Chair of Health Economics, Policy, and Management, School of Medicine, University of St. Gallen, St. Jakob-Strasse 21, St. Gallen, SG, 9000, Switzerland.
Chair of Digital Health Interventions, School of Medicine, University of St. Gallen, St. Gallen, SG, Switzerland.
J Patient Rep Outcomes. 2024 Nov 25;8(1):136. doi: 10.1186/s41687-024-00812-x.
As one of the main goals of hip and knee replacements is to improve patients' health-related quality of life, a meaningful evaluation can be achieved by calculating minimal important changes (MICs) for improvements in patient-reported outcome measures (PROMs). This study aims at providing MICs adjusted for patient characteristics for EQ-5D-3L index score improvements after hip and knee replacements. It adds to existing literature by relying on a large national sample and precise clustering algorithms, and by employing a state-of-the-art methodology for the calculation of improved adjusted MICs.
A retrospective observational study was conducted using the publicly available National Health Service (NHS) PROMs dataset for primary hip and knee replacements. We used information on 252,331 hip replacements and 279,668 knee replacements from all NHS-funded providers in England between 2013 and 2020. Clusters of patients were created based on pre-operative EQ-VAS, depression status, and sex. Unstratified and stratified estimates for meaningful EQ-5D-3L improvements were obtained through anchor-based predictive MICs corrected for the proportion of improved patients and the reliability of transition ratings.
Stratifying patients showed that MICs varied across subgroups based on pre-operative EQ-VAS, depression status, and sex. MICs were larger for patients with worse pre-operative EQ-VAS scores, while patients with better pre-operative scores required smaller MICs to achieve a meaningful change. We show how after stratification the percentage of patients achieving their stratified MIC was better in line with the actual share of improved patients. Larger MICs were found for patients with depression and for female patients. MICs calculated for knee replacements were consistently lower than those for hip replacements.
Our findings show the importance of adjusting MICs for patients' characteristics and should be considered for quality-related choices and policy initiatives.
髋关节和膝关节置换术的主要目标之一是改善患者的健康相关生活质量，通过计算患者报告的结果测量（PROM）改善的最小重要变化（MIC）可以实现有意义的评估。本研究旨在为髋关节和膝关节置换术后 EQ-5D-3L 指数评分改善提供针对患者特征调整的 MIC。它通过依赖大型国家样本和精确的聚类算法，以及采用最先进的方法来计算改进的调整后的 MIC，为现有文献做出了补充。
使用英国国家卫生服务（NHS） PROMs 数据集进行了一项回顾性观察研究，该数据集涵盖了 2013 年至 2020 年期间英格兰所有 NHS 资助的提供者进行的初次髋关节和膝关节置换术。我们使用了 252331 例髋关节置换术和 279668 例膝关节置换术的信息。根据术前 EQ-VAS、抑郁状态和性别创建了患者群。通过基于锚定的预测性 MIC，对未分层和分层的有意义的 EQ-5D-3L 改善进行了估计，这些 MIC 校正了改善患者的比例和转换评分的可靠性。
分层患者显示，基于术前 EQ-VAS、抑郁状态和性别，MIC 在亚组之间存在差异。MIC 对于术前 EQ-VAS 评分较差的患者较大，而术前评分较好的患者需要较小的 MIC 才能实现有意义的变化。我们展示了如何在分层后，达到分层 MIC 的患者比例与实际改善患者的比例更加一致。对于患有抑郁症和女性患者，MIC 更大。对于膝关节置换术，MIC 始终低于髋关节置换术。
我们的研究结果表明，调整 MIC 以适应患者特征的重要性，这应该在与质量相关的选择和政策举措中得到考虑。
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