Defining and Measuring a Standard Set of Patient-Relevant Outcomes in Coronary Artery Disease

Daeter, Edgar J.; Timmermans, Marijke J. C.; Hirsch, Alexander; Lipsic, Eric; Houterman, Saskia; Amoroso, Giovanni; Aydın, Seçkin; Bax, Matthijs; Boven, Wim Jan van; Brinckman, Stijn L.; Dambrink, Jan-Henk; Fuente, S. de la; Ent, Martin van der; Galema, Tjebbe W.; Haenen, Jo; Kraaijeveld, Adriaan O.; Magro, Michael; Noyez, Luc; Opstal, Jurren M. van; Rensing, Benno J.; Straten, Albert H.M. van; Umans, Victor; Vernooy, Kevin; Vos, Jeroen; Waterbolk, Tjalling W.; Rademaker, Philip C; Veghel, Dennis van; Nat, P. B. van der

doi:10.1016/j.amjcard.2018.02.037

Cited by 29 publications

(34 citation statements)

References 20 publications

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“…In about one third (n = 13, 29.5%) of the 44 articles analyzed, no reason was provided why the outcomes reported were considered to be relevant to patients (Table 4). However, in other studies we found different explanations justifying the selection of patient-relevant outcomes that refer mainly to three core issues: [14,26] or to both patients' and experts' opinion (n = 5) [11,12,18,19,21]. One study on early childhood disease included caregivers instead of patients [21], another one on critical disease included caregivers in addition to patients [13].…”

Section: Justificationmentioning

confidence: 89%

Patient-relevant outcomes: what are we talking about? A scoping review to improve conceptual clarity

Kersting

Kneer

Barzel

2020

BMC Health Serv Res

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Background: With respect to patient-centered care, measuring care effects based on patient-relevant outcomes is becoming increasingly important. There is some uncertainty about what outcomes are particularly relevant to patients and who determines their relevance. To determine this, we conducted a scoping review of the international literature with the aim to improve the conceptual clarity regarding (1) the terminology used for supposedly patient-relevant outcomes, (2) the variety of outcomes considered patient-relevant, and (3) justifications for the choice of these specific outcomes. Methods: We conducted a systematic search in Embase, PubMed (including Medline), Cochrane Central, Scopus, and Google Scholar with a special focus on article titles. Search terms included patient-relevant, patient-important, patient-preferred, and outcome(s), endpoint(s), parameter(s), indicator(s). We limited the search period from January 2000 to July 2019. Full-text articles reporting outcomes that were described as patient-relevant met the inclusion criteria. Two researchers independently analyzed all eligible articles applying quantitative and structuring content analysis. Results: We identified 155 articles, 44 of which met the inclusion criteria. A content analysis revealed 35 different terms used with regard to patient-relevant outcomes. However, authors predominantly referred to patientimportant outcomes (23 articles, 52.3%) and patient-relevant outcomes (17 articles, 38.6%). A structuring content analysis of all extracted outcomes revealed a total of 281 codes, pooled in 32 inductive categories. Among these, the following categories dominated: symptoms, adverse events/complications, survival/mortality, pain. In just 16 of the articles (36.4%), authors provided justifications for the choice of the outcome being based either on patient and/or expert opinions. In another 13 articles (29.5%), no justification was provided. Conclusion: This scoping review on patient-relevant outcomes was driven by the questions (1) what outcomes are particularly relevant to patients, and (2) who determines their relevance. We found a wide range of supposedly patientrelevant outcomes, with only one third of articles involving patients in the justification of the outcome selection. In view of this conceptual uncertainty it appears difficult to determine or even to compare a particular patient benefit of interventions. A set of generic outcomes relevant to patients would be helpful to contribute to a consistent understanding of patient relevance.

