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Critical Care (London, England) Nov 2013Outcomes research plays a key role in defining the effects of medical care in critical care. Last year Critical Care published a number of papers that evaluated... (Review)
Review
Outcomes research plays a key role in defining the effects of medical care in critical care. Last year Critical Care published a number of papers that evaluated patient-centered and policy-relevant outcomes. We present this review article focusing on key reported outcomes associated with severe community-acquired pneumonia, mortality associated with decisions regarding triage to the ICU, and both short-term and long-term mortality associated with ICU admissions. We further analyze the literature, assessing outcomes such as quality of life and the psychological burden associated with critical care. We also reviewed processes of care, and studies looking at cost analysis of treatment associated with critical care.
Topics: Community-Acquired Infections; Cost-Benefit Analysis; Critical Care; Critical Illness; Decision Making; Female; Hospital Mortality; Humans; Intensive Care Units; Light; Male; Outcome Assessment, Health Care; Patient Admission; Patient Discharge; Pneumonia; Quality of Life; Sex Distribution; Time Factors; Triage
PubMed: 24438819
DOI: 10.1186/cc12759 -
Oncology (Williston Park, N.Y.) Mar 1998Outcomes assessment describes a variety of activities, including classic clinical trials with quality of life and cost end points, observational studies examining the... (Review)
Review
Outcomes assessment describes a variety of activities, including classic clinical trials with quality of life and cost end points, observational studies examining the outcomes of treatment in the course of routine clinical care, and the process of managing patterns of care in clinical practice. These activities share important common features, including an emphasis on quality of life and economic outcomes, an explicit consideration of the importance of patient characteristics in determining outcomes, and a broad definition of what constitutes cancer care. The primary uses of outcomes data are to evaluate treatments and to assess the quality of care provided by physicians, health care institutions, and health insurance plans. Outcomes management integrates these activities through the implementation of guidelines, ideally based on empiric data on the relationship between medical interventions and outcomes; and the measurement of performance against a set of quality indicators derived from those guidelines. One of the biggest challenges facing clinicians today is how to reconcile the need to do what is best for patients with the need to practice cost-conscious medicine. High-quality outcomes data are at the heart of the solution. This presentation is a brief overview of outcomes research and management and its role in oncology practice.
Topics: Decision Making; Evaluation Studies as Topic; Health Personnel; Humans; Medical Oncology; Outcome Assessment, Health Care; Outcome and Process Assessment, Health Care; Professional Practice; Treatment Outcome
PubMed: 9556777
DOI: No ID Found -
Clinics in Plastic Surgery Apr 2008Outcomes research in hand surgery provides patients and providers with objective, reliable information to assist in making medical decisions. Endpoint measures in... (Review)
Review
Outcomes research in hand surgery provides patients and providers with objective, reliable information to assist in making medical decisions. Endpoint measures in outcomes research and the instruments used to evaluate these endpoints are often specific to a particular disease or region. Hand surgery has many different measurable outcomes that can be used to monitor the quality of surgical practice, inform practice guidelines, and aid in the appropriate allocation of healthcare resources. In this article, we review some research techniques available to study the following surgical outcomes of the hand: national trends in surgical care, surgical complications, objective measures of hand function, patient-reported measures of hand function, and economic burden.
Topics: Databases as Topic; Disability Evaluation; Hand; Hand Injuries; Health Services Research; Humans; Outcome Assessment, Health Care; Research Support as Topic
PubMed: 18298996
DOI: 10.1016/j.cps.2007.10.001 -
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 -
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... Jan 2006A critical evaluation of existing scientific evidence of treatment efficacy can be an important part of communicating risk and benefits of treatment options to patients... (Review)
Review
A critical evaluation of existing scientific evidence of treatment efficacy can be an important part of communicating risk and benefits of treatment options to patients during the course of clinical practice. A checklist of key methodological issues to examine when reading a research study is presented and discussed. Steps in reading a paper include: identifying the research question; identifying the manner in which subjects get enrolled in the study; identifying the treatments and outcomes used; identifying the study design and the comparisons being made; evaluating the study methods for the possibility of bias and uncontrolled confounding; assessing whether the statistical analysis used is appropriate for the study design; assessing whether the study has sufficient statistical power to demonstrate hypotheses being tested. Finally, procedures for grading and evaluating evidence, as used by systematic review groups and international best evidence synthesis consensus groups is briefly described.
Topics: Back Pain; Cohort Studies; Cross-Sectional Studies; Humans; Outcome Assessment, Health Care; Randomized Controlled Trials as Topic; Research Design; Review Literature as Topic; Statistics as Topic
PubMed: 16317562
DOI: 10.1007/s00586-005-1057-5 -
Value in Health : the Journal of the... Dec 2022Despite the increasing interest in applying machine learning (ML) methods in health economics and outcomes research (HEOR), stakeholders face uncertainties in when and... (Review)
Review
OBJECTIVES
Despite the increasing interest in applying machine learning (ML) methods in health economics and outcomes research (HEOR), stakeholders face uncertainties in when and how ML can be used. We reviewed the recent applications of ML in HEOR.
