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[null,null,"This Excel workbook contains the Evidence Map  on \nPRO Tools Measuring Patient Involvement in Healthcare Decisions"]
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[null,null,"How this Evidence Map was generated"]
[null,null,"We searched heoro.com on the 27th December 2017 using the PRO tool filter"]
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[null,null,"The search identified a total of 65 relevant abstracts published since 1960, which were  segmented with the following standard heoro.com fields:"]
[null,null,null,"Locations - the geographical setting of the study, or, where this is unknown, the authors' location"]
[null,null,null,"Disease - the patients disease if stated"]
[null,null,null,"Interventions - the interventions evaluated in the study, if any"]
[null,null,null,"PRO tools - the PRO intruments that were cited in the title or abstract"]
[null,null,null,"Study methodology - the type of study that was conducted, e.g. clinical tral, systematic review, tool validation study"]
[null,null,null,"Subpopulation - the patient characteristics, if mentioned"]
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[null,null,"In addition the following publication date segmentations are used:"]
[null,null,null,"1960 to 1990, 1991 to 1995, 1996 to 1999, 2000 to 2004, 2005 to 2009, 2010 to 2014, 2015 to 2017"]
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[null,null,"All data in this Evidence Map is taken from the heoro.com database"]
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[null,null,"Details of the PubMed search strategy used to populate the heoro.com database can be found here."]
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[null,null,"Contact us:"]
[null,null,"Address: Crystallise Ltd. Unit 21, Thames Enterpise Centre, Thames Industrial Park, East Tilbury, Essex, UK RM18 8RH"]
[null,null,"Tel: +44 (0)1375 488020"]
[null,null,"Email: alison.martin@crystallise.com"]

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[{"$f":"COUNT(A2:A986)","v":63},"Full citation","DOI","Authors","Title","Abstract","Citation","Locations","Year","Diseases","Interventions","PROtools","Subpopulations","Study types","Study methodologies","LocationsTags","SubpopulationsTags","DiseaseTags","InterventionsTags","StudytypesTags","StudyMethodologyTags","PROtoolTags","DateBand","C1","C2","C3","C4","C5"]
[1,"Johnson,B. R.,et al. (2006). \"A chairside aid for shared decision making in dentistry: a randomized controlled trial.\" J Dent Educ 70(2): 133-141.",null,"Johnson,B. R.,et al.","A chairside aid for shared decision making in dentistry: a randomized controlled trial","The concept of shared decision making (SDM) is an important emerging trend in clinical medicine but has received little or no attention in the dental literature. Decision aids can play a useful role in SDM by helping patients and clinicians choose among reasonable alternative treatment options. The purpose of this study was to develop and test an Endodontic Decision Board (EndoDB) for chairside use to help clarify treatment alternatives,benefits,risks,prognosis,and costs when root canal therapy or extraction of a tooth was indicated. The hypothesis was that the use of the EndoDB would lead to improved patient knowledge,greater satisfaction with the decision-making process,and no difference in anxiety when compared to the standard discussion and informed consent process (usual care). The EndoDB was tested in a randomized controlled trial in a postgraduate endodontics clinic. After treatment discussion,a brief questionnaire was completed by the patient to measure knowledge,satisfaction,and anxiety. Patients in the EndoDB group (n=32) demonstrated a small,but statistically significant,increase in knowledge (t-test; difference=+0.37; p=0.03) compared to the usual care group (n=35). There was no difference between groups in the measures of satisfaction or anxiety (Mann-Whitney U-test; p>0.05). Decision aids may emerge as a useful tool to facilitate SDM and evidence-based clinical practice.","J Dent Educ,70(2): 133-141","USA",2006,"Oral Health","Tooth extraction","SWD","Not Specified","PRO study","RCT"]
[2,"Bower,P.,et al. (2015). \"A cluster randomised controlled trial and process evaluation of a training programme for mental health professionals to enhance user involvement in care planning in service users with severe mental health issues (EQUIP): study protocol for a randomised controlled trial.\" Trials 16: 348.",null,"Bower,P.,et al.","A cluster randomised controlled trial and process evaluation of a training programme for mental health professionals to enhance user involvement in care planning in service users with severe mental health issues (EQUIP): study protocol for a randomised controlled trial","BACKGROUND: Involving service users in planning their care is at the centre of policy initiatives to improve mental health care quality in England. Whilst users value care planning and want to be more involved in their own care,there is substantial empirical evidence that the majority of users are not fully involved in the care planning process. Our aim is to evaluate the effectiveness and cost-effectiveness of training for mental health professionals in improving user involvement with the care planning processes. METHODS/DESIGN: This is a cluster randomised controlled trial of community mental health teams in NHS Trusts in England allocated either to a training intervention to improve user and carer involvement in care planning or control (no training and care planning as usual). We will evaluate the effectiveness of the training intervention using a mixed design,including a 'cluster cohort' sample,a 'cluster cross-sectional' sample and process evaluation. Service users will be recruited from the caseloads of care co-ordinators. The primary outcome will be change in self-reported involvement in care planning as measured by the validated Health Care Climate Questionnaire. Secondary outcomes include involvement in care planning,satisfaction with services,medication side-effects,recovery and hope,mental health symptoms,alliance/engagement,well-being and quality of life. Cost- effectiveness will also be measured. A process evaluation informed by implementation theory will be undertaken to assess the extent to which the training was implemented and to gauge sustainability beyond the time-frame of the trial. DISCUSSION: It is hoped that the trial will generate data to inform mental health care policy and practice on care planning. TRIAL REGISTRATION NUMBER: ISRCTN16488358 (14 May 2014).","Trials,16(348","UK",2015,"Mental Health","HCP Training","HCCQ","Mental Health Carers","Cost-effectiveness","RCT"]
[3,"Howie,J. G.,et al. (1998). \"A comparison of a Patient Enablement Instrument (PEI) against two established satisfaction scales as an outcome measure of primary care consultations.\" Fam Pract 15(2): 165-171.",null,"Howie,J. G.,et al.","A comparison of a Patient Enablement Instrument (PEI) against two established satisfaction scales as an outcome measure of primary care consultations","OBJECTIVES: We aimed to compare a new primary care outcome measure-the Patient Enablement Instrument (PEI)-against two established satisfaction measures [the Medical Interview Satisfaction Scale (MISS) and the Consultation Satisfaction Questionnaire (CSQ)]. Specifically,we sought (i) to test whether enablement and satisfaction are related or separate concepts; and (ii) to assess whether the internal consistency of the PEI might be enhanced by the inclusion of items from the satisfaction instruments. METHODS: Questionnaire forms containing the three instruments in a variety of combinations were distributed to a total of 818 patients attending for routine surgery consultations in three urban general practices of varying socio-economic mix. The main outcome measures were: scores on the PEI; scores on the CSQ,the MISS and their individual components; rank correlations between scores on the PEI and scores on the CSQ,the MISS and their component subscales; and Cronbach's alpha coefficient for the PEI. RESULTS: Overall mean scores,expressed as percentages of maximum scores attainable,were 44.1% for the PEI,76.9% for the CSQ and 77.6% for the MISS. Rank correlations between PEI scores and scores for the complete CSQ and MISS instruments were 0.48 (P < 0.01) and 0.47 (P < 0.01),respectively. Correlations of PEI scores with individual component scores on the CSQ were generally lower and ranged from 0.14 to 0.53; correlations of PEI scored with MISS component scores were also generally lower and ranged from 0.21 to 0.53. Internal consistency of the PEI items (assessed by Cronbach's alpha coefficient) was lowered when items from the CSQ or MISS were added. CONCLUSIONS: The study shows that 'enablement' is a primary care outcome measure which is related to but is different from general satisfaction.","Fam Pract,15(2): 165-171","UK",1998,"Not Specified","Surgery","PEI","Not Specified","Tool Validation","Cross-sectional"]
[4,"Julian,S.,et al. (2007). \"An integrated care pathway for menorrhagia across the primary-secondary interface: patients' experience,clinical outcomes,and service utilisation.\" Qual Saf Health Care 16(2): 110-115.",null,"Julian,S.,et al.","An integrated care pathway for menorrhagia across the primary-secondary interface: patients' experience,clinical outcomes,and service utilisation","BACKGROUND: \"Referral\" characterises a significant area of interaction between primary and secondary care. Despite advantages,it can be inflexible,and may lead to duplication. OBJECTIVE: To examine the outcomes of an integrated model that lends weight to general practitioner (GP)-led evidence based care. DESIGN: A prospective,non-random comparison of two services: women attending the new (Bridges) pathway compared with those attending a consultant-led one-stop menstrual clinic (OSMC). Patients' views were examined using patient career diaries,health and clinical outcomes,and resource utilisation. Follow-up was for 8 months. SETTING: A large teaching hospital and general practices within one primary care trust (PCT). RESULTS: Between March 2002 and June 2004,99 women in the Bridges pathway were compared with 94 women referred to the OSMC by GPs from non-participating PCTs. The patient career diary demonstrated a significant improvement in the Bridges group for patient information,fitting in at the point of arrangements made for the patient to attend hospital (ease of access) (p<0.001),choice of doctor (p = 0.020),waiting time for an appointment (p<0.001),and less \"limbo\" (patient experience of non-coordination between primary and secondary care) (p<0.001). At 8 months there were no significant differences between the two groups in surgical and medical treatment rates or in the use of GP clinic appointments. Significantly fewer (traditional) hospital outpatient appointments were made in the Bridges group than in the OSMC group (p<0.001). CONCLUSION: A general practice-led model of integrated care can significantly reduce outpatient attendance while improving patient experience,and maintaining the quality of care.","Qual Saf Health Care,16(2): 110-115","UK",2007,"Menorrhagia","Not Specified","Patient career diary","Women","PRO study","Cross-sectional"]
[5,"Fried,R. A.,et al. (1994). \"Appropriateness of hospital use by family physicians.\" J Am Board Fam Pract 7(3): 229-235.",null,"Fried,R. A.,et al.","Appropriateness of hospital use by family physicians","BACKGROUND: Reducing inappropriate hospital admissions could lead to lower total health care costs without compromising the quality of care. Research suggests that a sizeable portion of hospital admissions are inappropriate. Other studies indicate that family physicians use health care resources,including hospitalizations,less often than other primary care physicians. To gain additional insight into family physicians' decisions to admit patients,we performed an exploratory study using the Appropriateness Evaluation Protocol,a validated,clinically based utilization review instrument. METHODS: We assessed admissions by community-based and residency-based family physicians to a single university-affiliated hospital during calendar year 1988. A total of 905 patients were admitted to the hospital by family physicians during the study period. Of these,889 records had complete data. Each was reviewed for appropriateness of admission. We calculated percentages of inappropriate admissions and used logistic regression to ascertain variables that were significant predictors of inappropriateness. RESULTS: Overall,5.4 percent of admissions were categorized as inappropriate. Omitting obstetric cases,the rate was 10.5 percent. Inappropriate admissions did not cluster around a small number of diagnoses or diagnosis-related groups. Using logistic regression,we found that urgency of admission,patient insurance status,and residency-based physician admission versus community-based physician admission were significant predictors of inappropriate hospital use. Of the inappropriate admissions,70 percent were so rated because diagnostic procedures or treatments could have been performed on an outpatient basis. CONCLUSIONS: In contrast with other studies for which physician specialty was not controlled,family physicians less frequently admitted patients inappropriately. Predictors of inappropriateness differed from those found in other studies. Changes in hospital systems,in addition to educational efforts directed toward individual physicians,hold promise as a strategy for reducing inappropriate hospital use.","J Am Board Fam Pract,7(3): 229-235","USA",1994,"Not Specified","Hospitalisation","AEP","Adults","Resource Use","Cross-sectional"]
