Patient defined outcomes: lessons from systematic review
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
‘ ...a successful outcome, as defined from the professionals perspective, may not necessarily be regarded as a successful outcome by the patient.’
Wright, 1999
Patient centred outcome• determined solely by health
professions and researchers
Patient defined outcome• identified by patients as being
important
Dixon, 1995
Aim
To carry out a systematic review of literature to identify:
• the prevalence, • use of patient focused outcome measures
in radiology.
Search Strategy
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Databases searched
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Abstracts read according to defined criteria
▼
Criteria redefined, abstracts to be re-read in light of this
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Articles to be retrieved
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Initial paper review
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Data synthesis1. Data extraction form
2. Quality checklist
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Data analysis1.SPSS
2. Summary tables3. Meta-analysis
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Write up and dissemination.
Modified from NHS Centre for Reviews and Dissemination, (UK)
• 47 key words used
radiology, diagnostic imaging, x-ray/
outcomes patient satisfaction
efficacy outcome measures
utility adverse reaction
waiting times quality of care
• Databases searched e.g. MEDLINE
Results
• Citations 5516
• Citations reviewed111
• Patient focused outcome 23
• NO paper was found in which patient defined outcome had been used in radiology
Patient focused outcome papers
Primary focus of research
4 papers
- ALL concerned with lumbar spine imaging
Patient focused outcome papers
Secondary focus of research
5 papers
- 4 interventional studies
- 1 chest imaging
Lessons learned
• RSNA Index of Imaging Literature does not include outcome measure as key word
• A data extraction form had to be developed to facilitate systematic review of literature
• Papers not published in mainstream radiology publications
Conclusions
• Dearth of research into patient centred outcomes in radiology
• Lack of coherent body of work
• Demonstrates little patient involvement in radiology research
Recommendations
• Outcome measurement should be embedded within the cultures of radiology and radiography
• Patient engagement should take place in developing patient defined outcome especially in the area of interventional radiology
• Value of patient defined outcomes incorporated into education, benchmarking and planning of health care
Acknowledgements
The Royal College of Radiologists (UK)
(Pump Priming Research Award)
