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BMC Geriatrics Apr 2022Comprehensive geriatric assessment (CGA) addresses the bio-psycho-social needs of older adults through multidimensional assessments and management. Synthesising evidence...
Health outcomes and implementation barriers and facilitators of comprehensive geriatric assessment in community settings: a systematic integrative review [PROSPERO registration no.: CRD42021229953].
BACKGROUND
Comprehensive geriatric assessment (CGA) addresses the bio-psycho-social needs of older adults through multidimensional assessments and management. Synthesising evidence on quantitative health outcomes and implementation barriers and facilitators would inform practice and policy on CGA for community-dwelling older adults.
METHODS
We systematically searched four medical and social sciences electronic databases for quantitative, qualitative, and mixed methods studies published from 1 January 2000 to 31 October 2020. Due to heterogeneity of articles, we narratively reviewed the synthesis of evidence on health outcomes and implementation barriers and facilitators.
RESULTS
We screened 14,151 titles and abstracts and 203 full text articles, and included 43 selected articles. Study designs included controlled intervention studies (n = 31), pre-post studies without controls (n = 4), case-control (n = 1), qualitative methods (n = 3), and mixed methods (n = 4). A majority of articles studied populations aged ≥75 years (n = 18, 42%). CGAs were most frequently conducted in the home (n = 25, 58%) and primary care settings (n = 8, 19%). CGAs were conducted by nurses in most studies (n = 22, 51%). There was evidence of improved functional status (5 of 19 RCTs, 2 of 3 pre-post), frailty and fall outcomes (3 of 6 RCTs, 1 of 1 pre-post), mental health outcomes (3 of 6 RCTs, 2 of 2 pre-post), self-rated health (1 of 6 RCTs, 1 of 1 pre-post), and quality of life (4 of 17 RCTs, 3 of 3 pre-post). Barriers to implementation of CGAs involved a lack of partnership alignment and feedback, poor acceptance of preventive work, and challenges faced by providers in operationalising and optimising CGAs. The perceived benefits of CGA that served to facilitate its implementation included the use of highly skilled staff to provide holistic assessments and patient education, and the resultant improvements in care coordination and convenience to the patients, particularly where home-based assessments and management were performed.
CONCLUSION
There is mixed evidence on the quantitative health outcomes of CGA on community-dwelling older adults. While there is perceived positive value from CGA when carried out by highly skilled staff, barriers such as bringing providers into a partnership, greater acceptance of preventive care, and operational issues could impede its implementation.
Topics: Accidental Falls; Aged; Geriatric Assessment; Humans; Independent Living; Outcome Assessment, Health Care; Quality of Life
PubMed: 35488198
DOI: 10.1186/s12877-022-03024-4 -
BMC Palliative Care May 2017As in other areas of health delivery, there is a need to ensure that end-of-life care is guided by patient centred research. A systematic review was undertaken to... (Review)
Review
BACKGROUND
As in other areas of health delivery, there is a need to ensure that end-of-life care is guided by patient centred research. A systematic review was undertaken to examine the quantity and quality of data-based research aimed at improving the (a) processes and (b) outcomes associated with delivering end-of-life care in hospital settings.
METHODS
Medline, EMBASE and Cochrane databases were searched between 1995 and 2015 for data-based papers. Eligible papers were classified as descriptive, measurement or intervention studies. Intervention studies were categorised according to whether the primary aim was to improve: (a) end of life processes (i.e. end-of-life documentation and discussions, referrals); or (b) end-of-life outcomes (i.e. perceived quality of life, health status, health care use, costs). Intervention studies were assessed against the Effective Practice and Organisation of Care methodological criteria for research design, and their effectiveness examined.
RESULTS
A total of 416 papers met eligibility criteria. The number increased by 13% each year (p < 0.001). Most studies were descriptive (n = 351, 85%), with fewer measurement (n = 17) and intervention studies (n = 48; 10%). Only 18 intervention studies (4%) met EPOC design criteria. Most reported benefits for end-of-life processes including end-of-life discussions and documentation (9/11). Impact on end-of-life outcomes was mixed, with some benefit for psychosocial distress, satisfaction and concordance in care (3/7).