[6,"Katz,M.,et al. (2001). \"Appropriateness of pediatric admissions to a tertiary care facility in Israel.\" Isr Med Assoc J 3(7): 501-503.",null,"Katz,M.,et al.","Appropriateness of pediatric admissions to a tertiary care facility in Israel","BACKGROUND: Appropriateness of hospital admission has both clinical and economic relevance,especially in light of the growing pressure for increased efficiency of health services utilization. In Israel,the number of referrals and use of the emergency room continue to rise along with an increase in hospital admissions and the number of inappropriate admissions. Using evaluation protocols,such as the Pediatric Appropriateness Evaluation Protocol,international studies have shown that 10-30% of hospital admissions are medically unnecessary. Inappropriate hospitalizations have an economic impact as well as medical and psychological effects on the child and the family. OBJECTIVES: To assess the extent and characteristics of inappropriate pediatric admissions to a tertiary care facility in Israel. METHODS: We conducted a prospective study using chart review of pediatric admissions to Soroka University Medical Center on 18 randomly selected days in 1993,and evaluated the appropriateness of admissions using the PAEP. RESULTS: Of the 221 pediatric admissions 18% were evaluated as inappropriate. The main reason for such an evaluation was that the problem could have been managed on an ambulatory basis. Inappropriate admissions were associated with hospitals stays of 2 or less days,children older than 1 year of age,Jewish children,and self-referrals to the pediatric emergency room. CONCLUSIONS: The assessment and identification of characteristics of inappropriate hospital admissions can serve as indicators of problems in healthcare management and as a basis for improving quality of care and developing appropriate medical decision-making processes.","Isr Med Assoc J,3(7): 501-503","Israel",2001,"Not Specified","Hospitalisation","AEP","Children","Resource Use","Cross-sectional"]
[7,"Kreger,B. E. and J. D. Restuccia (1989). \"Assessing the need to hospitalize children: pediatric appropriateness evaluation protocol.\" Pediatrics 84(2): 242-247.",null,"Kreger,B. E. and J. D. Restuccia","Assessing the need to hospitalize children: pediatric appropriateness evaluation protocol","Rapidly increasing hospital costs have necessitated use review of hospitalized patients to improve the appropriateness (medical necessity) of hospital use. The development and testing of the Pediatric Appropriateness Evaluation Protocol,an objective,criteria-based instrument intended to assist physicians and use reviewers in making decisions regarding appropriateness of pediatric hospital admissions and days of care,are described.","Pediatrics,84(2): 242-247","USA",1989,"Not Specified","Hospitalisation","AEP","Children","Resource Use","Cross-sectional"]
[8,"Goncalves-Pereira,M.,et al. (2017). \"Assessment of the consequences of caregiving in psychosis: a psychometric comparison of the Zarit Burden Interview (ZBI) and the Involvement Evaluation Questionnaire (IEQ).\" Health Qual Life Outcomes 15(1): 63.",null,"Goncalves-Pereira,M.,et al.","Assessment of the consequences of caregiving in psychosis: a psychometric comparison of the Zarit Burden Interview (ZBI) and the Involvement Evaluation Questionnaire (IEQ)","BACKGROUND: The Zarit Burden Interview (ZBI) was originally developed to assess the level of subjective burden in caregivers of people with dementia. The Involvement Evaluation Questionnaire (IEQ) is amongst the leading scales to assess caregiving consequences in severe mental illness. We aimed to compare the psychometric properties of the ZBI,a generic tool,and of the IEQ,a more specific tool to assess the consequences of caregiving in schizophrenia and related disorders. METHODS: Secondary analyses of a 16-week,randomized controlled trial of a psychoeducational intervention in 223 primary caregivers of patients with schizophrenia or schizoaffective disorder. Psychometric properties (internal consistency,convergent and discriminative validity,and sensitivity to change) were evaluated for both ZBI and IEQ. RESULTS: Internal consistency was good and similar for both scales (ZBI: 0.91,95% CI: 0.89,0.94; IEQ: 0.86,95% CI: 0.83,0.89). Convergent validity was relevant for similar domains (e.g. ZBI total score vs IEQ-tension r = 0.69,95% CI: 0.61,0.75) and at least moderate for the rest of domains (ZBI total score,personal strain and role strain vs IEQ-urging and supervision). Discriminative validity against psychological distress and depressive symptoms was good (Area Under the Curve [AUC]: 0.77,95% CI: 0.71,0.83; and 0.69,95% CI: 0.63,0.78 - for ZBI against GHQ-28 and CES-D respectively; and AUC: 0.72,95% CI: 0.65,0.78; and 0.69,95% CI: 0.62,0.77 - for IEQ against GHQ-28 and CES-D respectively). AUCs against the reference criteria did not differ significantly between the two scales. After the intervention,both scales showed a significant decrease at endpoint (p-values < 0.001) with similar standardised effect sizes for change (-0.36,95% CI: -0.58,-0.15 - for ZBI; -0.39,95% CI: -0.60,-0.18 - for IEQ). CONCLUSIONS: Both ZBI and IEQ have shown satisfactory psychometric properties to assess caregiver burden in this sample. We provided further evidence on the performance of the ZBI as a general measure of subjective burden. TRIAL REGISTRATION: ( ISRCTN32545295 ).","Health Qual Life Outcomes,15(1): 63","Portugal,Spain",2017,"Dementia","HCP Training","IEQ-EU","Not Specified","Tool Validation","RCT"]
[9,"Seid,M.,et al. (2009). \"Barriers to care questionnaire: reliability,validity,and responsiveness to change among parents of children with asthma.\" Acad Pediatr 9(2): 106-113.",null,"Seid,M.,et al.","Barriers to care questionnaire: reliability,validity,and responsiveness to change among parents of children with asthma","BACKGROUND: Although it is well known which groups of children are more vulnerable to poor health care access,quality,and outcomes,less is known about how and why this occurs. Barriers to care-sociobehavioral processes that interfere with successful interaction with the health care system--may be a link between vulnerability and access,experiences,and outcomes. OBJECTIVE: The aim of this study was to examine the reliability,validity,and responsiveness to change of the Barriers to Care Questionnaire (BCQ) in a sample of children with persistent asthma recruited from federally qualified health centers. METHOD: Children (N = 252; aged 2-14 years) with persistent asthma and their parents (93.7% mother,83.3% Hispanic,76.9% Spanish speaking; 72.6% less than a high school diploma),enrolled in a clinical trial,and completed the BCQ,questions relating to access to care,the Parent's Perceptions of Primary Care Measure,and the Pediatric Quality of Life Inventory 4.0 (PedsQL) at baseline and 3 months. RESULTS: The BCQ demonstrated internal consistency reliability. Supporting construct validity,barriers to care were worse for children without health insurance or an identified provider and who had problems with care or foregone care. Higher barriers correlated with poorer primary care and lower patient health-related quality of life. The BCQ was responsive to change,showing within- and between-subject differences for subjects with improved realized access from baseline to 3 months. CONCLUSION: The BCQ is a reliable,valid,and responsive measure of barriers to care for vulnerable children with asthma. Barriers to care were associated with poorer access,lower primary care quality,and worse health-related quality of life.","Acad Pediatr,9(2): 106-113","USA",2009,"Asthma","Not Specified","BCQ","Children","Tool Validation","Cross-sectional"]
[10,"Bloom,K. C.,et al. (2004). \"Barriers to prenatal care for homeless pregnant women.\" J Obstet Gynecol Neonatal Nurs 33(4): 428-435.",null,"Bloom,K. C.,et al.","Barriers to prenatal care for homeless pregnant women","OBJECTIVE: The purpose of this study was to explore and describe the barriers to prenatal care for homeless pregnant women. DESIGN: A descriptive survey with written questionnaires. PARTICIPANTS: About 183 pregnant homeless women live in Northeast Florida in any given month. More than 250 surveys were distributed to homeless pregnant women via agencies that provide shelter and/or services to homeless people in Northeast Florida. Forty-seven surveys were returned,representing 25.7% of the estimated population. MAIN OUTCOME MEASURE: Barriers to prenatal care were measured using Melnyk's Barriers Scale,a 27-item Likert-type scale. RESULTS: Of the respondents,75.61% perceived barriers to prenatal care. Site-related factors were the most significant,followed by provider/client relationship,inconvenience,fear,and cost. CONCLUSIONS: Although prenatal care is available to all pregnant women in Northeast Florida,barriers to accessing this care for homeless pregnant women are significant and need to be addressed by health care providers and administrators. Additional qualitative study of these issues is warranted.","J Obstet Gynecol Neonatal Nurs,33(4): 428-435","USA",2004,"Not Specified","Not Specified","MBS","Pregnant,Women","PRO study","Cross-sectional"]
[11,"Henley,L.,et al. (1991). \"Bed use in the medical wards of Red Cross War Memorial Children's Hospital,Cape Town.\" S Afr Med J 80(10): 487-490.",null,"Henley,L.,et al.","Bed use in the medical wards of Red Cross War Memorial Children's Hospital,Cape Town","OBJECTIVE: To determine extent of appropriate (medically necessary) and inappropriate bed use and level of care (LOC) needed by patients admitted to hospital. DESIGN: A cross-sectional,descriptive survey. SETTING: Medical wards of Red Cross War Memorial Children's Hospital (RCCH),a teaching hospital of the University of Cape Town. MEASUREMENT AND RESULTS: A 25% sample of beds was selected randomly each day for 12 consecutive days during September-October 1990. Data were collected using a questionnaire based on the Pediatric Appropriateness Evaluation Protocol and the Delay Tool. A subjective measure of LOC was developed. Questionnaires were completed for 171 admissions and 365 patient days; 98% of admissions and 79.5% of patient days were medically justified,and 49% of admissions needed tertiary care. The remaining 51% could have been treated by general paediatricians (17%) or medical officers (32%) in community hospitals. Of delays (unnecessary patient days) 62% were hospital-related,20% were family-related and 18% were related to inadequate lower level institutional care and outpatient services. CONCLUSION: RCCH is functioning as a general,specialist and super-specialist hospital. Its future role as a tertiary referral centre will depend on adequate provision of community-based care. Further cost-benefit research is needed to address areas of inappropriate bed use identified in this study.","S Afr Med J,80(10): 487-490","South Africa",1991,"Not Specified","Hospitalisation","AEP","Children","Resource Use","Cross-sectional"]
[12,"Egan,E. A.,et al. (2015). \"Building the bridge from pediatric to adult diabetes care: making the connection.\" Diabetes Educ 41(4): 432-443.",null,"Egan,E. A.,et al.","Building the bridge from pediatric to adult diabetes care: making the connection","PURPOSE: The purpose of this study was to evaluate the effectiveness of a structured transition program by measuring clinical and psychometric properties related to transition and adherence to follow-up. Transition of emerging adults with type 1 diabetes can be problematic. This natural progression to adult health care is often delayed,leading to transition at less than optimal times. Implementation of a transition program will improve the transition process for emerging adults with type 1 diabetes. METHODS: Mixed-method,prospective longitudinal study involving collaboration between pediatric and adult providers. Subjects age 18 to 28 years were identified for transition. Transition was facilitated via joint appointment with pediatric and adult health care providers. Participants completed pre- and posttransition surveys measuring diabetes-related distress (Diabetes Distress Scale [DDS]),quality of life (Diabetes Quality of Life Youth-Short Form [DQOLY-SF]),and perceived health care provider autonomy support (Health Care Climate Questionnaire [HCCQ]). Primary outcome was adherence to follow-up. Secondary outcomes evaluated correlations in DDS,DQOLY-SF,HCCQ,and A1C. Chart review assessed acute complications,A1C,and adherence to follow-up. RESULTS: Adherence to follow-up was 100%. This study found that correlations between DQOLY-SF and DDS and correlations between DDS and A1C were highly significant during the pretransition phase. This study also indicated that the same correlations were highly significant following transition. Paired t test indicated a statistically significant reduction in diabetes distress from pre- to posttransition evaluations and an increase in HCCQ. Content comparative analysis of open-ended questions further illustrated issues related to transition. CONCLUSION: Use of a structured transition process with joint appointments and transition coordinator improves adherence to follow-up and reduces diabetes-related distress.","Diabetes Educ,41(4): 432-443","USA",2015,"Diabetes","Not Specified","HCCQ","Adults","PRO study","Cohort"]
