International Consortium for Health Outcomes Measurement, Boston, Massachusetts, USA
International Consortium for Health Outcomes Measurement, Boston, Massachusetts, USA.
BMJ Open. 2021 Nov 15;11(11):e051065. doi: 10.1136/bmjopen-2021-051065.
The COVID-19 pandemic has resulted in widespread morbidity and mortality with the consequences expected to be felt for many years. Significant variation exists in the care even of similar patients with COVID-19, including treatment practices within and between institutions. Outcome measures vary among clinical trials on the same therapies. Understanding which therapies are of most value is not possible unless consensus can be reached on which outcomes are most important to measure. Furthermore, consensus on the most important outcomes may enable patients to monitor and track their care, and may help providers to improve the care they offer through quality improvement. To develop a standardised minimum set of outcomes for clinical care, the International Consortium for Health Outcomes Measurement (ICHOM) assembled a working group (WG) of 28 volunteers, including health professionals, patients and patient representatives.
A list of outcomes important to patients and professionals was generated from a systematic review of the published literature using the MEDLINE database, from review of outcomes being measured in ongoing clinical trials, from a survey distributed to patients and patient networks, and from previously published ICHOM standard sets in other disease areas. Using an online-modified Delphi process, the WG selected outcomes of greatest importance.
The outcomes considered by the WG to be most important were selected and categorised into five domains: (1) functional status and quality of life, (2) mental functioning, (3) social functioning, (4) clinical outcomes and (5) symptoms. The WG identified demographic and clinical variables for use as case-mix risk adjusters. These included baseline demographics, clinical factors and treatment-related factors.
Implementation of these consensus recommendations could help institutions to monitor, compare and improve the quality and delivery of care to patients with COVID-19. Their consistent definition and collection could also broaden the implementation of more patient-centric clinical outcomes research.
新冠疫情导致了广泛的发病率和死亡率,预计其影响将持续多年。即使是 COVID-19 相似患者的治疗也存在显著差异,包括机构内和机构间的治疗实践。同一疗法的临床试验之间的疗效衡量标准也有所不同。除非就哪些结果最重要达成共识,否则无法确定哪些疗法最有价值。此外,就最重要的结果达成共识可能使患者能够监测和跟踪他们的治疗情况,并帮助提供者通过质量改进来提高他们提供的治疗。为了制定临床护理的标准化最低结果集,国际健康结果测量联合会 (ICHOM) 召集了一个由 28 名志愿者组成的工作组(WG),包括卫生专业人员、患者和患者代表。
通过使用 MEDLINE 数据库对已发表文献进行系统评价、对正在进行的临床试验中正在衡量的结果进行审查、向患者和患者网络分发调查以及对其他疾病领域已发表的 ICHOM 标准集进行审查,生成了对患者和专业人员重要的结果清单。WG 使用在线改良 Delphi 流程选择最重要的结果。
WG 认为最重要的结果被选择并分为五个领域:(1)功能状态和生活质量,(2)精神功能,(3)社会功能,(4)临床结果和(5)症状。WG 确定了用于作为病例组合风险调整器的人口统计学和临床变量。这些包括基线人口统计学、临床因素和与治疗相关的因素。
实施这些共识建议可以帮助机构监测、比较和改进 COVID-19 患者的护理质量和交付。它们的一致定义和收集也可以扩大更以患者为中心的临床结果研究的实施。