CONCLUSION
More methodologically robust studies are needed to evaluate the impact of interventions on end-of-life processes, including whether changes in processes translate to improved end-of-life outcomes. Interventions which target both the patient and substitute decision maker in an effort to achieve these changes would be beneficial.
Topics: Humans; Outcome Assessment, Health Care; Program Evaluation; Quality of Health Care; Research; Terminal Care
PubMed: 28526095
DOI: 10.1186/s12904-017-0204-1 -
European Spine Journal : Official... Apr 2023Adolescent idiopathic scoliosis (AIS) is the most common type of scoliosis that affects children aged 10-18 years old, manifesting in a three-dimensional spinal... (Review)
Review
PURPOSE
Adolescent idiopathic scoliosis (AIS) is the most common type of scoliosis that affects children aged 10-18 years old, manifesting in a three-dimensional spinal deformity. This study aimed to explore outcome measures used in defining AIS treatment success. Particularly, analyzing the extent of qualitative and quantitative (radiographic and quality of life domains) measures to evaluate AIS and whether AIS treatment approaches (surgical, bracing and physiotherapy) influences outcomes used as proxies of treatment success.
METHODS
EMBASE and MEDLINE databases were used to conduct a systematic scoping review with 654 search queries. 158 papers met the inclusion criteria and were screened for data extraction. Extractable variables included: study characteristics, study participant characteristics, type of study, type of intervention approach and outcome measures.
RESULTS
All 158 studies measured quantitative outcomes. 61.38% of papers used radiographic outcomes whilst 38.62% of papers used quantitative quality of life outcomes to evaluate treatment success. Irrespective of treatment intervention utilized, the type of quantitative outcome measure recorded were similar in proportion. Moreover, of the radiographic outcome measures, the subcategory Cobb angle was predominantly used across all intervention approaches. For quantitative quality of life measures, questionnaires investigating multiple domains such as SRS were primarily used as proxies of AIS treatment success across all intervention approaches.
CONCLUSION
This study identified that no articles employed qualitative measures of describing the psychosocial implications of AIS in defining treatment success. Although quantitative measures have merit in clinical diagnoses and management, there is increasing value in using qualitative methods such as thematic analysis in guiding clinicians to develop a biopsychosocial approach for patient care.
Topics: Child; Humans; Adolescent; Scoliosis; Quality of Life; Treatment Outcome; Outcome Assessment, Health Care; Research Design
PubMed: 36847911
DOI: 10.1007/s00586-023-07592-w -
European Urology Oct 2023In the oncology setting, patient-reported outcome measures (PROMs) provide important data that help to ensure patient-relevant endpoints are captured and reported. Use... (Review)
Review
CONTEXT
In the oncology setting, patient-reported outcome measures (PROMs) provide important data that help to ensure patient-relevant endpoints are captured and reported. Use of this information for treatment decision-making by clinicians and patients in real-world settings is facilitated by consistent and transparent reporting of trial methods.
OBJECTIVE
To identify and compare PROMs used in advanced renal cell carcinoma (RCC) trials in terms of the rationale for the choice of measure, endpoint hierarchy (primary, secondary, exploratory), assessment time points, statistical methods, and statistical metrics for interpretation.
EVIDENCE ACQUISITION
A systematic literature review via searches of four online databases (2016-2021) and recent conference abstracts (2019-2021) identified 2616 articles, of which 33 were included in the review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
EVIDENCE SYNTHESIS
Among the 33 clinical studies included, 19 different PROMs were identified: three kidney cancer-specific scales, two cancer-specific scales, two generic scales, and 12 symptom-specific scales. The endpoint hierarchy for patient reported outcome (PRO) assessment was reported in 42% of the studies; one study included PROs as a primary endpoint. Reporting of time points, minimal important differences, and statistical analyses was highly heterogeneous.
