心力衰竭门诊中患者报告结局测量对临床医生健康状况评估和患者体验的影响：PRO-HF 试验的子研究。
Impact of Patient-Reported Outcome Measurement in Heart Failure Clinic on Clinician Health Status Assessment and Patient Experience: A Substudy of the PRO-HF Trial.
机构信息
Division of Cardiovascular Medicine, Department of Medicine, Stanford University, CA (A.T.S., N.M.K., J.C., P.A.H.).
Palo Alto Veteran's Affairs Healthcare System, CA (A.T.S., N.M.K., M.S., P.A.H.).
出版信息
Circ Heart Fail. 2023 Feb;16(2):e010280. doi: 10.1161/CIRCHEARTFAILURE.122.010280. Epub 2022 Nov 5.
BACKGROUND
Clinicians typically estimate heart failure health status using the New York Heart Association Class, which is often discordant with patient-reported health status. It is unknown whether collecting patient-reported health status improves the accuracy of clinician assessments.
METHODS
The PRO-HF trial (Patient-Reported Outcomes in Heart Failure Clinic) is a randomized, nonblinded trial evaluating routine Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) collection in heart failure clinic. Patients with a scheduled visit to Stanford heart failure clinic between August 30, 2021 and June 30, 2022 were enrolled and randomized to KCCQ-12 assessment or usual care. In this prespecified substudy, we evaluated whether access to the KCCQ-12 improved the accuracy of clinicians' New York Heart Association assessment or patients' perspectives on their clinician interaction. We surveyed clinicians regarding their patients' New York Heart Association Class, quality of life, and symptom frequency. Clinician responses were compared with patients' KCCQ-12 responses. We surveyed patients regarding their clinician interactions.
RESULTS
Of the 1248 enrolled patients, 1051 (84.2%) attended a visit during the substudy. KCCQ-12 results were given to the clinicians treating the 528 patients in the KCCQ-12 arm; the 523 patients in the usual care arm completed the KCCQ-12 without the results being shared. The correlation between New York Heart Association Class and KCCQ-12 Overall Summary Score was stronger when clinicians had access to the KCCQ-12 (r=-0.73 versus r=-0.61, <0.001). More patients in the KCCQ-12 arm strongly agreed that their clinician understood their symptoms (95.2% versus 89.7% of respondents [odds ratio' 2.27; 95% CI' 1.32-3.87]). However, patients in both arms reported similar quality of clinician communication and therapeutic alliance.
CONCLUSIONS
Collecting the KCCQ-12 in heart failure clinic improved clinicians' accuracy of health status assessment; correspondingly, patients believed their clinicians better understood their symptoms.
REGISTRATION
URL: https://www.
CLINICALTRIALS
gov; Unique identifier: NCT04164004.
背景
临床医生通常使用纽约心脏协会（NYHA）分级来评估心力衰竭患者的健康状况，但该分级与患者报告的健康状况往往不一致。目前尚不清楚收集患者报告的健康状况是否能提高临床医生评估的准确性。
方法
PRO-HF 试验（心力衰竭诊所患者报告结局）是一项随机、非盲法试验，评估心力衰竭诊所常规使用堪萨斯城心肌病问卷-12 （KCCQ-12）的效果。2021 年 8 月 30 日至 2022 年 6 月 30 日期间在斯坦福心力衰竭诊所就诊的患者被纳入并随机分为 KCCQ-12 评估组或常规护理组。在本预先设定的亚研究中，我们评估了获取 KCCQ-12 是否能提高临床医生对 NYHA 评估的准确性或患者对临床医生互动的看法。我们调查了临床医生关于患者 NYHA 分级、生活质量和症状频率的情况。临床医生的回答与患者的 KCCQ-12 回答进行了比较。我们调查了患者对其临床医生互动的看法。
结果
在纳入的 1248 例患者中，有 1051 例（84.2%）在亚研究期间就诊。在 KCCQ-12 组的 528 例患者中，为治疗他们的临床医生提供了 KCCQ-12 结果；在常规护理组的 523 例患者中，在未分享结果的情况下完成了 KCCQ-12。当临床医生可以获取 KCCQ-12 时，NYHA 分级与 KCCQ-12 总概括评分之间的相关性更强（r=-0.73 与 r=-0.61，<0.001）。在 KCCQ-12 组中，更多的患者强烈认同他们的临床医生理解他们的症状（95.2%与 89.7%的应答者[比值比 2.27；95%置信区间 1.32-3.87]）。然而，两组患者均报告了类似的临床医生沟通和治疗联盟质量。
结论
在心力衰竭诊所收集 KCCQ-12 可提高临床医生对健康状况评估的准确性；相应地，患者认为他们的临床医生更好地了解他们的症状。
登记
网址：https://www.
临床试验
gov；独特标识符：NCT04164004。
Zotero 插件