-
Health Services Research Apr 2017To learn how minority and underserved communities would set priorities for patient-centered outcomes research (PCOR).
OBJECTIVE
To learn how minority and underserved communities would set priorities for patient-centered outcomes research (PCOR).
DATA SOURCES
Sixteen groups (n = 183) from minority and underserved communities in two states deliberated about PCOR priorities using the simulation exercise CHoosing All Together (CHAT). Most participants were minority, one-third reported income <$10,000, and one-fourth reported fair/poor health.
DESIGN
Academic-community partnerships adapted CHAT for PCOR priority setting using existing research agendas and interviews with community leaders, clinicians, and key informants.
DATA COLLECTION
Tablet-based CHAT collected demographic information, individual priorities before and after group deliberation, and groups' priorities.
PRINCIPAL FINDINGS
Individuals and groups prioritized research on Quality of Life, Patient-Doctor, Access, Special Needs, and (by total resources spent) Compare Approaches. Those with less than a high school education were less likely to prioritize New Approaches, Patient-Doctor, Quality of Life, and Families/Caregivers. Blacks were less likely to prioritize research on Causes of Disease, New Approaches, and Compare Approaches than whites. Compare Approaches, Special Needs, Access, and Families/Caregivers were significantly more likely to be selected by individuals after compared to before deliberation.
CONCLUSIONS
Members of underserved communities, in informed deliberations, prioritized research on Quality of Life, Patient-Doctor, Special Needs, Access, and Compare Approaches.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Attitude to Health; Female; Focus Groups; Health Services Accessibility; Health Services Needs and Demand; Health Services Research; Humans; Interviews as Topic; Male; Middle Aged; Minority Groups; Outcome Assessment, Health Care; Patient-Centered Care; Physician-Patient Relations; Quality of Life; Research; Vulnerable Populations; Young Adult
PubMed: 27206519
DOI: 10.1111/1475-6773.12505 -
Advanced Data Visualisation in Health Economics and Outcomes Research: Opportunities and Challenges.Applied Health Economics and Health... Aug 2019Data visualisation techniques are valuable tools for exploring, synthesising and communicating the results of research studies. Advanced data visualisation techniques,...
Data visualisation techniques are valuable tools for exploring, synthesising and communicating the results of research studies. Advanced data visualisation techniques, including dynamic and interactive visualisations, are just beginning to be used in health economics and outcome research (HEOR). In HEOR, there is the potential to use these techniques both to explore methodological challenges that are central to the design and interpretation of the findings of pharmacoeconomic and outcomes research studies, but also to communicate research findings to various stakeholders. In this manuscript, we discuss opportunities and methodological challenges for data visualisation specific to HEOR, describe external barriers that may impact the use of data visualisation methods, and discuss future applications of this technology in HEOR. While there are a number of obvious applications within the data-heavy field of HEOR, caution is required to ensure that visualisations, particularly advanced ones, accurately and fairly reflect the underlying data. However, researchers will benefit from adopting these increasingly sophisticated techniques to help ensure that decisionmakers and other stakeholders can understand, digest and communicate the data-which is critical for achieving the ultimate goal of improving patient outcomes.
Topics: Data Visualization; Economics, Medical; Outcome Assessment, Health Care
PubMed: 31054095
DOI: 10.1007/s40258-019-00476-5 -
American Journal of Health-system... May 2021Health-system specialty pharmacies (HSSPs) provide high-quality, efficient, and collaborative care to patients receiving specialty therapy. Despite proven benefits of...
PURPOSE
Health-system specialty pharmacies (HSSPs) provide high-quality, efficient, and collaborative care to patients receiving specialty therapy. Despite proven benefits of the integrated model, manufacturer and payer restrictions challenge the viability and utility of HSSPs. Vanderbilt Specialty Pharmacy developed a health outcomes and research program to measure and communicate the value of this model, drive improvement in patient care delivery, and advocate for recognition of HSSP pharmacists' role in patient care. The purpose of this descriptive report is to describe the development and results of this program.
SUMMARY
The health outcomes and research program began as an initiative for pharmacists to evaluate and convey the benefits they provide to patients, providers, and the health system. Early outcomes data proved useful in communicating the value of an integrated model to key stakeholders and highlighted the need to further develop research efforts. The department leadership invested resources to build a research program with dedicated personnel, engaged research experts to train pharmacists, and fostered internal and external collaborations to facilitate research efforts. As of March 2021, the health outcomes and research program team has published 33 peer-reviewed manuscripts, presented 88 posters and 7 podium presentations at national conferences, and received 4 monetary research awards. Further, the program team engages other HSSP teams to initiate and expand their own health outcomes research in an effort to empower all HSSPs in demonstrating their value.