CONCLUSIONS
A diverse range of PROMs have been included in clinical studies for patients with advanced/metastatic RCC. Prespecified analyses for PRO assessments were generally not stated, while analytical methods and reporting varied. An improvement in alignment across studies would better inform regulatory, market-access, reimbursement, and clinical decision-making to improve patient care.
PATIENT SUMMARY
We reviewed how the impact of cancer therapies on health outcomes from the patient's point of view is being measured in clinical trials for kidney cancer. The techniques and reporting varied across trials. Standardisation of how these data are captured and reported may improve care and decision-making for patients with kidney cancer.
Topics: Humans; Carcinoma, Renal Cell; Patient Reported Outcome Measures; Kidney Neoplasms; Patient Outcome Assessment; Research Design
PubMed: 37550153
DOI: 10.1016/j.eururo.2023.07.006 -
Veterinary Surgery : VS May 2016To record and categorize the outcome measures used in dogs with naturally occurring osteoarthritis (OA) by systematically reviewing the peer reviewed publications on OA... (Review)
Review
OBJECTIVE
To record and categorize the outcome measures used in dogs with naturally occurring osteoarthritis (OA) by systematically reviewing the peer reviewed publications on OA in dogs.
STUDY DESIGN
Systematic literature review.
STUDY POPULATION
Peer reviewed literature on canine OA.
METHODS
A computer-based bibliographic search was performed on PubMed and CAB Abstracts in August 2013 to find peer reviewed publications relevant to canine OA. Inclusion and exclusion criteria were applied. The outcome measures reported within each publication were recorded and categorized for comparison. Adequately described outcome measures were assessed for uniqueness and evidence of prior validation.
RESULTS
Of 3,697 publications identified and screened, 117 were deemed eligible for inclusion. Within eligible publications, outcome measures were used 618 times (median of 4 outcome measures per publication). Outcomes measured were divided into 5 groups containing 65 categories. The most frequently assessed outcomes were lameness assessment with no stated gait/mixed gaits (66 outcomes), radiography (58), and lameness single gait/lateral motion (55). Of 618 outcome measures reported, 491 were assessed for uniqueness and 348 (71%) were unique to a single publication. Ten outcome measures were reported to have been validated.
CONCLUSION
Many outcome measures have been used to assess canine OA. There is no consensus on which are the most useful outcomes or by which method they should be assessed. There is a pressing need for agreement on outcomes reporting in canine OA and for validation of outcome measures used for these assessments. Until consensus is reached, we recommend at least one validated outcome measure be used in every clinical study.
Topics: Animals; Dog Diseases; Dogs; Gait; Lameness, Animal; Osteoarthritis; Outcome Assessment, Health Care
PubMed: 27120270
DOI: 10.1111/vsu.12479 -
The Journal of Surgical Research Sep 2018Small bowel obstruction (SBO) is a condition which is commonly treated by general surgeons. The evidence base for treatment of this condition is limited in part by...
BACKGROUND
Small bowel obstruction (SBO) is a condition which is commonly treated by general surgeons. The evidence base for treatment of this condition is limited in part by variable reporting of outcomes in the literature. The aim of this study was to identify commonly used outcomes in research on SBO.
METHODS
This review was reported in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered with PROSPERO (CRD42017065538). Searches were performed of MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases to identify prospective cohort or randomized trials reporting outcomes of interventions in SBO. Studies addressing diagnostics, pediatric populations, and SBO due to malignancy were excluded. Studies were screened for inclusion. Study and outcome characteristics were extracted into a -predesigned pro forma and mapped onto the Outcome Measures in Rheumatology (OMERACT) framework.