METHODS
We searched PubMed for studies published between January 2020 and March 2021 and randomly chose 20% of the identified studies for the sake of manageability. Studies that were in HEOR and applied an ML technique were included. Studies related to wearable devices were excluded. We abstracted information on the ML applications, data types, and ML methods and analyzed it using descriptive statistics.
RESULTS
We retrieved 805 articles, of which 161 (20%) were randomly chosen. Ninety-two of the random sample met the eligibility criteria. We found that ML was primarily used for predicting future events (86%) rather than current events (14%). The most common response variables were clinical events or disease incidence (42%) and treatment outcomes (22%). ML was less used to predict economic outcomes such as health resource utilization (16%) or costs (3%). Although electronic medical records (35%) were frequently used for model development, claims data were used less frequently (9%). Tree-based methods (eg, random forests and boosting) were the most commonly used ML methods (31%).
CONCLUSIONS
The use of ML techniques in HEOR is growing rapidly, but there remain opportunities to apply them to predict economic outcomes, especially using claims databases, which could inform the development of cost-effectiveness models.
Topics: Humans; Economics, Medical; Outcome Assessment, Health Care; Machine Learning; Cost-Benefit Analysis; Electronic Health Records
PubMed: 35989154
DOI: 10.1016/j.jval.2022.07.011 -
Value in Health : the Journal of the... Sep 2022This study aimed to review definitions of digital health and understand their relevance for health outcomes research. Four umbrella terms (digital health, electronic... (Review)
Review
OBJECTIVES
This study aimed to review definitions of digital health and understand their relevance for health outcomes research. Four umbrella terms (digital health, electronic health, mobile health, and telehealth/telemedicine) were summarized in this article.
METHODS
PubMed/MEDLINE, Embase, Cochrane Library, and EconLit were searched from January 2015 to May 2020 for systematic reviews containing key Medical Subject Headings terms for digital health (n = 38) and synonyms of "definition." Independent pairs of reviewers performed each stage of the review, with reconciliation by a third reviewer if required. A single reviewer consolidated each definition for consistency. We performed text analysis via word clouds and computed document frequency-and inverse corpus frequency scores.
RESULTS
The search retrieved 2610 records with 545 articles (20.9%) taken forward for full-text review. Of these, 39.3% (214 of 545) were eligible for data extraction, of which 134 full-text articles were retained for this analysis containing 142 unique definitions of umbrella terms (digital health [n = 4], electronic health [n = 36], mobile health [n = 50], and telehealth/telemedicine [n = 52]). Seminal definitions exist but have increasingly been adapted over time and new definitions were created. Nevertheless, the most characteristic words extracted from the definitions via the text analyses still showed considerable overlap between the 4 umbrella terms.
CONCLUSIONS
To focus evidence summaries for outcomes research purposes, umbrella terms should be accompanied by Medical Subject Headings terms reflecting population, intervention, comparator, outcome, timing, and setting. Ultimately a functional classification system is needed to create standardized terminology for digital health interventions denoting the domains of patient-level effects and outcomes.
Topics: Humans; Outcome Assessment, Health Care; Public Opinion; Systematic Reviews as Topic; Telemedicine; Text Messaging
PubMed: 36049797
DOI: 10.1016/j.jval.2022.04.1730 -
PharmacoEconomics Mar 2014
Topics: China; Decision Making; Evidence-Based Practice; Government Regulation; Health Care Reform; Health Services Research; Outcome Assessment, Health Care
PubMed: 24554475
DOI: 10.1007/s40273-014-0141-2 -
Academic Emergency Medicine : Official... Apr 2016The Patient-Centered Outcomes Research Institute (PCORI) was established by Congress in 2010 to promote the conduct of research that could better inform patients in...
The Patient-Centered Outcomes Research Institute (PCORI) was established by Congress in 2010 to promote the conduct of research that could better inform patients in making decisions that reflect their desired health outcomes. PCORI has established five national priorities for research around which specific funding opportunities are issued: 1) assessment of prevention, diagnosis, and treatment options; 2) improving healthcare systems; 3) communication and dissemination research; 4) addressing disparities; and 5) improving methods for conducting patient-centered outcomes research. To date, implementation of patient-centered research in the emergency care setting has been limited, in part because of perceived challenges in meeting PCORI priorities such as the need to focus on a specific disease state or to have planned follow up. We suggest that these same factors that have been seen as challenges to performing patient-centered research within the emergency setting are also potential strengths to be leveraged to conduct PCORI research. This paper explores factors unique to patient-centered emergency care research and highlights specific areas of potential alignment within each PCORI priority.
Topics: Decision Making; Emergency Service, Hospital; Healthcare Disparities; Humans; Information Dissemination; Outcome Assessment, Health Care; Patient Outcome Assessment; Patient-Centered Care; Quality Improvement; United States
PubMed: 26919027
DOI: 10.1111/acem.12944