Hospital Management, Quirónsalud 4H Network, Madrid, Spain.
Clinical and Organizational Innovation Unit (UICO), Quirónsalud 4H Network, Madrid, Spain.
Front Public Health. 2024 Aug 29;12:1452440. doi: 10.3389/fpubh.2024.1452440. eCollection 2024.
The spreading adoption of value-based models of healthcare delivery has incentivized the use of patient-reported outcomes and experience measures (PROMs and PREMs) in clinical practice, with the potential to enrich the decision-making process with patient-reported data.
This perspective article explores PROs and the shared decision-making (SDM) process as components of value-based healthcare. We describe the potential of PROMs and PREMs within the decision-making process and present a digital framework for informing the shared decision-making process using aggregated data from a healthcare system PROMs and PREMs program, including early results from implementation in hospital network in Madrid, Spain.
The proposed digital framework incorporates aggregated data from a hospital network PROMs and PREMs program as part of a digital patient decision aid (PDA) for patients with lymphoma. After the first hematologist appointment, participating patients access the PDA to review relevant information about clinical and patient-reported outcomes for each of the possible options, assign a personal order of priority to different outcomes, and then select their preferred course of action. Patients' answers are automatically uploaded to the EHR and discussed with hematologists at the next appointment. After beginning treatment, patients are invited to participate in the network PROMs program; participants' PROMs data are fed back into the PDA, thus "closing the circle" between the decision-making process and patient-reported data collection.During the first 14 months after launching the decision aid in October 2022, of 25 patients diagnosed with follicular lymphoma at the four participating hospitals, 13 patients decided to participate. No significant differences in age or sex were observed between groups. Average SDM Q-9 score for patients filling in the questionnaire ( = 6) was 36.15 of 45 points.
Various obstacles toward widespread implementation of SDM exist such as time constraints, lack of motivation, and resistance to change. Support and active engagement from policy makers and healthcare managers is key to overcome hurdles for capturing patient-reported data and carrying out shared decision-making at healthcare system level. Early results of a digital framework for PRO-enriched SDM seem to be beneficial to the decision-making process.
基于价值的医疗服务模式的广泛采用，激励了在临床实践中使用患者报告的结局和体验测量（PROMs 和 PREMs），有可能通过患者报告的数据丰富决策过程。
本文探讨了 PROs 和共同决策（SDM）过程作为基于价值的医疗保健的组成部分。我们描述了 PROMs 和 PREMs 在决策过程中的潜力，并提出了一个使用医疗系统 PROMs 和 PREMs 计划汇总数据为共同决策过程提供信息的数字框架，包括在西班牙马德里的医院网络实施的早期结果。
所提出的数字框架纳入了来自医院网络 PROMs 和 PREMs 计划的汇总数据，作为淋巴瘤患者数字患者决策辅助工具（PDA）的一部分。在第一次血液科就诊后，参与的患者可以访问 PDA，查看每个可能选项的临床和患者报告结局的相关信息，对不同结局进行个人优先级排序，然后选择他们首选的行动方案。患者的答案会自动上传到电子病历，并在下次就诊时与血液科医生讨论。开始治疗后，患者会被邀请参与网络 PROMs 计划；参与者的 PROMs 数据会反馈到 PDA 中，从而在决策过程和患者报告数据收集之间“闭环”。自 2022 年 10 月推出决策辅助工具以来的头 14 个月中，在四家参与医院诊断为滤泡性淋巴瘤的 25 名患者中，有 13 名患者决定参与。参与组和不参与组在年龄和性别方面没有显著差异。填写问卷的患者的平均 SDM Q-9 评分（ = 6）为 45 分中的 36.15 分。
广泛实施 SDM 存在各种障碍，如时间限制、缺乏动力和抵制变革。政策制定者和医疗保健管理人员的支持和积极参与是克服障碍的关键，以便在医疗系统层面捕获患者报告的数据并进行共同决策。PRO 丰富的 SDM 数字框架的早期结果似乎对决策过程有益。