CONCLUSIONS
The health outcomes and research program described has pioneered outcomes research among HSSPs nationwide and has proven valuable to specialty pharmacists, the health system, and key specialty pharmacy stakeholders.
Topics: Humans; Outcome Assessment, Health Care; Pharmaceutical Services; Pharmacies; Pharmacists; Pharmacy
PubMed: 33693451
DOI: 10.1093/ajhp/zxab082 -
Depression and Anxiety Jun 2018Socioeconomic deprivation is associated with higher prevalence of mental health problems; however, the influence of socioeconomic status (SES) on psychological therapy... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Socioeconomic deprivation is associated with higher prevalence of mental health problems; however, the influence of socioeconomic status (SES) on psychological therapy outcomes is as yet unclear.
AIM
To review published evidence on the association between indicators of SES (income, education, employment, neighborhood deprivation, social position) and the outcomes of psychological interventions for depression and anxiety.
METHODS
Systematic review and meta-analysis of outcomes research studies published in the last 10 years.
RESULTS
Seventeen studies including 165,574 patients measured at least one indicator of SES and its relationship with psychological therapy outcomes. Twelve of these studies found significant relationships between SES measures and mental health outcomes. Six studies focusing on employment status offered sufficient quantitative information to conduct meta-analysis. The overall effect of employment was not significant (-0.66, confidence of interval (CI) -1.33, 0.02). A sensitivity analysis (k = 5) showed a small effect (-0.22, CI -0.36, -0.09) of employment on treatment outcomes.
CONCLUSIONS
There is some evidence to indicate that socioeconomic deprivation is associated with poorer treatment outcomes, although limitations of the available data warrant treating this as a preliminary conclusion.
Topics: Anxiety Disorders; Depressive Disorder; Educational Status; Employment; Humans; Income; Outcome Assessment, Health Care; Psychotherapy; Social Class
PubMed: 29697880
DOI: 10.1002/da.22765 -
Cancer Investigation 2018To ascertain how change in upper body lymphedema is assessed and understand how clinically significant change is determined. (Review)
Review
PURPOSE
To ascertain how change in upper body lymphedema is assessed and understand how clinically significant change is determined.
METHOD
A systematic search of the literature resulted in 55 eligible studies for analysis.
RESULTS
A range of assessment methods, measurement protocols, and outcomes were used in the literature. Of the 21 studies in which thresholds for change were set a priori, 20 different thresholds were reported.
CONCLUSION
How data was measured, analysed and reported was inconsistent across studies. Consensus on a core outcome set with standardised assessment protocols and reporting; and investigation into empirically based minimum important differences (MID) is needed.
Topics: Diagnostic Self Evaluation; Humans; Lymphedema; Outcome Assessment, Health Care; Quality of Life; Randomized Controlled Trials as Topic; Upper Extremity
PubMed: 30289283
DOI: 10.1080/07357907.2018.1517362 -
Nature Reviews. Clinical Oncology May 2019Surgery remains a mainstay in the treatment of most solid cancers. Surgeons have always engaged in various forms of high-quality cancer research to optimize outcomes for... (Review)
Review
Surgery remains a mainstay in the treatment of most solid cancers. Surgeons have always engaged in various forms of high-quality cancer research to optimize outcomes for their patients, for example, contributing to clinical research and outcomes research as well as health education and public health policy. Over the past decade, however, concerns have been raised about a global decline in the number of surgeons performing basic science research alongside clinical activity - so-called surgeon scientists. Herein, we describe some of the unique obstacles faced by contemporary trainee and practising surgeons engaged in research, as well as providing a perspective on the implications of the diminishing prominence of the surgeon scientist. Finally, we offer some thoughts on potential strategies and future directions for surgical engagement in oncology research to increase the number of research-active surgeons.
Topics: Biomedical Research; Clinical Competence; Cost of Illness; Health Education; Humans; Medical Oncology; Neoplasms; Outcome Assessment, Health Care; Public Health; Surgeons
PubMed: 30617343
DOI: 10.1038/s41571-018-0149-1 -
Chest Nov 2020
Topics: Aged; Humans; Outcome Assessment, Health Care; Patient-Centered Care; Retrospective Studies; Sepsis
PubMed: 33160521
DOI: 10.1016/j.chest.2020.07.049 -
PharmacoEconomics Dec 2023Missing data in costs and/or health outcomes and in confounding variables can create bias in the inference of health economics and outcomes research studies, which in...
