project stakeholders, 177 (45.3%) surgeons and 1138 (12.9%). Cost analysis determined an overall cost per patient of AUD7 - AUD15 (approximately USD5 - USD12) for two PROMs collections per joint replacement procedure once the program was established. CONCLUSIONS Successful implementation of an orthopaedic PROMs program with planned scalability for a broader national rollout requires significant funding and staffing resources. However, this expenditure can be considered worthwhile, given that collection and reporting of PROMs can drive healthcare improvement processes. Further consideration of strategies to improve stakeholder engagement with electronic reporting dashboards (particularly for patients and surgeons) will be critical to the ongoing success of a national PROMs program.

scholarly journals A protocol for chronic pain outcome measurement enhancement by linking PROMIS-29 scale to legacy measures and improving chronic pain stratification

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Patricia M. Herman ◽  
Maria O. Edelen ◽  
Anthony Rodriguez ◽  
Lara G. Hilton ◽  
Ron D. Hays
Keyword(s):  
Chronic Pain ◽  
Data Collection ◽  
Relative Effectiveness ◽  
Advisory Council ◽  
Primary Data ◽  
Pool Data ◽  
Extensive Literature ◽  
List Type ◽  
Patient Reported ◽  
The Impact

Abstract Background Substantial investment has gone into research on the efficacy and effectiveness of pharmaceutical and nonpharmacologic interventions for chronic pain. However, synthesizing this extensive literature is challenging because of differences in the outcome measures used in studies of similar or competing interventions. The absence of a common metric makes it difficult to replicate findings, pool data from multiple studies, resolve conflicting conclusions, or reach consensus when interpreting findings. Methods This study has a seven-member Advisory Council of chronic pain experts. Preliminary analyses will be performed on data from several large existing datasets; intermediate analyses will be performed using primary data collected from Amazon’s Mechanical Turk (MTurk); and cross-validation will use primary data collected from a nationally-representative, probability-based panel. Target sample size for both primary datasets is 1500. The three study aims are as follows: Aim 1 will develop and evaluate links between the 29-item Patient-Reported Outcomes Measurement Information System (PROMIS®-29) and legacy measures used for chronic pain such as the Roland-Morris Disability Questionnaire (RMDQ) and the Oswestry Disability Index (ODI). We will assess the best method of score linking and create crosswalk tables. Aim 2 will evaluate and refine the Impact Stratification Score (ISS) based on 9 PROMIS-29 items and proposed by the NIH Research Task Force on chronic low back pain. We will evaluate the ISS in terms of other indicators of condition severity and patient prognosis and outcomes and identify cut-points to stratify chronic pain patients into subgroups. Aim 3 will evaluate the strengths and limitations of MTurk as a data collection platform for estimating chronic pain by comparing its data to other data sources. Discussion The accomplishment of Aims 1 and 2 will allow direct comparison of results across past and future studies of chronic pain. These comparisons will help us to understand different results from seemingly similar studies, and to determine the relative effectiveness of all pharmaceutical and nonpharmacologic interventions for chronic pain across different trials. Aim 3 findings will provide valuable information to researchers about the pros and cons of using the MTurk platform for research-based data collection. Trial registration ClinicalTrials.gov: NCT04426812; June 10, 2020.

scholarly journals Estimating VO2peak in 18-91 year-old adults: Development and Validation of the FitMáx© - Questionnaire

2021 ◽  
Author(s):  
Renske Meijer ◽  
Martijn van Hooff ◽  
Nicole E. Papen-Botterhuis ◽  
Charlotte J.L. Molenaar ◽  
Marta Regis ◽  
...  
Keyword(s):  
Cardiorespiratory Fitness ◽  
Specific Activity ◽  
Objective Assessment ◽  
Large Population ◽  
Cardiopulmonary Exercise Testing ◽  
Healthcare Providers ◽  
Patient Reported Outcome Measures ◽  
Stair Climbing ◽  
List Type ◽  
Patient Reported

AbstractObjectivesCardiorespiratory fitness plays an essential role in health outcomes and quality of life. Objective assessment of cardiorespiratory fitness is costly, labour intensive and not widely available. Although patient-reported outcome measures estimate cardiorespiratory fitness more cost-efficiently, the current questionnaires lack accuracy. The aim of this study is to develop and validate the FitMáx©-questionnaire, a self-reported questionnaire to estimate cardiorespiratory fitness in healthcare.MethodsWe developed the FitMáx©-questionnaire, consisting of three questions assessing walking, stair climbing, and cycling capacity. A comparison on estimating VO2peak was made with the Duke Activity Status Index (DASI), Veterans Specific Activity Questionnaire (VSAQ) and cardiopulmonary exercise testing as the gold standard. A total of 716 patients and athletes (520 men, 196 women) aged 18□91 performed a CPET in our hospital. We randomly selected 70% of the subjects to fit a linear regression model to estimate VO2peak based on the FitMáx© scores. The remaining 30% of participants was used for validation of this model.ResultsThe VO2peak estimated by the FitMáx© strongly correlates with the VO2peak measured objectively with CPET; r=0.95 (0.93□0.96) SEE=3.94 ml·kg-1·min-1. Bias between predicted and measured VO2peak was 0.32 ml·kg-1·min-1 and the 95% limits of agreement were −8.11 □ 9.40 ml·kg-1·min-1. In our sample, the FitMáx scored superiorly on correlation and SEE compared with those from the DASI and VSAQ, r=0.80 (0.73□0.86) SEE=4.22 ml·kg-1·min-1 and r=0.88 (0.84□0.91) SEE=6.61 ml·kg-1·min-1, respectively.ConclusionFitMáx© is a valid and accessible questionnaire to estimate cardiorespiratory fitness expressed as VO2peak and shows substantial improvement compared to currently used questionnaires.Key pointsFitMáx© relies on three simple single-answer questions, which are recognizable for a large population, to accurately estimate cardiorespiratory fitness.The FitMáx© is a self-reported instrument in which involvement of physicians, healthcare providers or other instrumentation is not necessary.Cardiorespiratory fitness estimated by the FitMáx© may serve as an easily applicable measure in clinical and non-clinical settings.

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