Miller Deborah M, Moss Brandon, Rose Susannah, Li Hong, Schindler David, Weber Malory, Planchon Sarah M, Alberts Jay, Boissy Adrienne, Bermel Robert
Mellen Center, Cleveland Clinic, OH, USA.
Lerner College of Medicine, Cleveland Clinic, OH, USA.
J Patient Exp. 2020 Aug;7(4):541-548. doi: 10.1177/2374373519864011. Epub 2019 Jul 24.
In order to provide patient center care, our multiple sclerosis (MS) clinic assesses patient concerns before clinical encounters, first by asking the optional qualitative question "What is the most important thing you what your health-care provider to know today" (most important concern of the patient [MIPC]) and then completing quantitative patient-reported outcome measures (PROMs) including Quality of Life in Neurological Disorders (Neuro-QoL). Both sets of questions are designed to facilitate encounters that address patients' values and preferences.
Determine whether the qualitative MIPC responses provided unique information not included in PROMs or clinical assessments.
We randomly selected 400 first-time MIPC responders and 400 first-time MIPC nonresponders from 2788 participants in our database. We categorized MIPC responses by content and number of unique concerns and appended them to the Neuro-QoL framework. Nonresponders were compared to those who provided 1 and 2 or more responses.
Several MIPCs MS symptoms categories were added to the Neuro-QoL Physical domain. Most important concern of the patients work and cost-of-care categories were added to the Social Domain. Domains regarding treatment satisfaction and disease management were added. Two hundred thirty (58%) MIPC respondents reported 1 concern, 140 (35%) expressed 2 to 6 concerns, and 30 (7%) reported MS-unrelated concerns and not analyzed. Physical symptoms were the most common MIPC (69.9%). Respondents with more concerns were more likely African American, lacked private insurance, and worse disability.
Importantly, MIPC responders described idiosyncratic symptoms, disease management, and social concerns not included in the PROMS, suggesting the MIPC question offered patients a unique opportunity to share specific concerns with their providers.
为了提供以患者为中心的护理，我们的多发性硬化症（MS）诊所会在临床诊疗前评估患者的关切，首先会询问一个可选的定性问题“你今天希望你的医疗服务提供者了解的最重要的事情是什么”（患者最重要的关切[MIPC]），然后完成包括神经疾病生活质量（Neuro-QoL）在内的定量患者报告结局测量（PROMs）。这两组问题旨在促进能解决患者价值观和偏好的诊疗过程。
确定定性的MIPC回答是否提供了PROMs或临床评估中未包含的独特信息。
我们从数据库中的2788名参与者中随机选择了400名首次回答MIPC的人和400名首次未回答MIPC的人。我们根据内容和独特关切的数量对MIPC回答进行分类，并将其附加到Neuro-QoL框架中。将未回答者与提供了1条以及2条或更多回答的人进行比较。
几个MIPC的MS症状类别被添加到Neuro-QoL身体领域。患者最重要的关切工作和护理费用类别被添加到社会领域。增加了关于治疗满意度和疾病管理的领域。230名（58%）MIPC回答者报告了1个关切，140名（35%）表达了2至6个关切，30名（7%）报告了与MS无关的关切且未进行分析。身体症状是最常见的MIPC（69.9%）。有更多关切的回答者更有可能是非裔美国人，缺乏私人保险，且残疾情况更差。
重要的是，MIPC回答者描述了PROMs中未包含的特殊症状、疾病管理和社会关切，这表明MIPC问题为患者提供了一个与医疗服务提供者分享特定关切的独特机会。