BACKGROUND
Missing data in costs and/or health outcomes and in confounding variables can create bias in the inference of health economics and outcomes research studies, which in turn can lead to inappropriate policies. Most of the literature focuses on handling missing data in randomized controlled trials, which are not necessarily always the data used in health economics and outcomes research.
OBJECTIVES
We aimed to provide an overview on missing data issues and how to address incomplete data and report the findings of a systematic literature review of methods used to deal with missing data in health economics and outcomes research studies that focused on cost, utility, and patient-reported outcomes.
METHODS
A systematic search of papers published in English language until the end of the year 2020 was carried out in PubMed. Studies using statistical methods to handle missing data for analyses of cost, utility, or patient-reported outcome data were included, as were reviews and guidance papers on handling missing data for those outcomes. The data extraction was conducted with a focus on the context of the study, the type of missing data, and the methods used to tackle missing data.
RESULTS
From 1433 identified records, 40 papers were included. Thirteen studies were economic evaluations. Thirty studies used multiple imputation with 17 studies using multiple imputation by chained equation, while 15 studies used a complete-case analysis. Seventeen studies addressed missing cost data and 23 studies dealt with missing outcome data. Eleven studies reported a single method while 20 studies used multiple methods to address missing data.
CONCLUSIONS
Several health economics and outcomes research studies did not offer a justification of their approach of handling missing data and some used only a single method without a sensitivity analysis. This systematic literature review highlights the importance of considering the missingness mechanism and including sensitivity analyses when planning, analyzing, and reporting health economics and outcomes research studies.
Topics: Humans; Data Interpretation, Statistical; Bias; Research Design; Cost-Benefit Analysis; Outcome Assessment, Health Care
PubMed: 37490207
DOI: 10.1007/s40273-023-01297-0 -
Journal of Evidence-based Medicine May 2018To systematically review the comparative effectiveness of patient education strategies in cataract surgery. (Review)
Review
OBJECTIVE
To systematically review the comparative effectiveness of patient education strategies in cataract surgery.
METHODS
A comprehensive literature search of five electronic databases was conducted for randomized controlled trials (RCTs) studying the efficacy of educational interventions for cataract surgery patients. Peer-reviewed articles published in English were considered for inclusion without restriction limits on publication date. General study characteristics, measurement methodologies, and outcome measures were narratively synthesized. Quality appraisal was conducted using the Oxford quality rating system (for individual studies) and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) guidelines (for bodies of evidence).
RESULTS
Sixteen RCTs were compiled for qualitative review. We identified 21 distinct patient outcomes, four (19%) with a multi-study evidence base: knowledge of cataracts/cataract surgery, knowledge of postoperative care, proficiency in postoperative care, and anxiety. Targeted interventions significantly increased educational efficacy in 11 (69%) studies, but there were consistent improvements only for patient understanding of cataracts/cataract surgery and postoperative care. Quality of evidence was poor for all outcomes examined in multiple studies, as well as for deciding to undergo cataract surgery (measured in one study). Cross-study examination revealed appreciable clinical and methodological heterogeneity.
CONCLUSIONS
Targeted interventions fostered patients' understanding of cataract surgery and postoperative care. Additional high-quality studies are needed to determine appropriate educational strategies that improve other clinical, performance, and humanistic outcomes.
Topics: Cataract Extraction; Humans; Outcome Assessment, Health Care; Patient Education as Topic; Randomized Controlled Trials as Topic
PubMed: 29878582
DOI: 10.1111/jebm.12297 -
Pediatric Clinics of North America Oct 2017The focus of critical care has evolved from saving lives to preservation of function. Morbidity rates in pediatric critical care are approximately double mortality... (Review)
Review
The focus of critical care has evolved from saving lives to preservation of function. Morbidity rates in pediatric critical care are approximately double mortality rates. Morbidity includes complications of disease and medical care. In pediatric critical care, functional status morbidity is an intermediate outcome in the progression toward death and is the result of the same factors associated with mortality, including physiologic profiles and case-mix factors. The Functional Status Scale developed by Collaborative Pediatric Critical Care Research Network is a validated, granular, age-independent measure of functional status that has proved valuable and practical even in large outcome studies.
Topics: Child; Critical Care; Critical Illness; Health Status Indicators; Humans; Morbidity; Outcome Assessment, Health Care; Pediatrics; Quality of Life; Risk Assessment
PubMed: 28941541
DOI: 10.1016/j.pcl.2017.06.011