[13,"Carelle,N.,et al. (2002). \"Changing patient perceptions of the side effects of cancer chemotherapy.\" Cancer 95(1): 155-163.",null,"Carelle,N.,et al.","Changing patient perceptions of the side effects of cancer chemotherapy","BACKGROUND: Quality-of-life (QoL) issues have become increasingly important as the number of newly diagnosed patients with cancer increases and survival improves. In 1983,Coates et al. reported a survey of patient perceptions of the side effects of cancer chemotherapy and showed the importance of including patient feedback for the accurate assessment of QoL (Eur J Cancer Clin Oncol. 1983;19:203-208.). The authors carried out a similar survey in 100 patients with cancer with the objectives of 1) investigating the changes in patient perceptions that have occurred and 2) evaluating the impact of new treatments on the profile of chemotherapy side effects among patients receiving anticancer drugs. METHODS: One hundred patients attending the outpatient Medical Oncology Department of the Pitie Salpetriere Hospital Group were surveyed between August 1998 and February 2000 by trained interviewers who were blinded to the patients' treatment. Patients identified all side effects associated with their treatment using a set of 45 cards that named physical side effects (Group A) and a set of 27 cards that named nonphysical side effects (Group B),and the patients ranked these side effects according to severity. The top 5 cards from each group were then combined,and the resulting 10 cards were rated again by severity,regardless of group. Results were analyzed for the entire cohort and for demographic,social,and clinical subgroups. RESULTS: The participants included 65 women and 35 men; the most common malignancies were breast carcinoma (40 patients),gastrointestinal carcinoma (19 patients),lung carcinoma (7 patients),and ovarian carcinoma (9 patients). Patients rated affects my family or partner as the most severe side effect,alopecia was second,and fatigue was the third most severe. Effects on work or home responsibilities,effects on social activities,and loss of interest in sex were ranked fourth,fifth,and sixth,respectively. The results contrasted with those of Coates et al.,in which affects my family or partner was ranked 10th,and fatigue was ranked 8th. CONCLUSIONS: Patient perceptions of the side effects of cancer chemotherapy have changed markedly. In the current study,fatigue and psychosocial QoL concerns predominated,compared with emesis,nausea,and negative reactions to the treatment visit in the original survey. The current findings are consistent with the progress that has been made in reducing certain chemotherapy-associated toxicities. Fatigue,however,although it often is related to anemia and is treatable with recombinant human erythropoietin,remains a major concern. The emotional,social,and sexual consequences of cancer treatment present continuing challenges in efforts to optimize QoL and to develop effective supportive care.","Cancer,95(1): 155-163","France,USA",2002,"Cancer","Chemotherapy","PPS","Adults","PRO study","Cross-sectional"]
[14,"Chen,J. Y.,et al. (2016). \"Clinical and patient-reported outcomes of Chinese patients undergoing haemodialysis in hospital or in the community: A 1-year longitudinal study.\" Nephrology (Carlton) 21(7): 617-623.",null,"Chen,J. Y.,et al.","Clinical and patient-reported outcomes of Chinese patients undergoing haemodialysis in hospital or in the community: A 1-year longitudinal study","AIM: Little is known about the effect of haemodialysis (HD) setting on outcomes of patients with end stage renal disease (ESRD). The study aimed at comparing clinical outcomes and patient-reported outcomes (PRO) of patients on community-based (CBHD) and hospital-based haemodialysis (HBHD). METHODS: A prospective cohort of Chinese ESRD patients receiving HBHD (n = 89) or CBHD (n = 117) in Hong Kong were followed up for 12 months. Subjects were assessed on clinical outcomes of dialysis adequacy (Kt/V) and blood haemoglobin and PRO of health-related quality of life (SF-12v2),general health condition (Global Rating Scale (GRS)) and confidence to cope with their illness (Patient Enablement Instrument (PEI)). Differences between groups were analyzed by independent t-tests for the SF-12v2,GRS and PEI scores. chi(2) tests were used to analyze the difference in proportion of patients reaching the targets of Kt/V and blood haemoglobin and with GRS > 0 and PEI > 0. Multiple linear and logistic regressions were performed to assess the adjusted difference-in-difference estimation. RESULTS: The mean PEI and GRS scores of CBHD patients at 12 months were significantly higher than those of HBHD patients. CBHD patients had significantly greater improvement in self-efficacy and were more likely to be enabled after 12 months than the HBHD patients. CONCLUSION: The study showed similar clinical outcomes and PRO between CBHD and HBHD but CBHD was more effective than HBHD in promoting patient enablement over a 12-month period. The results suggest added value for patients receiving CBHD and support the transfer of HD care from the hospital to the community.","Nephrology (Carlton),21(7): 617-623","China",2016,"Renal Disease","Haemodialysis","PEI","Not Specified","PRO study","Cross-sectional"]
[15,"Mort,E. A. (1996). \"Clinical decision-making in the face of scientific uncertainty: hormone replacement therapy as an example.\" J Fam Pract 42(2): 147-151.",null,"Mort,E. A.","Clinical decision-making in the face of scientific uncertainty: hormone replacement therapy as an example","There is widespread variation in the prescribing patterns of postmenopausal hormone replacement therapy. While some degree of variation is expected,the systematic variation according to geographic region,physician gender,and medical specialty raises questions about how clinical decisions are made. This paper explores the determinants of these practice patterns,specifically the contribution of patients' preferences,scientific uncertainty,and physicians' recommendations. A role for collaborative decision-making is described and the use of decision-support tools is discussed. The primary care setting is proposed as the ideal context in which to study collaborative decision-making. Additional research is needed to more fully elucidate the value of collaborative decision-making with respect to clinical and quality-of-life outcomes,patient satisfaction with decision-making,and costs.","J Fam Pract,42(2): 147-151","USA",1996,"Menopause","Hormone replacement therapy","SWD","Women","PRO study","Cross-sectional"]
[16,"Santos-Eggimann,B.,et al. (1997). \"Comparing results of concurrent and retrospective designs in a hospital utilization review.\" Int J Qual Health Care 9(2): 115-120.",null,"Santos-Eggimann,B.,et al.","Comparing results of concurrent and retrospective designs in a hospital utilization review","Hospital utilization reviews are performed on the basis of lists of explicit criteria,such as the Appropriateness Evaluation Protocol,both concurrently and retrospectively,in an increasing number of settings as part of efforts to improve the performance of hospitals and to reduce health care costs. Retrospective data collection has advantages in terms of expenses and ease of sampling,but relies on the quality of medical records. We report on a comparison between concurrent and retrospective data collection performed simultaneously and independently by two reviewers on the same hospital stays in the regional St-Loup Hospital. Results suggest that retrospective data collection produces higher rates of inappropriate hospital utilization,due to a limited number of criteria that are recorded concurrently,but are not found in the retrospective reading of medical records. These results should encourage a further investigation of the comparability between concurrent and retrospective designs in other settings.","Int J Qual Health Care,9(2): 115-120","Switzerland",1997,"Not Specified","Hospitalisation","AEP","Adults","Resource Use","Cross-sectional"]
[17,"VandenBergh,M. F.,et al. (1996). \"Cost-effectiveness of perioperative mupirocin nasal ointment in cardiothoracic surgery.\" Infect Control Hosp Epidemiol 17(12): 786-792.",null,"VandenBergh,M. F.,et al.","Cost-effectiveness of perioperative mupirocin nasal ointment in cardiothoracic surgery","OBJECTIVE: To assess the cost-effectiveness of perioperative intranasal application of mupirocin calcium ointment in cardiothoracic surgery. DESIGN: Cost-effectiveness analysis based on results of an intervention study with historical controls. SETTING: University Hospital Rotterdam,a tertiary referral center for cardiac and pulmonary surgery. PATIENTS: Consecutive patients undergoing cardiothoracic surgery between August 1,1989,and February 1,1991 (control group,n = 928),and between March 1,1991,and August 1,1992 (intervention group,n = 868). INTERVENTION: Perioperative nasal application of mupirocin calcium ointment started on the day before surgery,continued for 5 days,twice daily. RESULTS: Postoperative costs were increased significantly in patients with a surgical-site infection (SSI),compared with uninfected patients (P < .001). Mean SSI-attributable costs were estimated at $16,878 (95% confidence interval,$15,575-$18,181). The incidence of SSIs was 7.3% in the control group and 2.8% in the intervention group,mupirocin effectiveness being 62%. The costs of mupirocin were $11 per patient. Thus,the savings per SSI prevented were $16,633. To validate this comparative estimate of SSI-attributable costs,a noncomparative analysis of the postoperative length of stay (POLS) was performed,according to the Appropriateness Evaluation Protocol. Approximately 50% of the comparative SSI-attributable POLS were judged SSI-attributable in the noncomparative analysis. Sensitivity analyses,testing for the robustness of our conclusions,indicated that the presented model is rather insensitive to variations in the incidence of SSIs and for the effectiveness and costs of mupirocin. SSI-attributable costs were shown to be the only variable with substantial effect on the cost-effectiveness ratio. Perioperative mupirocin would result in net costs instead of savings only if SSI-attributable costs were less than $245. CONCLUSIONS: SSIs in patients undergoing cardiothoracic surgery are associated with a substantial increase in postoperative costs. Provided that perioperative mupirocin reduces the SSI rate,this measure will be highly cost-effective in most centers providing cardiothoracic surgical services.","Infect Control Hosp Epidemiol,17(12): 786-792","Netherlands",1996,"Cardiovascular","Surgery","AEP","Adults","Costs","Cross-sectional"]
