Kroenke Kurt, Monahan Patrick O, Kean Jacob
VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, 1481 W. 10th St., Indianapolis, IN 46202, USA; Department of Medicine, Indiana University School of Medicine, 545 Barnhill Drive, Indianapolis, IN 46202, USA; Regenstrief Institute, Inc., 1050 Wishard Blvd, Indianapolis, IN 46202, USA.
Department of Biostatistics, Indiana University School of Medicine and School of Public Health, 410 W. 10th St., Indianapolis, IN 46202, USA.
J Clin Epidemiol. 2015 Sep;68(9):1085-92. doi: 10.1016/j.jclinepi.2015.03.023. Epub 2015 Apr 11.
Measures for assessing patient-reported outcomes (PROs) that may have initially been developed for research are increasingly being recommended for use in clinical practice as well. Although psychometric rigor is essential, this article focuses on pragmatic characteristics of PROs that may enhance uptake into clinical practice.
Three sources were drawn on in identifying pragmatic criteria for PROs: (1) selected literature review including recommendations by other expert groups; (2) key features of several model public domain PROs; and (3) the authors' experience in developing practical PROs.
Eight characteristics of a practical PRO include: (1) actionability (i.e., scores guide diagnostic or therapeutic actions/decision making); (2) appropriateness for the relevant clinical setting; (3) universality (i.e., for screening, severity assessment, and monitoring across multiple conditions); (4) self-administration; (5) item features (number of items and bundling issues); (6) response options (option number and dimensions, uniform vs. varying options, time frame, intervals between options); (7) scoring (simplicity and interpretability); and (8) accessibility (nonproprietary, downloadable, available in different languages and for vulnerable groups, and incorporated into electronic health records).
Balancing psychometric and pragmatic factors in the development of PROs is important for accelerating the incorporation of PROs into clinical practice.
最初可能是为研究而制定的评估患者报告结局(PROs)的方法,如今也越来越多地被推荐用于临床实践。尽管心理测量的严谨性至关重要,但本文重点关注PROs的实用特征,这些特征可能会促进其在临床实践中的应用。
在确定PROs的实用标准时借鉴了三个来源:(1)选定的文献综述,包括其他专家组的建议;(2)几个典型公共领域PROs的关键特征;(3)作者在开发实用PROs方面的经验。
实用PRO的八个特征包括:(1)可操作性(即分数指导诊断或治疗行动/决策制定);(2)适用于相关临床环境;(3)通用性(即用于多种病症的筛查、严重程度评估和监测);(4)自我管理;(5)条目特征(条目数量和捆绑问题);(6)回答选项(选项数量和维度、统一选项与不同选项、时间框架、选项之间的间隔);(7)评分(简单性和可解释性);(8)可及性(非专有、可下载、有不同语言版本且可供弱势群体使用,并纳入电子健康记录)。
在PROs的开发中平衡心理测量和实用因素对于加速将PROs纳入临床实践非常重要。