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Section: Justificationmentioning

confidence: 89%

Patient-relevant outcomes: what are we talking about? A scoping review to improve conceptual clarity

Kersting

Kneer

Barzel

2020

BMC Health Serv Res

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“…The set was developed by physicians, as there was a strong need for standardisation from the medical specialties. Annual maintenance cycles in order to evaluate the set should be considered important to continuously improve the set, as suggested by others 21. These cycles can be used to generate new scientific input to re-evaluate the outcome measures incorporated in the set.…”

Section: Discussionmentioning

confidence: 99%

First patient-centred set of outcomes for pulmonary sarcoidosis: a multicentre initiative

et al. 2019

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IntroductionRoutine and international comparison of clinical outcomes enabling identification of best practices for patients with pulmonary sarcoidosis is lacking. The aim of this study was to develop a standard set of outcome measures for pulmonary sarcoidosis, using the value-based healthcare principles.MethodsSix expert clinics for interstitial lung diseases in four countries participated in a consensus-driven RAND-modified Delphi study. A mixed-method approach was applied for the identification of an outcome measures set and initial conditions for patients with pulmonary sarcoidosis. The expert team consisted of multidisciplinary professionals (n=14) from Cleveland Clinic, Cincinnati MC, Erasmus MC, Leuven UZ, Royal Brompton and St. Antonius Hospital. During a ranking process, participants were instructed to rank variables on a scale from 1 to 10 based on whether it has (1) impact of the outcome on quality of life, (2) impact of quality of care on the outcome and (3) the number of patients negatively affected by the outcome.ResultsAn outcome measures set was defined consisting of seven outcome measures: mortality, pulmonary function, soluble interleukin-2 receptor change as an activity biomarker, weight gain, quality of life, osteoporosis and clinical outcome status.DiscussionCollecting outcomes in pulmonary sarcoidosis internationally and the use of a broadly accepted set can enable international comparison. Differences in outcomes can potentially be used as a starting point for quality improvement initiatives.

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“…This choice is based on previous research that has shown that all cardiac surgery-related mortalities were covered at 120 days post-surgery [16] whereas for PCI, risk of death seems to move from cardiac to non-cardiac after a period of 30 days post-PCI [17]. For all outcome measures, definitions and time periods as defined by Meetbaar Beter [18] are adopted in the present study.…”

Section: Clinical Outcomesmentioning

confidence: 99%

Improving clinical outcomes and patient satisfaction among patients with coronary artery disease: an example of enhancing regional integration between a cardiac centre and a referring hospital

Veghel

Hamad

Schulz

et al. 2020

BMC Health Serv Res

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Background: Value-based healthcare (VBHC) is a promising strategy to increase patient value. For a successful implementation of VBHC, intensive collaborations between organizations and integrated care delivery systems are key conditions. Our aim was to evaluate the effects of a pilot study regarding enhancing regional integration between a cardiac centre and a referring hospital on patient-relevant clinical outcomes and patient satisfaction. Methods:The study population consisted of a sample of patients treated for coronary artery disease by use of a coronary artery bypass graft (CABG) or a percutaneous coronary intervention between 2011 and 2016. Since 2013, the two hospitals have implemented different interventions to improve clinical outcomes and the degree of patient satisfaction, e.g. improvement of communication, increased consultant capacity, introduction of outpatient clinic for complex patients, and improved guideline adherence. To identify intervention effects, logistic regression analyses were conducted. Patients' initial conditions, like demographics and health status, were included in the model as predictors. Clinical data extracted from the electronic health records and the hospitals' cardiac databases as well as survey-based data were used. Results: Our findings indicate a non-significant increase of event-free survival of patients treated for coronary artery disease between 2014 and 2016 compared to patients treated between 2011 and 2013 (97.4% vs. 96.7% respectively). This non-significant improvement over time has led to significant better outcomes for patients referred from the study referring hospital compared to patients referred from other hospitals. The level of patient satisfaction (response rate 32.2%; 216 out of 669) was improved and reached statistically significant higher scores regarding patient information and education (p = .013), quality of care (p = .007), hospital admission and stay (p = .032), personal contact with the physician (p = .024), and total impression (p = .007).

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Defining and Measuring a Standard Set of Patient-Relevant Outcomes in Coronary Artery Disease

Cited by 29 publications

References 20 publications

Patient-relevant outcomes: what are we talking about? A scoping review to improve conceptual clarity

Patient-relevant outcomes: what are we talking about? A scoping review to improve conceptual clarity

First patient-centred set of outcomes for pulmonary sarcoidosis: a multicentre initiative

Improving clinical outcomes and patient satisfaction among patients with coronary artery disease: an example of enhancing regional integration between a cardiac centre and a referring hospital

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