[18,"Stacey,D.,et al. (2012). \"Decision coaching to prepare patients for making health decisions: a systematic review of decision coaching in trials of patient decision AIDS.\" Med Decis Making 32(3): E22-33.",null,"Stacey,D.,et al.","Decision coaching to prepare patients for making health decisions: a systematic review of decision coaching in trials of patient decision AIDS","BACKGROUND: Decision coaching is individualized,nondirective facilitation of patient preparation for shared decision making. PURPOSE: To explore characteristics and effectiveness of decision coaching evaluated within trials of patient decision aids (PtDAs) for health decisions. DATA SOURCES: A subanalysis of trials included in the 2011 Cochrane Review of PtDAs. STUDY SELECTION: Eligible trials allowed the effectiveness of decision coaching to be compared with another intervention and/or usual care. DATA EXTRACTION: Two reviewers independently screened 86 trials,extracted data,and appraised quality. DATA SYNTHESIS: Ten trials were eligible. Decision coaching was provided by genetic counselors,nurses,pharmacists,physicians,psychologists,or health educators. Coaching compared with usual care (n = 1 trial) improved knowledge. Coaching plus PtDA compared with usual care (n = 4) improved knowledge and participation in decision making without reported dissatisfaction. Coaching compared with PtDA alone (n = 4) increased values-choice agreement and improved satisfaction with the decision-making process without any difference in knowledge or participation in decision making. Coaching plus PtDA compared with PtDA alone (n = 4) had no difference in knowledge,values-choice agreement,participation in decision making,or satisfaction with the process. Decision coaching plus PtDA was more cost-effective compared with PtDA alone or usual care (n = 1). LIMITATIONS: Methodological quality,number of trials,and description of decision coaching. CONCLUSIONS: Compared with usual care,decision coaching improved knowledge. However,the improvement in knowledge was similar when coaching was compared with PtDA alone. Outcomes for other comparisons are more variable,some trials showing positive effects and other trials reporting no difference. Given the small number of trials and variability in results,further research is required to determine the effectiveness of decision coaching.","Med Decis Making,32(3): E22-33","Canada",2012,"Not Specified","Decision Aids","SWD","Not Specified","Systematic Review","Systematic Review"]
[19,"Wallace,P.,et al. (2002). \"Design and performance of a multi-centre randomised controlled trial and economic evaluation of joint tele-consultations [ISRCTN54264250].\" BMC Fam Pract 3: 1.",null,"Wallace,P.,et al.","Design and performance of a multi-centre randomised controlled trial and economic evaluation of joint tele-consultations [ISRCTN54264250]","BACKGROUND: Appropriate information flow is crucial to the care of patients,particularly at the interface between primary and secondary care. Communication problems can result from inadequate organisation and training,There is a major expectation that information and communication technologies may offer solutions,but little reliable evidence. This paper reports the design and performance of a multi-centre randomised controlled trial (RCT),unparalleled in telemedicine research in either scale or range of outcomes. The study investigated the effectiveness and cost implications in rural and inner-city settings of using videoconferencing to perform joint tele-consultations as an alternative to general practitioner referral to the hospital specialist in the outpatient clinic. METHODS: Joint tele-consultation services were established in both the Royal Free Hampstead NHS Trust in inner London,and the Royal Shrewsbury Hospitals Trust,in Shropshire. All the patients who gave consent to participate were randomised either to joint tele-consultation or to a routine outpatients appointment. The principal outcome measures included the frequency of decision by the specialist to offer a follow-up outpatient appointment,patient satisfaction (Ware Specific Questionnaire),wellbeing (SF12) and enablement (PEI),numbers of tests,investigations,procedures and treatments. RESULTS: A total of 134 general practitioners operating from 29 practices participated in the trial,referring a total of 3170 patients to 20 specialists in ENT medicine,general medicine (including endocrinology,and rheumatology),gastroenterology,orthopaedics,neurology and urology. Of these,2094 patients consented to participate in the study and were correctly randomised. There was a 91% response rate to the initial assessment questionnaires,and analysis showed equivalence for all key characteristics between the treatment and control groups. CONCLUSION: We have designed and performed a major multi-centre trial of teleconsultations in two contrasting centres. Many problems were overcome to enable the trial to be carried out,with a considerable development and learning phase. A lengthier development phase might have enabled us to improve the patient selection criteria,but there is a window of opportunity for these developments,and we believe that our approach was appropriate,allowing the evaluation of the technology before its widespread implementation.","BMC Fam Pract,3(1","UK",2002,"Not Specified","Tele-communications","PEI","Not Specified","Costs","RCT"]
[20,"Loblaw,D. A.,et al. (1999). \"Development and testing of a visit-specific patient satisfaction questionnaire: the Princess Margaret Hospital Satisfaction With Doctor Questionnaire.\" J Clin Oncol 17(6): 1931-1938.",null,"Loblaw,D. A.,et al.","Development and testing of a visit-specific patient satisfaction questionnaire: the Princess Margaret Hospital Satisfaction With Doctor Questionnaire","PURPOSE: To develop a psychometrically sound patient-satisfaction-with-physician questionnaire that can be used in an outpatient oncology setting. PATIENTS AND METHODS: The questionnaire was developed by a four-step process involving a total of 277 cancer patients. The item-generation process utilized input from 95 oncology outpatients,three medical researchers,and the relevant literature. Items were tested by 70 of the above patients. Initial item reduction was achieved by input from another eight patients. Factor analysis and validity testing used data derived from a different group of 174 oncology outpatients. Convergent validity was tested by correlating the Princess Margaret Hospital Patient Satisfaction with Doctor Questionnaire (PMH/PSQ-MD) with Rubin et al's Physician subscale of the Patient's Viewpoint Questionnaire (PS-PVQ) and Smith et al's Patient-Doctor Interaction Scale (PDIS). Divergent validity was tested by comparing these questionnaires with Spitzer's quality of life (QOL) questionnaire. RESULTS: The final PMH/PSQ-MD is a 29-item self-administered questionnaire with four response categories and a \"does not apply\" category. Four domains were confirmed by factor analysis: (1) information exchange,(2) interpersonal skills,(3) empathy,and (4) quality of time. The questionnaire has an overall Cronbach's alpha of 0.97; the values for each domain are,respectively,0.92,0.90,0. 88,and 0.88. The PMH/PSQ-MD correlated well with both the PDIS and the PS-PVQ (P <.001 for both). Divergent validity was confirmed with Spitzer's QOL questionnaire. CONCLUSION: The PMH/PSQ-MD is an outpatient satisfaction questionnaire specific to the patient-physician interaction that has shown excellent internal consistency,is feasible,and has strong support for validity in this oncology population.","J Clin Oncol,17(6): 1931-1938","Canada",1999,"Cancer","Not Specified","PDIS,PS-PVQ","Adults,Elderly","Tool Validation","Cross-sectional"]
[21,"Fujishima-Hachiya,A. and T. Inoue (2012). \"Development and validation of a disease-specific scale to assess psychosocial well-being of patients living with unruptured intracranial aneurysm.\" J Neurosci Nurs 44(6): 317-328.",null,"Fujishima-Hachiya,A. and T. Inoue","Development and validation of a disease-specific scale to assess psychosocial well-being of patients living with unruptured intracranial aneurysm","Although the detection rate for unruptured intracranial aneurysm (UIA) has improved since the 1990s,the quality of life and psychosocial status of patients living with UIA have been negatively affected. However,a comprehensive assessment tool for UIA patients is still awaited. This study aimed to develop and validate a disease-specific scale to assess UIA patients' psychosocial well-being in their daily lives. On the basis of previous qualitative research,52 items on a six-dimension scale were generated. After a pilot study,statistical analysis was conducted to examine construct validity-including convergent validity,discriminant and known-group validity,and internal reliability. Between 2010 and 2011,124 patients across three hospitals in Japan were tested using a tentative scale. As a result of exploratory factor analysis,we identified 25 items based on five conceptually derived dimensions (psychological stability,trust in healthcare resources,satisfaction with the decision-making process,positive perception of self-management,and confidence in UIA knowledge) as a final psychosocial well-being scale for UIA patients (UIA-PW scale). Cronbach's alpha coefficients for each subscale ranged between .76 and .90,with .83 for the total score,which indicated satisfactory internal consistency. The total score for the UIA-PW scale correlated significantly with the existing quality of life and mental health scales,but it is important to note that psychological stability and positive perception of self-management were negatively correlated. Although additional investigation is needed,the UIA-PW scale shows reasonable validity and reliability in assessing psychosocial well-being of patients living with UIA.","J Neurosci Nurs,44(6): 317-328","Japan",2012,"Intracranial Aneurysm","Not Specified","SWD","Not Specified","Tool Validation","Clinical Trial"]
[22,"Wan,E. Y.,et al. (2017). \"Effectiveness of a multidisciplinary risk assessment and management programme-diabetes mellitus (RAMP-DM) on patient-reported outcomes.\" Endocrine 55(2): 416-426.",null,"Wan,E. Y.,et al.","Effectiveness of a multidisciplinary risk assessment and management programme-diabetes mellitus (RAMP-DM) on patient-reported outcomes","Little is known about how the patient-reported outcomes is influenced by multidisciplinary-risk-assessment-and-management-programme for patients with diabetes mellitus (RAMP-DM). This paper aims to evaluate the effectiveness of RAMP-DM on patient-reported outcomes. This was a prospective longitudinal study on 1039 diabetes mellitus patients (714/325 RAMP-DM/non-RAMP-DM) managed in primary care setting. 536 and 402 RAMP-DM participants,and 237 and 187 non-RAMP-DM participants were followed up at 12 and 24 months with completed survey,respectively. Patient-reported outcomes included health-related quality of life,change in global health condition and patient enablement measured by Short Form-12 Health Survey version-2 (SF-12v2),Global Rating Scale,Patient Enablement Instrument respectively. The effects of RAMP-DM on patient-reported outcomes were evaluated by mixed effect models. Subgroup analysis was performed by stratifying haemoglobin A1c (HbA1c) (optimal HbA1c < 7 % and suboptimal HbA1c >/= 7 %). RAMP-DM with suboptimal HbA1c was associated with greater improvement in SF-12v2 physical component summary score at 12-month (coefficient:3.80; P-value < 0.05) and 24-month (coefficient:3.82;P-value < 0.05),more likely to feel more enabled at 12-month (odds ratio: 2.57; P-value < 0.05),and have improved in GRS at 24-month (odds ratio:4.05; P-value < 0.05) compared to non-RAMP-DM participants. However,there was no significant difference in patient-reported outcomes between RAMP-DM and non-RAMP-DM participants with optimal HbA1c. Participation in RAMP-DM is effective in improving physical component of HRQOL,Global Rating Scale and patient enablement among diabetes mellitus patients with suboptimal HbA1c,but not in those with optimal HbA1c. Patients with sub-optimal diabetes mellitus control should be the priority target population for RAMP-DM. This observational study design may have potential bias in the characteristics between groups,and randomized clinical trial is needed to confirm the results.","Endocrine,55(2): 416-426","China",2017,"Diabetes","Risk-assessment and Management","PEI","Not Specified","PRO study","Cohort"]
[23,"Tavakoli,N.,et al. (2015). \"Evaluation of Appropriate and Inappropriate Admission and Hospitalization Days According to Appropriateness Evaluation Protocol (AEP).\" Arch Iran Med 18(7): 430-434.",null,"Tavakoli,N.,et al.","Evaluation of Appropriate and Inappropriate Admission and Hospitalization Days According to Appropriateness Evaluation Protocol (AEP)","BACKGROUND: Inappropriate admission and hospitalization days are the factors that impose more costs to hospitals. By considering current condition of hospitals,it is vital to have an insight into the data on inappropriate admission and hospitalization days in order to eliminate obstacles to the proper and appropriate hospitalization. METHODS: In this study,198 patients who were admitted to receive surgical or non-surgical treatment in Sina public hospital were selected. An appropriateness Evaluation Protocol (AEP) was used for data collection. The validity of AEP is well established by the preceding studies. In order to achieve the study objectives,binary logistic regression test was used. RESULTS: According to our findings,39.4% of hospitalization days and 16.2% of admissions are inappropriate. In this study,inappropriate admission was observed among married patients eight times more than among single ones. Inappropriate hospitalization days were 12 times more prevalent among patients from provinces than among those from Tehran. With increasing age of the patient the probability of inappropriate admission decreases slightly,i.e. the probability of inappropriate admission decreases 10% as the age increases one year. The number of hospitalization days was significantly correlated to the following parameters: type of admission,patient's city of residence,type of treatment,and length of stay (P < 0.05). CONCLUSION: Regarding the results of this study,a large number of admissions and specially hospitalization days are inappropriate. According to other studies,with suitable programming many inappropriate admissions and hospitalization days are preventable.","Arch Iran Med,18(7): 430-434","Iran",2015,"Not Specified","Hospitalisation","AEP","Not Specified","Resource Use","Cross-sectional"]
