Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK.
BMC Health Serv Res. 2012 Jun 21;12:171. doi: 10.1186/1472-6963-12-171.
Patient reported outcome measures (PROMs) are increasingly being used to compare the performance of health care providers. Our objectives were to determine the relative frequency of use of different metrics that can be derived from PROMs, explore clinicians' and patients' views of the options available, and make recommendations.
First a rapid review of the literature on metrics derived from two generic (EQ-5D and EQ-VAS) and three disease-specific (Oxford Hip Score; Oxford Knee Score; Aberdeen Varicose Vein Questionnaire) PROMs was conducted. Next, the findings of the literature review were mapped onto our typology of metrics to determine their relative frequency of use, Finally, seven group meetings with surgical clinicians (n = 107) and six focus groups with patients (n = 45) were held which were audio-taped, transcribed and analysed thematically.
Only nine studies (9.3% of included papers) used metrics for comparing providers. These were derived from using either the follow-up PROM score (n = 3) or the change in score as an outcome (n = 5), both adjusted for pre-intervention score. There were no recorded uses of the proportion reaching a specified ('good') threshold and only two studies used the proportion reaching a minimally important difference (MID).Surgical clinicians wanted multiple outcomes, with most support expressed for the mean change in score, perceiving it to be more interpretable; there was also some support for the MID. For patients it was apparent that rather than the science behind these measures, the most important aspects were the use of language that would make the metrics personally meaningful and linking the metric to a familiar scale.
For clinicians the recommended metrics are the mean change in score and the proportion achieving a MID, both adjusted for pre-intervention score. Both need to be clearly described and explained. For patients we recommend the proportion achieving a MID or proportion achieving a significant improvement in hip function, both adjusted for pre-intervention score.
患者报告的结果测量（PROM）越来越多地用于比较医疗保健提供者的绩效。我们的目标是确定可以从 PROM 中得出的不同指标的相对使用频率，探讨临床医生和患者对现有选项的看法，并提出建议。
首先对来自两种通用（EQ-5D 和 EQ-VAS）和三种疾病特异性（牛津髋关节评分；牛津膝关节评分；阿伯丁静脉曲张问卷）PROM 的指标的文献进行快速回顾。接下来，将文献综述的结果映射到我们的指标分类法中，以确定它们的相对使用频率。最后，与外科临床医生（n=107）进行了七次小组会议，并与患者（n=45）进行了六次焦点小组会议，这些会议进行了录音、转录并进行了主题分析。
只有九项研究（纳入文献的 9.3%）使用了比较提供者的指标。这些指标是通过使用随访 PROM 评分（n=3）或作为结果的评分变化（n=5）得出的，两者均根据干预前的评分进行了调整。没有记录到达到特定（“良好”）阈值的比例和只有两项研究使用了达到最小重要差异（MID）的比例。外科临床医生希望有多种结果，最支持的是平均评分变化，认为它更具可解释性；也有一些人支持 MID。对于患者，显然重要的不是这些措施背后的科学，而是使用能够使指标具有个人意义的语言，以及将指标与熟悉的量表联系起来。
对于临床医生，推荐的指标是调整了干预前评分的平均评分变化和达到 MID 的比例。两者都需要清楚地描述和解释。对于患者，我们建议调整了干预前评分的达到 MID 或达到髋关节功能显著改善的比例。
