Prom120926

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Prom120926

  1. 1. The most important results: Patient-reported outcomes Evalill Nilsson, MD, PhD County Council of Östergötland evalill.nilsson@lio.se
  2. 2. What is PROM?• Patient-reported outcome measures (often questionnaires) – Disease symptoms – Functional ability – Patient satisfaction – Health-related quality of life, HRQoL • Generic (e.g. SF-36, EQ-5D) • Disease specific (e.g. SHS; 4 items: symptoms, function, worry, general wellbeing)
  3. 3. Outcome measures in SwedishNational Quality Registries (PROM bold type)• Survival• Complications• (Wound) Healing• Symptoms (profession-reported)• Symptoms (patient-reported)• Functional ability• Health-Related Quality of Life, HRQoL (generic & disease specific measures)• Patient satisfaction
  4. 4. Why use PROM?• Identifying and prioritising problems• Facilitating communication• Screening för hidden problems• Facilitating shared clinical decision-making• Monitoring changes or responses to treatments• Choosing between different treatments (clinical trials)• Health economics
  5. 5. PROM make sense, but do the they make a difference?• Researchers have been more interested in creating new questionnaires than in the theory behind why PROM should be suitable for the improvement of health care• Feedback Intervention Theory (FIT) – Health care professionals become more focused on the target (better health for their patients) when given new, earlier unknown data about their patients
  6. 6. Evidence for improved health/health care• Relations and communication between patients and health care professionals are improved – The most important issues are directly addressed – Showing an interest• Less evidence for improved health (so far) – Lower incidence of pain and depression (earlier detection?) – Discovering unknown symptoms in a patient group – Patients feel empowered (self-awarness)
  7. 7. Analysing the results• Consider the variation; comparing the before-and- after mean values may falsely show no differences (Pareto etc)• Significantly different may not = clinically different (MCID etc)• Sub group and casemix analyses are often necessary, especially regarding general HRQoL – Disease activity, comorbidity, sex, age, SES, social support, coping ability etc
  8. 8. References and websites• Visit promcenter.se• A list of references will be included with the ppp• Questions? Send me an email!
  9. 9. References and websites• Visit promcenter.se• A list of references will be included with the ppp• Questions? Send me an email!

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