Chen Ming, Jones Conor M, Bauer Hailey E, Osakwe Onyekachukwu, Ketheeswaran Pavinarmatha, Baker Justin N, Huang I-Chan
College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA.
Weill Medical College, Cornell University, New York, NY 10021, USA.
Children (Basel). 2022 Feb 2;9(2):185. doi: 10.3390/children9020185.
To characterize pediatricians' perceived barriers and areas of confidence in assessing patient-reported outcomes (PROs) in the U.S., and to test associations of these factors with implementing PRO assessment.
Using a random sample from the members of American Medical Association, we recruited general pediatricians and pediatric subspecialists to complete a survey (July 2011 to December 2013). Perceived barriers and confidence in PRO assessment were compared by age, pediatric specialty (general pediatrics, seven subspecialties), practice settings (academic, private), and region of practice. Multivariable logistic regressions tested associations of demographic factors, barriers, and confidence factors with the implementation of PRO assessment.
The survey was completed by 458 participants (response rate 48.5%); of these, 40.4%, 15.9%, 15.5%, and 8.1% were general pediatricians, cardiology, hematology/oncology, and pulmonary specialists, respectively. PRO assessment was implemented by 29.0% of the pediatricians. The top five barriers for PRO assessment included limited time/manpower (79.0%), limited training (77.4%), lengthy PRO instruments (76%), lack of meaningful cut-offs on PRO scores (75.5%), and unavailable PRO instruments (75.0%). Limited knowledge of PROs (OR 4.10; 95% CI 2.21, 7.60) and unavailability of PRO instruments (OR 1.87; 95% CI 1.01, 3.49) increased the odds of not implementing the assessment, whereas confidence in PRO assessments compatible with norms (OR 0.41; 95% CI 0.23, 0.72) and perceived benefit over clinical judgment alone (OR 0.53; 95% CI 0.31, 0.93) decreased the odds of not implementing the assessment.
significant barriers to PRO assessment in pediatric settings suggest the need for providing training, resources, and practical guidance toward implementation. Patient or Public Contribution: healthcare service users contributed to this study by completing a survey and providing feedback about the barriers and areas of confidence in assessing PROs for pediatric populations.
描述美国儿科医生在评估患者报告结局（PROs）时所感知到的障碍和信心领域，并测试这些因素与实施PRO评估之间的关联。
我们从美国医学协会成员中随机抽样，招募了普通儿科医生和儿科专科医生来完成一项调查（2011年7月至2013年12月）。根据年龄、儿科专科（普通儿科、七个亚专科）、执业环境（学术、私人）和执业地区，比较了对PRO评估的感知障碍和信心。多变量逻辑回归测试了人口统计学因素、障碍和信心因素与PRO评估实施之间的关联。
458名参与者完成了调查（回复率48.5%）；其中，普通儿科医生、心脏病学、血液学/肿瘤学和肺科专家分别占40.4%、15.9%、15.5%和8.1%。29.0%的儿科医生实施了PRO评估。PRO评估的前五大障碍包括时间/人力有限（79.0%）、培训有限（77.4%）、PRO工具冗长（76%）、PRO分数缺乏有意义的临界值（75.5%）以及没有可用的PRO工具（75.0%）。对PROs的了解有限（比值比4.10；95%置信区间2.21，7.60）和没有可用的PRO工具（比值比1.87；95%置信区间1.01，3.49）增加了不实施评估的几率，而对符合规范的PRO评估有信心（比值比0.41；95%置信区间0.23，0.72）以及认为其比单纯临床判断更有益（比值比0.53；95%置信区间0.31，0.93）则降低了不实施评估的几率。
儿科环境中PRO评估存在重大障碍，这表明需要提供培训、资源和实施方面的实际指导。患者或公众贡献：医疗服务使用者通过完成调查并提供有关评估儿科人群PROs的障碍和信心领域的反馈，为这项研究做出了贡献。