[24,"Wong,C. K.,et al. (2016). \"Evaluation of patient-reported outcomes data in structured diabetes education intervention: 2-year follow-up data of patient empowerment programme.\" Endocrine 54(2): 422-432.",null,"Wong,C. K.,et al.","Evaluation of patient-reported outcomes data in structured diabetes education intervention: 2-year follow-up data of patient empowerment programme","To examine the effects of a structured group-based education programme,patient empowerment programme (PEP),compared with usual care on 2-year changes in patient-reported outcomes (PRO) in patients with diabetes mellitus (DM). A prospective observational study of 715 patients (PEP/non-PEP: 390/325) was conducted to complete the baseline PRO survey and followed up for 2 years. Health-related quality of life (HRQOL) was measured using the short-form 12 at baseline and annually at two follow-up assessments,which yielded physical and mental component summary and SF-6D preference-based scores. Perceived control over diabetes and general health status were measured using the patient enablement instrument (PEI) and global rating scale (GRS) at follow-ups. When compared with non-PEP,PEP participants significantly reported improvement in health condition (GRS score > 0; 24.55 % vs 10.16 %; odds ratio = 2.502; P = 0.018) in 2 years and enabled the self-perceived control over diabetes (PEI score > 0; 72.20 % vs 38.40 %; odds ratio = 3.25; P < 0.001) in 1-year follow-up but no sustained effects in year 2 (52.65 % vs 39.04 %; odds ratio = 1.366; P = 0.265). There were no significant differences between PEP and non-PEP groups in the changes in quality of life scores (all P > 0.05) at 1 year. Although HRQOL scores deteriorated over 2-year period in both groups,PEP participants reported similar changes in HRQOL scores to that of non-PEP. PEP for DM patients preserved self-perceived disease control and health condition,whereas PEP participants perceived their HRQOL similar to that of non-PEP participants. Findings of PRO should be considered alongside clinical outcomes when evaluating the overall benefits of PEP.","Endocrine,54(2): 422-432","China",2016,"Diabetes","Empowerment Program","PEI","Not Specified","PRO study","Cross-sectional"]
[25,"Chang,P.,et al. (2011). \"Expanded prostate cancer index composite for clinical practice: development and validation of a practical health related quality of life instrument for use in the routine clinical care of patients with prostate cancer.\" J Urol 186(3): 865-872.",null,"Chang,P.,et al.","Expanded prostate cancer index composite for clinical practice: development and validation of a practical health related quality of life instrument for use in the routine clinical care of patients with prostate cancer","PURPOSE: Measuring the health related quality of life of patients with prostate cancer in routine clinical practice is hindered by the lack of instruments enabling efficient,real-time,point of care scoring of multiple health related quality of life domains. Thus,we developed an instrument for this purpose. MATERIALS AND METHODS: The Expanded Prostate Cancer Index Composite for Clinical Practice is a 1-page,16-item questionnaire that we constructed to measure urinary incontinence,urinary irritation,and the bowel,sexual and hormonal health related quality of life domains. We eliminated conceptually overlapping items from the 3-page Expanded Prostate Cancer Index Composite-26 and revised the questionnaire format to mirror the AUA symptom index,thereby enabling practitioners to calculate health related quality of life scores at the point of care. We administered the Expanded Prostate Cancer Index Composite for Clinical Practice to a new cohort of patients with prostate cancer in community based and academic oncology,radiation,and urology practices to evaluate instrument validity as well as ease of use in clinical practice. RESULTS: A total of 175 treated and 132 untreated subjects with prostate cancer completed the Expanded Prostate Cancer Index Composite for Clinical Practice. The domain scores of the Expanded Prostate Cancer Index Composite for Clinical Practice correlated highly with the respective domain scores from longer versions of the Expanded Prostate Cancer Index Composite (r>/=0.93 for all domains). The Expanded Prostate Cancer Index Composite for Clinical Practice showed high internal consistency (Cronbach's alpha 0.64-0.84) and sensitivity to prostate cancer treatment related effects (p<0.05 in each of 5 health related quality of life domains). Patients completed the Expanded Prostate Cancer Index Composite for Clinical Practice efficiently (96% in less than 10 minutes and with 11% missing items). It was deemed very convenient by clinicians in 87% of routine clinical encounters and clinicians accurately scored completed questionnaires 94% of the time. CONCLUSIONS: The Expanded Prostate Cancer Index Composite for Clinical Practice is a valid instrument that enables patient reported,health related quality of life to be measured efficiently and accurately at the point of care,and thereby facilitates improved emphasis and management of patient reported outcomes.","J Urol,186(3): 865-872","USA",2011,"Cancer","Not Specified","PEI","Adults,Elderly","Tool Validation","Cross-sectional"]
[27,"Merom,D.,et al. (1998). \"Factors associated with inappropriate hospitalization days in internal medicine wards in Israel: a cross-national survey.\" Int J Qual Health Care 10(2): 155-162.",null,"Merom,D.,et al.","Factors associated with inappropriate hospitalization days in internal medicine wards in Israel: a cross-national survey","BACKGROUND: The high costs of health care mandate a quality control system that ensures efficient utilization of hospitalization days. OBJECTIVES: To obtain a national estimate of the rate of inappropriate hospitalization days in medical wards and to identify the variables associated with inappropriateness. DESIGN: A 1-day cross-national survey. SETTING: A sample of internal medicine wards in all public hospitals in Israel. SURVEY POPULATION: The survey population included all patients hospitalized in the ward for at least 24 hours on the survey day. INSTRUMENTS: We used an adapted version of the appropriateness evaluation protocol (AEP) (Gertman and Restuccia). Reviewers were final year medical students trained to work with the AEP. Final classification of inappropriate days was done by one of the senior investigators. OUTCOME MEASURE: Utilization of hospitalization days according to the AEP. RESULTS: A total of 1003 hospitalization days in 33 medical wards in 24 hospitals was surveyed. Of this,182 (18.1%) of the days were found to be inappropriate. In multiple logistic regression analysis,variables significantly associated with inappropriate days were government versus other hospital ownership (OR,1.51; CI,1.15-1.96),diagnosis on admission of acute cardiac event versus other diagnosis (OR,0.46; CI,0.27-0.77),and period (first,second or final third) of the stay (OR,1.61; CI,1.29-2.03). In 62.6% of the 'inappropriate days',continuation of hospitalization was justified (72% were patients awaiting tests or consultation). In 6.7% of the total days surveyed,no justification for continuation of hospitalization was found. CONCLUSION: The percentage of inappropriate days found in this study is similar to the means found in studies that were conducted in other countries. Awaiting procedures and consultation is a major cause of inappropriate days and may be an important target for intervention.","Int J Qual Health Care,10(2): 155-162","Israel",1998,"Not Specified","Hospitalisation","AEP","Adults","Resource Use","Cross-sectional"]
[28,"Menand,E.,et al. (2015). \"French Multicenter Evaluation of the Appropriateness of Admission to the Emergency Department of the Over-80s.\" J Nutr Health Aging 19(6): 681-687.",null,"Menand,E.,et al.","French Multicenter Evaluation of the Appropriateness of Admission to the Emergency Department of the Over-80s","BACKGROUND: Persons over 80 represents 40% of patients in French emergency services. We assessed the appropriateness of these admissions and sought to identify risk factors for inappropriate hospital stays. METHODS: The appropriateness of admission was assessed in a prospective,cross-sectional,multicenter study in eight hospitals in France by means of the Appropriateness Evaluation Protocol (French version,AEPf) during two non-consecutive periods of four weeks in 2010. We analyzed admission of patients aged 80 and over who were admitted to the hospital after a stay in the emergency department of the same hospital. Demographics and morbidity factors were recorded as were administrative hospitalization data to identify risk factors associated with inappropriate admissions. We also evaluated the economic impact of inappropriate admissions. For cost analysis,all variables were obtained from anonymized hospital reports of a diagnosis-related group system used for funding of the hospitals by health insurance. RESULTS: During two different periods,1577 patients were included. 139 (8.8%) hospital admissions were inappropriate according to explicit criteria of the AEPf,but 18 of these (1.1%) were in fact considered appropriate by the physician responsible for the admission,leading to 121 (7.7%) inappropriate admissions. Multivariate logistic regression showed that patients with heart disease were less often subject to inappropriate admission (odds ratio OR= 0.36 [0.23; 0.56],p < 0.001),as also were patients who usually lived in a nursing home (OR = 0.53 [0.30; 0.87],p = 0.018) and patients with higher Acute Physiology Scores (OR = 0.97 [0.95; 0.99],p < 0.001). Inappropriate admission increased when patients had a syndrome as the main diagnosis (OR = 1.81 [1.81; 2.83],p = 0.010). By contrast,cognitive functions,gait and balance disturbance or falls,behavioral disorders and method of transport to the emergency department did not change the probability of inappropriateness. The median cost of the hospital stay of an older patient was 3 606.5 [2 498.1; 4 994.2] euros for inappropriate admissions. CONCLUSION: Inappropriate emergency admissions of older patients were infrequent. None of the geriatric syndromes were linked with the phenomenon and principle causes were severity of illness,mention of a cardiac disease,unclear pattern of consultation and institutionalized way of life.","J Nutr Health Aging,19(6): 681-687","France",2015,"Not Specified","Hospitalisation","AEP","Elderly","Resource Use","Cross-sectional"]
[29,"ten Klooster,P. M.,et al. (2012). \"Further validation of the 5-item Perceived Efficacy in Patient-Physician Interactions (PEPPI-5) scale in patients with osteoarthritis.\" Patient Educ Couns 87(1): 125-130.",null,"ten Klooster,P. M.,et al.","Further validation of the 5-item Perceived Efficacy in Patient-Physician Interactions (PEPPI-5) scale in patients with osteoarthritis","OBJECTIVE: To examine the structural validity,internal consistency,test-retest reliability,and construct validity of the 5-item Perceived Efficacy in Patient-Physician Interactions (PEPPI-5) scale in patients with osteoarthritis (OA). METHODS: A cross-sectional sample of 224 outpatients with OA completed a survey containing the Dutch PEPPI-5 and other standardized measures assessing perceived health-management skills,general self-efficacy,social support,and health-related quality of life. A subsample of 100 patients completed the PEPPI-5 again approximately 3 weeks later. RESULTS: Confirmatory factor analysis demonstrated good fit for a unidimensional model of the PEPPI-5. Additionally,the scale showed high internal consistency (alpha=0.92) and fair test-retest reliability (ICC=0.68). As hypothesized,the PEPPI-5 was strongly correlated with perceived health-management skills,moderately with social support and psychosocial aspects of health,and not with physical aspects of health. Contrary to expectations,however,it was not correlated with general self-efficacy. CONCLUSION: The Dutch PEPPI-5 demonstrated adequate validity and reliability in patients with OA. PRACTICE IMPLICATIONS: The PEPPI-5 is a brief and appropriate tool for measuring self-efficacy of patients with OA to interact with their physicians. Additional research into its sensitivity to change is needed before it can be confidently recommended as an outcome measure in intervention studies.","Patient Educ Couns,87(1): 125-130","Netherlands",2012,"Osteoarthritis","Not Specified","PEPPI-5","Adults","Tool Validation","Cross-sectional"]