RESULTS
A total of 1222 studies were screened for eligibility, 74 full text articles retrieved, and 51 studies included for synthesis. A total of 50 different outcomes were used. Duration of hospital stay was the most frequently reported outcome (n = 21 studies). Resolution of SBO was reported in 12 studies but only defined in eight studies which used six different definitions. Patient-reported outcomes were reported in only four studies.
CONCLUSIONS
There is a high degree of variation in the outcomes reported in SBO research. There is a clear need for a core outcome set. Development of a patient-reported outcome measure for this condition should also be explored.
Topics: Digestive System Surgical Procedures; Humans; Intestinal Obstruction; Intestine, Small; Length of Stay; Outcome Assessment, Health Care; Postoperative Complications; Time Factors; Treatment Outcome
PubMed: 29937015
DOI: 10.1016/j.jss.2018.03.044 -
Journal of Pediatric Surgery Aug 2016Core outcome sets (COS) facilitate clinical research by providing an agreed set of outcomes to be measured when evaluating treatment efficacy. Gastroschisis is... (Review)
Review
BACKGROUND
Core outcome sets (COS) facilitate clinical research by providing an agreed set of outcomes to be measured when evaluating treatment efficacy. Gastroschisis is increasing in frequency and evidence-based treatments are lacking. We aimed to identify initial candidate outcomes for a gastroschisis COS from existing literature.
METHODS
Using a sensitive search strategy we identified randomized controlled trials (RCTs) and systematic reviews (SRs) of treatment interventions for gastroschisis. Outcomes were extracted and assigned to the core areas, 'Pathophysiological Manifestations', 'Life Impact', 'Resource Use', 'Adverse Events' and 'Mortality'.
RESULTS
A total of 50 outcomes were identified. RCTs reported 6-9 outcomes each; SRs reported 9-25. The most frequently reported outcomes were 'Length of hospital stay' (reported in 8 studies), 'Duration of ventilation' and 'Time to full enteral feeds' (7 studies). Outcomes identified could be assigned to all five core areas.
CONCLUSIONS
There is wide heterogeneity in outcomes reported in studies evaluating treatment interventions for gastroschisis. It is unclear which outcomes are of highest importance across stakeholder groups. Developing a COS to standardize outcome measurement and reporting for gastroschisis is warranted.
Topics: Gastroschisis; Humans; Outcome Assessment, Health Care; Randomized Controlled Trials as Topic; Review Literature as Topic
PubMed: 27312236
DOI: 10.1016/j.jpedsurg.2016.05.008 -
Developmental Medicine and Child... Feb 2020To develop a core outcome set (COS) for evaluating gastrostomy/gastrojejunostomy tube impact in children with neurological impairment.
AIM
To develop a core outcome set (COS) for evaluating gastrostomy/gastrojejunostomy tube impact in children with neurological impairment.
METHOD
Healthcare providers/researchers and caregivers rated the importance of candidate outcomes on a 5-point Likert scale. Outcomes rated 'somewhat important' or 'very important' by most (≥85%) respondents were voted on during a consensus meeting. Outcomes that reached consensus for inclusion were ratified and assigned to Outcome Measures in Rheumatology filter core areas. The COS was validated in a separate group of caregivers.
RESULTS
Twelve outcomes were selected from 120 candidate outcomes to form the COS. These included five 'Life Impact' outcomes, three 'Pathophysiological Manifestations' outcomes, two 'Resource Use' outcomes, one 'Growth and Development' outcome, and one 'Death' outcome.
INTERPRETATION
We developed an evidence-informed and consensus-based COS for use in studies of gastrostomy/gastrojejunostomy tube feeding in children with neurological impairment. Implementation of this COS will help reduce heterogeneity between studies and facilitate evidence-based decision-making.
WHAT THE PAPER ADDS
Caregivers, healthcare providers, and researchers ranked the importance of 120 outcomes. Twelve core outcomes were identified as essential to measure in future clinical research studies.
