Santana Maria-Jose, Feeny David
W21C Research and Innovation Centre, Faculty of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada,
Qual Life Res. 2014 Jun;23(5):1505-13. doi: 10.1007/s11136-013-0596-1. Epub 2013 Dec 7.
The inclusion of patient-reported outcome measures (PROMs) in the routine clinical care of chronically ill patients has the potential to add valuable information about the impact of the disease and its treatment and promotes effective patient self-management in which patients become more active participants in their own care. PROMs provide clinicians with timely information on patients' symptoms as well as functional and emotional status. PROMs are a useful tool for enhancing patient-clinician communication.
We develop a conceptual framework describing the potential effects of the use of PROMs in chronic care management. The framework summarizes insights from the methods for evaluating the clinical effectiveness and methods for the health technology assessment of diagnostic technologies and results from the relevant studies.
The framework describes potential effects, from proximal to distal, including communication (patient-clinician, patient-relative, clinician-clinician, and clinician-relative), engaging patients in shared clinical decision making, patient management (clinician management and patient self-management), and patient outcomes. Important potential effects also include enhancement in patient activation as well as improvements in clinician and patient satisfaction, and patient adherence to recommended treatment. Previous frameworks have described patient-physician communication, patient satisfaction, and health outcomes. Our framework adds unique domains, including patient engagement, patient activation, shared clinical decision making, and patient self-management.
The framework can be used as a tool to guide the development of interventions to improve chronic care management through the use of PROMs.
将患者报告的结局指标（PROMs）纳入慢性病患者的常规临床护理中，有可能增加有关疾病及其治疗影响的有价值信息，并促进有效的患者自我管理，使患者在自身护理中成为更积极的参与者。PROMs为临床医生提供有关患者症状以及功能和情绪状态的及时信息。PROMs是增强患者与临床医生沟通的有用工具。
我们构建了一个概念框架，描述了在慢性病管理中使用PROMs的潜在效果。该框架总结了评估临床有效性的方法、诊断技术的卫生技术评估方法以及相关研究的结果所提供的见解。
该框架描述了从近端到远端的潜在效果，包括沟通（患者与临床医生、患者与亲属、临床医生与临床医生、临床医生与亲属）、让患者参与共同的临床决策、患者管理（临床医生管理和患者自我管理）以及患者结局。重要的潜在效果还包括患者积极性的提高、临床医生和患者满意度的改善以及患者对推荐治疗的依从性。以前的框架描述了患者与医生的沟通、患者满意度和健康结局。我们的框架增加了独特的领域，包括患者参与、患者积极性、共同的临床决策和患者自我管理。
该框架可作为一种工具，用于指导通过使用PROMs来改善慢性病管理的干预措施的开发。