[30,"van Andel,P.,et al. (2003). \"Group cohesion and working alliance: prediction of treatment outcome in cardiac patients receiving cognitive behavioral group psychotherapy.\" Psychother Psychosom 72(3): 141-149.",null,"van Andel,P.,et al.","Group cohesion and working alliance: prediction of treatment outcome in cardiac patients receiving cognitive behavioral group psychotherapy","BACKGROUND: Various definitions of both group cohesion and working alliance are used in theories on group psychotherapy,making the study of their relative contribution to the treatment outcome difficult. In this study,two different,nonoverlapping questionnaires were used to explore the relationship between group cohesion,working alliance and treatment outcome in a time-limited,structured cognitive behavioral group psychotherapy aiming at the reduction of coronary risk factors. METHODS: After having undergone percutaneous transluminal coronary angioplasty,42 patients were treated with the aim to reduce exhaustion,anxiety,hostility and depression. The newly developed Group Cohesion Questionnaire (GCQ) and the Helping Alliance Questionnaire (HAQ-II,measuring the bond between individual patients and the group psychotherapist) were administered after the fifth and tenth treatment session. Exhaustion,quality of life,anxiety,blood pressure and heart rate were measured before and after treatment. To test the relationship between the GCQ,the HAQ-II and outcome variables,Pearson Product-Moment correlations and hierarchical regression was applied. RESULTS: Principal Component Analysis of the GCQ yielded two dimensions,the bond with the group as a whole and the bond with other group members. Hierarchical regression showed that both the bond with other group members and working alliance contributed significantly and independently to the prediction of posttreatment systolic and diastolic blood pressure as well as posttreatment quality of life (confidence). CONCLUSIONS: Conceptually and empirically,group cohesion and the working alliance may be considered to represent different relationships in a psychotherapy group,contributing in different ways to the treatment outcome in cardiac patients receiving cognitive behavioral group psychotherapy.","Psychother Psychosom,72(3): 141-149","Netherlands",2003,"Heart Disease","Cognitive Therapy","GCQ,HAQ-II","Adults","PRO study","Cross-sectional"]
[31,"Visaya,M. A. (2010). \"Hemodialysis patients' perceptions of home hemodialysis and self-care.\" Cannt j 20(2): 23-28.",null,"Visaya,M. A.","Hemodialysis patients' perceptions of home hemodialysis and self-care","Home hemodialysis (HHD) is an optimal option for patients requiring renal replacement therapy. It has been noted through research that this type of therapy is more cost-effective than in-centre therapies,and the benefits to patients are well documented (Harwood & Leitch,2006). As stated by the Ministry of Health and Long-Term Care (MoHLTC),a total of 40% of renal failure patients are expected to do home dialysis (either peritoneal dialysis or HHD) by the year 2010 (Kashani & Motiwala,2007). Even though the literature indicates that the numbers of those doing home dialysis are declining every year,there is no evidence to demonstrate why the numbers are declining. A quantitative cross-sectional descriptive study was conducted using the Patient Perception Survey and the Jo Pre-Training Assessment Tool (JPAT) to assess in-centre hemodialysis patients' perceptions regarding home dialysis,as well as their self-care ability. The two frameworks utilized were the Theory of Planned Behavior and Orem's Theory of Self-Care. According to the Theory of Planned Behavior,the 26 patients out of 49 who had positive perceptions regarding home dialysis would be expected to participate in home dialysis. However,according to the patients' responses to the domains within the JPAT,only eight out of the 26 would be considered suitable to participate in home dialysis. Only two of the domains,communication and social support,were found to be significantly related to patients'perceptions regarding home dialysis. Health care professionals need to implement interventions that incorporate assessment of communication and social support when addressing home dialysis therapy with a patient with end-stage renal disease (ESRD).","Cannt j,20(2): 23-28","Canada",2010,"Renal Disease","Haemodialysis","PPS","Adults,Elderly","PRO study","Cross-sectional"]
[32,"Martinez-Mas,E.,et al. (1994). \"How many days of hospitalization for an appendectomy?\" Int J Qual Health Care 6(4): 347-352.",null,"Martinez-Mas,E.,et al.","How many days of hospitalization for an appendectomy?","The length of stay (LOS) of a surgical procedure is influenced both by the real need for medical and nursing care of the patient and also by the practice style of each unit,which can include unjustified stays. The aim of this work was to estimate the appropriate LOS for appendectomy and its differences with the LOS observed in practice. Two hundred and forty-nine medical records (249 admission days and 1447 successive stays) for patients over 6 years old who had had an appendectomy in 1992 were classified by Diagnosis Related Groups (DRG) and reviewed using the Appropriateness Evaluation Protocol. 1.6% of admission days and 31.7% of successive stays were assessed inappropriate. The appropriate LOS for appendectomy was 4.7 days as opposed to 6.8 days of observed LOS. For the DRG 167 (76.3% of the sample) appropriate LOS was 3.4 days (observed LOS 4.9 days). These results suggest the existence of an important proportion of avoidable hospital stays and provides a simple and low cost methodology for assessing the suitability of local hospitalization practices.","Int J Qual Health Care,6(4): 347-352","Spain",1994,"Not Specified","Appendectomy","AEP","Adults","Resource Use","Cross-sectional"]
[33,"Rosenfeld,R. M.,et al. (2000). \"Impact of tympanostomy tubes on child quality of life.\" Arch Otolaryngol Head Neck Surg 126(5): 585-592.",null,"Rosenfeld,R. M.,et al.","Impact of tympanostomy tubes on child quality of life","BACKGROUND: The objective benefits of tympanostomy tubes for otitis media are well established,but the subjective impact of surgery on child quality of life (QOL) has not been systematically studied. OBJECTIVES: To determine the subjective impact of tympanostomy tubes on child QOL,and to compare the variability in QOL before surgery with that observed after surgery. DESIGN: Prospective,observational,before-and-after trial. SETTING: Fourteen referral-based pediatric otolaryngology practices in the United States. PATIENTS: Consecutive (64%) and convenience (36%) sample of 248 children (median age,1.4 years) with otitis media scheduled for bilateral tympanostomy tube placement as an isolated surgical procedure. INTERVENTION: Tympanostomy tubes were inserted as part of routine clinical care. Validated measures of QOL (OM-6 survey),satisfaction with health care decision (Satisfaction With Decision Scale),and satisfaction with office visit; surveys were completed at baseline (visit 1),at surgery (visit 2),and after surgery (visit 3). MAIN OUTCOME MEASURES: Short-term changes in QOL before surgery (visit 1 to visit 2) and after surgery (visit 2 to visit 3). RESULTS: Changes in QOL before surgery were mostly trivial,and were smaller than changes observed after surgery (P<.001). Large,moderate,and small improvements in QOL occurred after surgery in 56%,15%,and 8% of children,respectively. Physical symptoms,caregiver concerns,emotional distress,and hearing loss were most improved,but significant changes were also seen for activity limitations and speech impairment. Trivial changes occurred in 17% of children,and 4% had poorer QOL. Predictors of poorer QOL were otorrhea 3 or more days (10% of variance) and decreased satisfaction with surgical decision (3% of variance). Hearing status,child age,type of otitis media (recurrent vs chronic),and office visit satisfaction were unrelated to outcome. CONCLUSIONS: Tympanostomy tubes produce large short-term improvements in QOL for most children. The best outcomes occur when postoperative otorrhea is absent or minimal,and when parents are satisfied with their initial decision to have surgery. Further research is needed to document the long-term impact of tubes on child QOL.","Arch Otolaryngol Head Neck Surg,126(5): 585-592","USA",2000,"Otitis Media","Tympanostomy tubes","SWD","Children","PRO study","Clinical Trial"]
[34,"Pileggi,C.,et al. (2004). \"Inappropriate hospital use by patients needing urgent medical attention in Italy.\" Public Health 118(4): 284-291.",null,"Pileggi,C.,et al.","Inappropriate hospital use by patients needing urgent medical attention in Italy","The purpose of this study was to determine the extent of inappropriate admissions and days of stay in acute beds of patients who were admitted to hospital after attending the emergency department for urgent medical attention in Italy. The medical records of all adult patients (aged 16 years and over) on one randomly preselected day during the period January-December 2001 were reviewed. The retrospective application was made using the Appropriateness Evaluation Protocol list of criteria. Overall,28.4 and 75.7% of hospital admissions and days of stay,respectively,were judged to be inappropriate. Results of the multiple logistic regression analysis indicated that inappropriate admission was significantly more likely in patients who lived closer to hospital,in younger patients,in patients from lower socio-economic classes,and in patients who did not receive diagnostic procedures in the emergency department. The proportion of patients whose admission was considered inappropriate was significantly lower in medical specialties wards. The number of inappropriate hospitalisation days was significantly higher in younger patients,in those admitted inappropriately,and in patients sampled close to discharge (during the final-third of his/her stay). The number of inappropriate hospitalisation days was significantly lower in patients admitted to surgical and traumatology/orthopaedics and medical specialties wards. Our findings indicate the need for specific interventions to reduce the prevalence of inappropriate hospital use and to modify physicians' attitudes and behaviours.","Public Health,118(4): 284-291","Italy",2004,"Not Specified","Hospitalisation","AEP","Adults","Resource Use","Cross-sectional"]
[35,"Rader, T., et al. (2011). \"Influencing health equity: role of the effective consumer scale in measuring skills and abilities in a middle income country.\" J Rheumatol 38(8): 1798-1802.",null,"Rader, T., et al.","Influencing health equity: role of the effective consumer scale in measuring skills and abilities in a middle income country","The 2008 World Health Report emphasizes the need for patient-centered primary care service delivery models in which patients are equal partners in the planning and management of their health. It is argued that this involvement will lead to improved management of disease, improved health outcomes and patient satisfaction, better informed decision-making, increased compliance with healthcare decisions, and better resource utilization. This article investigates the domains captured by the Effective Consumer Scale (EC-17) in relation to vulnerable population groups that experience health inequity. Particular focus is paid to the domain of health literacy as an area fundamental to patients' involvement in managing their condition and negotiating the healthcare system. In examining the possible influence of Outcome Measures in Rheumatology Clinical Trials (OMERACT) on health equity, we used the recent translation and validation of the EC-17 scale into Spanish and tested Argentina as an example. Future plans to use the EC-17 with vulnerable groups include formal collaboration and needs assessment with the community to tailor an intervention to meet its needs in a culturally relevant manner. Some systematic reviews have questioned whether interventions to improve effective consumer skills are appropriate in vulnerable populations. We propose that these populations may have the most to gain from such interventions since they might be expected to have relatively lower skills and health literacy than other groups.","J Rheumatol, 38(8): 1798-1802","Canada",2011,"Rheumatoid Arthritis","Not Specified","EC-17","Not Specified","Tool Validation","Cross-sectional"]
