Challenges in measuring patient defined outcomes in diagnostic radiological

investigations

S Mathers*+, G McKenzie*, E Robertson*, J Proctor*+, R Chesson+

*NHS Grampian +The Health Services Research GroupAberdeen, Scotland, UK.

What aspects of health care can be evaluated?

Outcome

Change due to intervention

Process

Intervention e.g.surgery, procedure

Structure

Resources, facilitiesorganisational settings

Donabedian, 1980

Outcome measures

have been defined

‘... as the results (effects) of processes. They are

that part of the situation pertaining after a process

which can be attributed to the process.’

UK Clearing House on Health Outcomes, 1993

Why is outcome measurement important?

‘ ... to show that an intervention has been

appropriate and effective’

Austin and Clark, 1993

Aim

To carry out a systematic review of literature to

identify:

• the prevalence, • use of outcome measures in radiology.

Search Strategy

▼

Databases searched

▼

Abstracts read according to defined criteria

▼

Criteria redefined, abstracts to be re-read in light of this

▼

Articles to be retrieved

▼

Initial paper review

▼

Data synthesis1. Data extraction form

2. Quality checklist

▼

Data analysis1.SPSS

2. Summary tables3. Meta-analysis

▼

Write up and dissemination.

Modified from NHS Centre for Reviews and Dissemination, (UK)

• 46 key words used

radiology/diagnostic imaging/x-ray

outcomes patient satisfactionefficacy outcome measuresutility adverse reactionwaiting times quality of care

• Databases searched e.g. MEDLINE

Results

• Citations 4893

• Publications retrieved 84• Publication by references 25

• Patient focused outcome 22

Final Scrutiny

Exclude• 8 for a number of reasons

e.g. hypothetical studies

Included• 14 primary patient focused studies

Patient focused outcome papers

In total 8

• Mammography 2 x USA• Low back pain 2 x UK• Ankle radiography 1 Canada• DCBE/US/Mammography 1 Norway• MRI 1 UK• Effects of radiation dose 1 Canada

Conclusions

• Dearth of research into patient centred outcomes in radiology

• Lack of coherent body of work

• Demonstrates little patient involvement in radiology research

Challenges

• Imaging procedure only part of investigations and patient final outcome remote from department Blackmore et al 1999

• Multi-disciplinary approach to research Revicki et al 1999

• Development of suitable outcome measurement tools

• Would benefit from a qualitative methodology

Future agenda

• It is important that we develop a culture of outcome measurement in radiology

• Patient defined outcome is necessary to evaluate our procedures

Acknowledgements

The Royal College of Radiologists (UK)

(Pump Priming Research Award)