Topics: Adolescent; Child; Clinical Studies as Topic; Enteral Nutrition; Gastrostomy; Humans; Jejunostomy; Nervous System Diseases; Outcome Assessment, Health Care; Primary Health Care
PubMed: 31372989
DOI: 10.1111/dmcn.14326 -
International Journal For Quality in... Jun 2018To examine whether attachment styles of healthcare workers influence the quality of their relationships with patients, or impact patients' health outcomes. (Review)
Review
PURPOSE
To examine whether attachment styles of healthcare workers influence the quality of their relationships with patients, or impact patients' health outcomes.
DATA SOURCE
Literature database searches on the CINAHL, Cochrane Library, Embase, MEDLINE and PsyCinfo, and hand searching of reference lists of the retained articles.
STUDY SELECTION
Original empirical studies reporting an analysis of the relationship of interest were selected for review.
DATA EXTRACTION
Estimates of association between healthcare workers' attachment style and patients' health outcomes were extracted.
RESULTS OF DATA SYNTHESIS
Results from 13 studies were mixed in terms of which attachment styles related to patients' perceptions of care or health outcomes, and the evidence overall was of poor quality and methodologically heterogeneous. However, there is limited evidence that secure attachment styles of healthcare workers have little or a negative effect on patients' health outcomes or perceptions in the short term but in the long term have a more positive effect. Conversely, insecure styles tend to have a positive effect in the short term but little or a negative effect on long-term relationships. Studies which used self-report attachment measurements tended to report stronger associations with patients' outcome measurements than studies using the interviewer rated Adult Attachment Interview.
CONCLUSION
It is unclear whether or not there is a relationship between attachment style of health workers and patients' health outcomes. Further research using consistent data collection tools, especially in relation to the attachment measurement construct selected, and analysis methods across studies is required to draw recommendations for clinical practice.
Topics: Adult; Health Personnel; Humans; Object Attachment; Outcome Assessment, Health Care; Patient Outcome Assessment; Professional-Patient Relations
PubMed: 29917160
DOI: 10.1093/intqhc/mzy034 -
Value in Health : the Journal of the... Jun 2020Although comorbidities play an essential role in risk adjustment and outcomes measurement, there is little consensus regarding the best source of this data. The aim of...
OBJECTIVES
Although comorbidities play an essential role in risk adjustment and outcomes measurement, there is little consensus regarding the best source of this data. The aim of this study was to identify general patient-reported morbidity instruments and their measurement properties.
METHODS
A systematic review was conducted using multiple electronic databases (Embase, Medline, Cochrane Central, and Web of Science) from inception to March 2018. Articles focusing primarily on the development or subsequent validation of a patient-reported morbidity instrument were included. After including relevant articles, the measurement properties of each morbidity instrument were extracted by 2 investigators for narrative synthesis.
RESULTS
A total of 1005 articles were screened, of which 34 eligible articles were ultimately included. The most widely assessed instruments were the Self-Reported Charlson Comorbidity Index (n = 7), the Self-Administered Comorbidity Questionnaire (n = 3), and the Disease Burden Morbidity Assessment (n = 3). The most commonly included conditions were diabetes, hypertension, and myocardial infarction. Studies demonstrated substantial variability in item-level reliability versus the gold standard medical record review (κ range 0.66-0.86), meaning that the accuracy of the self-reported comorbidity data is dependent on the selected morbidity.
CONCLUSIONS
The Self-Reported Charlson Comorbidity Index and the Self-Administered Comorbidity Questionnaire were the most frequently cited instruments. Significant variability was observed in reliability per comorbid condition of patient-reported morbidity questionnaires. Further research is needed to determine whether patient-reported morbidity data should be used to bolster medical records data or serve as a stand-alone entity when risk adjusting observational outcomes data.
Topics: Comorbidity; Humans; Morbidity; Outcome Assessment, Health Care; Patient Reported Outcome Measures; Reproducibility of Results; Risk Adjustment; Surveys and Questionnaires
PubMed: 32540238
DOI: 10.1016/j.jval.2020.02.006