[36,"Demir, C., et al. (2002). \"Investigation of the correlation between inappropriate hospitalization and hospital stay rate: an application in medical clinics of a military hospital.\" Mil Med 167(10): 817-820.",null,"Demir, C., et al.","Investigation of the correlation between inappropriate hospitalization and hospital stay rate: an application in medical clinics of a military hospital","BACKGROUND: Medical services play a major role in hospital facilities. Along with the medical applications and diagnoses, physicians affect the hospital costs by 70% to 80%. Therefore, the hospital administrators should establish some systems that can modify the current application models of physicians. OBJECTIVE: This study aimed to investigate the appropriateness of hospitalization days and length of stay of the patients in 13 internal clinics in a military hospital. STUDY DESIGN: 5,205 patient days belonging to 416 patients were evaluated by Appropriateness Evaluation Protocol. Patients' data were retrospectively collected by using a \"data collection form\" through patients' files and then were evaluated by frequencies and percentage distributions. RESULTS: The unnecessary hospitalization rate and unnecessary stay rate were 4.8% and 15.75%, respectively. The highest unnecessary hospitalization rates were in nuclear medicine (50%). CONCLUSION: It was concluded that the inappropriate hospitalization rate and inappropriate stay rates were 4.8% and 15.75%, respectively.","Mil Med, 167(10): 817-820","Turkey",2002,"Not Specified","Hospitalisation","AEP","Military","Resource Use","Cross-sectional"]
[37,"Baker, R., et al. (1999). \"Measuring patients' attitudes to care across the primary/secondary interface: the development of the patient career diary.\" Qual Health Care 8(3): 154-160.",null,"Baker, R., et al.","Measuring patients' attitudes to care across the primary/secondary interface: the development of the patient career diary","BACKGROUND: A growing number of new ways of organising services across the primary/secondary interface are being introduced and evaluated. The principal motive for such reorganisation is to improve the efficiency of health care. However, unless the impact of the new services on patients is investigated and taken into account, it is possible that patients' reactions could be negative, a factor that could lead to unexpected consequences in the use and costs of services. OBJECTIVE: To develop a measure of patients' attitudes towards care across the interface between primary and secondary care. DESIGN: Generation of questions to be included in the measure from a qualitative study of patients' experiences of care across the interface; administration of pilot versions of the measure to samples of patients referred to secondary care; refinement of questions guided by analysis of response patterns, principal components analysis and internal consistency; administration of the final version of the patient career diary in complete form retrospectively to patients referred to secondary care, and one section alone to patients attending outpatient departments for follow up appointments. Face validity was assessed by analysis of open comments in a sample of 50 diaries, and review of the diary by 34 health professionals. Construct validity was assessed by investigation of levels of correlation between components of each section of the diary and the components of the healthcare section overall. SETTING: In the final field test, patients were attending various hospital services, including cardiology, dermatology, neurology, gynaecology, general surgery, general medicine, ophthalmology, trauma and orthopaedics, and gastroenterology. RESULTS: The final version of the diary included 109 questions in seven sections: general practitioner (GP) visits and referral, other GP visits, first outpatient visit, other outpatient visits, inpatient stay and discharge, care after discharge, and care overall. Response rates were poor for retrospective completion of the entire diary, but excellent when a section was given separately. Principal components analysis confirmed that components relating to issues identified as important to patients in the qualitative study had been included in the diary. Levels of internal consistency were good, and comments of patients and health professionals supported validity. CONCLUSION: The patient career diary is a valid and reliable measure of patients' attitudes to care across the interface. It should be given in sections to ensure adequate response rates, and is suitable for use in the evaluation or quality of patterns of care across the interface. In future, the impact on patients of new ways of organising services across the interface should be investigated by use of measures such as the patient career diary.","Qual Health Care, 8(3): 154-160","UK",1999,"Not Specified","Not Specified","Patient career diary","Not Specified","Tool Validation","Cross-sectional"]
[38,"Kemper, K. J. (1988). \"Medically inappropriate hospital use in a pediatric population.\" N Engl J Med 318(16): 1033-1037.",null,"Kemper, K. J.","Medically inappropriate hospital use in a pediatric population","To assess the extent of inappropriate hospital use in pediatric inpatients, I modified the Appropriateness Evaluation Protocol (AEP)--developed to assess inappropriate hospital use in adults--to apply to children and used it to evaluate pediatric inpatients retrospectively for every 10th day, from July 1982 to July 1983, at the University of Wisconsin Hospital. Of 1098 patient-days evaluated, 21.4 percent were judged to represent inappropriate hospital use on the basis of the protocol's criteria. The rate of inappropriate use varied according to admitting specialty, ranging from 7 of 70 days (10 percent) for pulmonary medicine to 43 of 61 days (70 percent) for neurology (P less than 0.005). There was a tendency toward lower rates of inappropriate use in uninsured patients (6 of 44 days [14 percent] vs. 226 of 1038 days [22 percent] in patients with Medicaid or private insurance, P = 0.13), and rates were lower in younger children (74 of 432 days [17 percent] in children less than or equal to 5 years of age vs. 162 of 656 days [25 percent] in children greater than 5 years of age, P less than 0.005). There was no variation according to sex, day of the week, or month. Contrary to expectations, inappropriate use decreased with increased lengths of stay (for stays of 1 day, 8 of 13 days were inappropriate [61 percent]; for stays of 2 to 6 days, 118 of 410 days were inappropriate [29 percent]; for 7 to 13 days, 58 of 291 [20 percent]; and for greater than or equal to 14 days, 51 of 362 [14 percent], P less than 0.001). I conclude that there is a substantial rate of inappropriate hospital use in pediatrics and that such use is more likely during short admissions than during long ones. Cost-containment efforts directed at limiting the length of hospitalization may therefore not reduce inappropriate hospital use in this population.","N Engl J Med, 318(16): 1033-1037","USA",1988,"Not Specified","Neurology,Pulmonary Medicine","AEP","Children","Resource Use","Cross-sectional"]
[39,"Kemper, K. and B. Forsyth (1988). \"Medically unnecessary hospital use in children seropositive for human immunodeficiency virus.\" Jama 260(13): 1906-1909.",null,"Kemper, K. and B. Forsyth","Medically unnecessary hospital use in children seropositive for human immunodeficiency virus","Stimulated by reports that some children who are seropositive for human immunodeficiency virus (HIV+) have been abandoned in the hospital, we studied the extent of, and reasons for, medically unnecessary hospital use at Yale-New Haven (Conn) Hospital among HIV+ children. We reviewed inpatient stays for all HIV+ children hospitalized through Oct 31, 1987. Hospital days were judged to be unnecessary if they failed to meet any of the criteria on the Pediatric Appropriateness Evaluation Protocol. Among 34 children eligible for the study, 54% of their hospital days were judged medically unnecessary; 59% of the children had at least one such day. Unnecessary use was 100% for one-day stays (all for gamma-globulin infusions) and 58% for stays longer than three weeks, with 94% of those unnecessary days being secondary to placement problems. The rate of unnecessary days has declined from 64% of all hospital days in 1983 and 1984 to 30% in 1987 as a result of improved outpatient services and access to foster care. Improved medical and social services could substantially reduce the cost of medically unnecessary hospital care in HIV+ children.","Jama, 260(13): 1906-1909","USA",1988,"HIV","Hospitalisation","AEP","Children","Resource Use","Cross-sectional"]
[40,"Sangha, O., et al. (2002). \"Metric properties of the appropriateness evaluation protocol and predictors of inappropriate hospital use in Germany: an approach using longitudinal patient data.\" Int J Qual Health Care 14(6): 483-492.",null,"Sangha, O., et al.","Metric properties of the appropriateness evaluation protocol and predictors of inappropriate hospital use in Germany: an approach using longitudinal patient data","BACKGROUND: The German health care system, renowned for its unrestricted access, high quality care, and comprehensive coverage, is challenged by increasing health care costs. This has been attributed partly to inefficiencies in the in-patient sector, but has been studied little. Attempts at quality improvement need to relate costs to outcomes. Until now, there has been no standardized methodology to evaluate the appropriateness of hospital care. OBJECTIVE: To develop and evaluate the metric properties of a method to assess inappropriate hospital care in Germany based on a widely used measure, the Appropriateness Evaluation Protocol (AEP). METHODS: The original AEP was translated and adapted to reflect differences in the provision of health care in Germany. Psychometric testing was performed in a stratified sample of all patients admitted to the Departments of Medicine and Surgery of a 400-bed teaching hospital during 1 year. Three board-certified physicians participated in each department to evaluate intra-rater reliability, while two additional independent physicians judged inter-rater reliability. RESULTS: Inter-rater agreement for the evaluation of hospital days among surgical patients was 84% (80-87%), with an average kappa value of 0.58 (0.48-0.68). Corresponding figures for patients in medicine were 76% (73-80%) with a K value of 0.42 (0.34-0.42). Inter-rater agreement for hospital admissions and K was 74% (62-86%) and 0.44 (0.21-0.67) in surgery, and 92% (85-100%) and 0.31 (0-0.80) in medicine, respectively. Thirty-three per cent of all admissions and 28% of consecutive hospital days were judged inappropriate in surgery; among medicine patients, reviewers found 6% of admissions and 33% of hospital days inappropriate. Time since admission was the strongest predictor of inappropriate hospital use adjusted for length of stay, comorbidity, age, and gender.","Int J Qual Health Care, 14(6): 483-492","USA",2002,"Not Specified","Surgery","AEP","Not Specified","Resource Use","Cross-sectional"]
[41,"Li, W., et al. (2011). \"Natural Orifice Translumenal Endoscopic Surgery (NOTES): patients' perceptions and attitudes.\" Dig Dis Sci 56(8): 2415-2422.",null,"Li, W., et al.","Natural Orifice Translumenal Endoscopic Surgery (NOTES): patients' perceptions and attitudes","BACKGROUND: Natural orifice translumenal endoscopic surgery (NOTES) has generated a surge of enthusiasm among researchers by virtue of its challenge to the dogma and potential benefits. However, no data is available in the medical literature about NOTES' acceptance by patients in Asia. The aim of the study is to survey patients' perceptions and attitudes towards NOTES. METHODS: It is a questionnaire-based multi-center study on inpatient subjects with various gastrointestinal disorders from 14 hospitals in 12 cities of China. Procedural details with the benefits and risks of NOTES, laparoscopic surgery, and conventional surgery were explained to all registered candidates. They were required to choose and cite reasons for adopting one of the above three surgical techniques as the preferred mode of treatment. The reasons for selection of the surgical treatment were: safety, efficacy, cost, postoperative pain, abdominal wounds, and scarring. RESULTS: There were 1,797 cases, including 976 (54.3%) males and 821 females (45.7%). Based on their comprehension of the procedure, 802 (44.6%) patients opted for NOTES, 757 (42.1%) for laparoscopic surgery, and 238 (13.2%) for conventional surgery. NOTES was mainly selected by the young and educated persons, especially females and by those with past exposure to laparoscopy or conventional surgery. The choice of treatment was significantly correlated with age (P=0.0021), education (P=0.0209), past medical history (laparoscopy, P=0.0134; open surgery, P<0.0001), and department of admission (P=0.0173). The preference for NOTES was based on safety (37.3%), cost (17.6%), elimination of postoperative scars (16.1%), abdominal wounds (16.0%), and efficacy (13.1%). CONCLUSIONS: The vast majority of patients prefer mini-invasive surgery to conventional surgery. The potential recipients of NOTES are educated and younger age groups. However, a few consider NOTES as a safe and effective intervention at present.","Dig Dis Sci, 56(8): 2415-2422","China",2011,"Gastrointestinal disorders","Surgery","PPS","Adolescent,Adults","PRO study","Cross-sectional"]
[42,"Paterson, C., et al. (2010). \"Outcomes of traditional Chinese medicine (traditional acupuncture) treatment for people with long-term conditions.\" Complement Ther Clin Pract 16(1): 3-9.",null,"Paterson, C., et al.","Outcomes of traditional Chinese medicine (traditional acupuncture) treatment for people with long-term conditions","A set of outcome questionnaires has been developed to measure the range of treatment effects of traditional acupuncture. In this descriptive outcome study we validated these questionnaires in a busy National Health Service funded acupuncture clinic serving communities of diverse socio-economic circumstances. Some of the questionnaires performed better than others in this setting but EQ-5D and MYMOP-qual both showed statistically and clinically significant improvement in physical and psychological health after six weeks and six months, in all categories of disease and degrees of chronicity. Both the written qualitative data and the Patient Enablement Instrument (PEI) demonstrated considerable patient enablement and, for some patients, the acquisition of new coping and self-care strategies.The questionnaires were feasible to administer, acceptable to patients and clinic staff, and provided robust and detailed quantitative and qualitative outcome data of use for service provision, future planning, and as a basis for further cost-effectiveness studies.","Complement Ther Clin Pract, 16(1): 3-9","UK",2010,"Not Specified","Acupuncture","PEI","Not Specified","Tool Validation","Cross-sectional"]
[43,"Seid, M., et al. (2004). \"Parents' reports of barriers to care for children with special health care needs: development and validation of the barriers to care questionnaire.\" Ambul Pediatr 4(4): 323-331.",null,"Seid, M., et al.","Parents' reports of barriers to care for children with special health care needs: development and validation of the barriers to care questionnaire","OBJECTIVE: To describe the development and validation of the Barriers to Care Questionnaire (BCQ). METHODS: The 39-item BCQ was developed through review of the literature, focus groups, and cognitive interviews of Spanish- and English-speaking parents of children with chronic health conditions. Barriers to care are conceptualized as a multidimensional construct consisting of pragmatics, health knowledge and beliefs, expectations about care, skills, and marginalization. The BCQ was field tested in 3 samples of children with special health care needs (CSHCN). RESULTS: Response rate for the field test was 77.2%. There were minimal missing data (0.08%), no floor effects, and minimal ceiling effects (3.8%, total scale). Internal consistency reliability (alpha) for the BCQ total scale was.95 and subscale alpha ranged from.75 to.91. The BCQ total scale and subscales correlated in the expected direction with validated measures of primary care characteristics and health-related quality of life. BCQ scores were higher (fewer barriers) for children with a primary care physician and for those who reported no problems getting care or foregone care. CONCLUSION: The BCQ is a feasible, reliable, and valid instrument for measuring barriers to care for CSHCN. Its use may inform efforts to support consumer choice, enhance provider accountability, and spur quality improvement.","Ambul Pediatr, 4(4): 323-331","USA",2004,"Chronic conditions","Not Specified","BCQ","Children","Tool Validation","Cross-sectional"]
[44,"Fullwood, C., et al. (2013). \"Patients' experiences of shared decision making in primary care practices in the United kingdom.\" Med Decis Making 33(1): 26-36.",null,"Fullwood, C., et al.","Patients' experiences of shared decision making in primary care practices in the United kingdom","BACKGROUND: Shared decision making (SDM) and patient self-management support are key components of US and UK policy for chronic disease management, whereby SDM is seen as enhancing physician-patient negotiation around self-management. The WISE trial is implementing training in self-management support for primary care physicians in one UK region. This article describes preintervention levels of patient-reported SDM and explores how this varies with patient and practice characteristics. METHODS: We analyzed baseline data from a cluster randomized controlled trial for 2965 patients with diabetes, chronic obstructive pulmonary disease, and irritable bowel syndrome (IBS) from 29 family practices. Patient-level measures included self-report of chronic conditions, SDM (Health Care Climate Questionnaire [HCCQ]), health status, and demographic characteristics. Area and practice characteristics included chronic disease workload and socioeconomic deprivation. RESULTS: The mean SDM score was 75 (out of 100), but the range was wide. The mean score was lower for IBS patients but did not vary with other disease conditions. Younger patients and those with poorer health status reported lower degrees of SDM. No associations were found with practice characteristics. LIMITATIONS: The study was restricted to one socioeconomically deprived region, and hence results may not be nationally representative of the United Kingdom. Ceiling effects on SDM scores may limit the utility of the HCCQ. CONCLUSIONS: Lower ratings from some patient groups may reflect differences in expectations rather than differences in physician behavior. Overall levels of SDM were high, and no patient or practice characteristic represented a serious barrier to SDM. However, we cannot say to what extent SDM in this chronic population addressed self-management issues rather than clinical care. More nuanced measures of SDM are required that distinguish between different forms of care.","Med Decis Making, 33(1): 26-36","UK",2013,"Various","Not Specified","HCCQ,SDM-Q-9","Not Specified","PRO study","RCT"]
[45,"Tierney, E. P., et al. (2008). \"Photodynamic therapy for actinic keratoses: survey of patient perceptions of treatment satisfaction and outcomes.\" J Cosmet Laser Ther 10(2): 81-86.",null,"Tierney, E. P., et al.","Photodynamic therapy for actinic keratoses: survey of patient perceptions of treatment satisfaction and outcomes","BACKGROUND: While there are many available treatments for actinic keratoses (AKs), patient-preferred treatment options remain undefined. OBJECTIVE: To quantify patient perceptions and preferences in the management of AKs, including comparison of photodynamic therapy (PDT) with other therapies. METHODS: A self-administered questionnaire was mailed to 45 patients who had received PDT for AKs in 2005-2006 in the Henry Ford Health System. A series of indicators for each treatment were surveyed, including: recovery time, cosmetic appearance, patient cost, effectiveness, patient satisfaction, treatment option preference, and perceived burden of treatment. RESULTS: A total of 39 of the 45 patients participated (86.7%). A patient's reported recovery time was significantly more likely to be 1 week or less for PDT when compared with cryotherapy (p = 0.02) and surgical excision (p = 0.02). Borderline significance was found for the improved cosmetic outcome in PDT vs. surgical excision (p = 0.058) and for patient satisfaction with PDT compared with 5-fluorouracil (p = 0.058). Patients significantly preferred PDT to 5-fluorouracil (p<0.001) or imiquimod (p = 0.031). CONCLUSION: While the effectiveness of lesion clearance with PDT for AKs has been well proven in the literature, this is the first study to evaluate patient perception of the effectiveness, side-effect profile and benefits of PDT relative to several standard treatment approaches for AKs. PDT was found to have equivalent or improved recovery times, cosmetic outcomes, patient satisfaction and preference as a treatment for AKs by patients compared with other options.","J Cosmet Laser Ther, 10(2): 81-86","USA",2008,"Cancer","Psychodynamic Therapy","PPS","Adults","PRO study","Cross-sectional"]
[46,"Wills, C. E. and M. Holmes-Rovner (2003). \"Preliminary validation of the Satisfaction With Decision scale with depressed primary care patients.\" Health Expect 6(2): 149-159.",null,"Wills, C. E. and M. Holmes-Rovner","Preliminary validation of the Satisfaction With Decision scale with depressed primary care patients","OBJECTIVE: To conduct a preliminary validation of the Satisfaction With Decision (SWD) scale with depressed primary care patients. DESIGN: Cross-sectional observational pilot study using a postal survey. SETTING AND PARTICIPANTS: Depressed primary care patients (n = 97) who recently had made a new decision about antidepressant medication use completed surveys regarding their treatment decisions. MAIN VARIABLES: Measures included patient-reported satisfaction with decision, decisional conflict, knowledge about depression and treatment, decision involvement, pain and health status, antidepressant medication efficacy, and satisfaction with health services. RESULTS: The SWD scale had good internal consistency reliability (alpha = 0.85). Evidence for construct validity was confirmed via a hypothesized pattern of relationships between the SWD scale and other measures. Decision satisfaction was associated with several issues of relevance for designing patient-centred decision support interventions: (1) knowledge about depression and treatment; (2) involvement in health-related decisions; and (3) aiding evaluation of trade-offs among pros and cons of treatment. CONCLUSIONS: The results of this pilot study show that the SWD scale appears to be a psychometrically sound and practical measure for research with this population. Additional research is needed on the theoretical nature of decision satisfaction and developing and testing patient-centred decision support interventions for depression treatment.","Health Expect, 6(2): 149-159","USA",2003,"Depression","Antidepressants","SWD","Not Specified","Tool Validation","Cross-sectional"]
[47,"Morgan, M. W., et al. (2000). \"Randomized, controlled trial of an interactive videodisc decision aid for patients with ischemic heart disease.\" J Gen Intern Med 15(10): 685-693.",null,"Morgan, M. W., et al.","Randomized, controlled trial of an interactive videodisc decision aid for patients with ischemic heart disease","OBJECTIVE: To determine the effect of the Ischemic Heart Disease Shared Decision-Making Program (IHD SDP) an interactive videodisc designed to assist patients in the decision-making process involving treatment choices for ischemic heart disease, on patient decision-making. DESIGN: Randomized, controlled trial. SETTING: The Toronto Hospital, University of Toronto, Toronto, Ontario, Canada. PARTICIPANTS: Two hundred forty ambulatory patients with MEASUREMENTS AND MAIN RESULTS: The primary outcome was patient satisfaction with the decision-making process. This was measured using the 12-item Decision-Making Process Questionnaire that was developed and validated in a randomized trial of the benign prostatic hyperplasia SDP. Secondary outcomes included patient knowledge (measured using 20 questions about knowledge deemed necessary for an informed treatment decision), treatment decision, patient-angiographer agreement on decision, and general health scores. Outcomes were measured at the time of treatment decision and/or at 6 months follow-up. Shared decision-making program scores were similar for the intervention and control group (71% and 70%, respectively; 95% confidence interval [CI] for 1% difference, -3% to 7%). The intervention group had higher knowledge scores (75% vs 62%; 95% CI for 13% difference, 8% to 18%). The intervention group chose to pursue revascularization less often (58% vs 75% for the controls; 95% CI for 17% difference, 4% to 31%). At 6 months, 52% of the intervention group and 66% of the controls had undergone revascularization (95% CI for 14% difference, 0% to 28%). General health and angina scores were not different between the groups at 6 months. Exposure to the IHD SDP resulted in more patient-angiographer disagreement about treatment decisions. CONCLUSIONS: There was no significant difference in satisfaction with decision-making process scores between the IHD SDP and usual practice groups. The IHD SDP patients were more knowledgeable, underwent less revascularization (interventional therapies), and demonstrated increased patient decision-making autonomy without apparent impact on quality of life.","J Gen Intern Med, 15(10): 685-693","Canada",2000,"Heart Disease","Decision Aids","SWD","Not Specified","PRO study","RCT"]
[48,"Zahid, M. A. and J. U. Ohaeri (2010). \"Relationship of family caregiver burden with quality of care and psychopathology in a sample of Arab subjects with schizophrenia.\" BMC Psychiatry 10: 71.",null,"Zahid, M. A. and J. U. Ohaeri","Relationship of family caregiver burden with quality of care and psychopathology in a sample of Arab subjects with schizophrenia","BACKGROUND: Although the burden experienced by families of people with schizophrenia has long been recognized as one of the most important consequences of the disorder, there are no reports from the Arab world. Following the example of the five-nation European (EPSILON) study, we explored the following research question: How does the relationship between domains of caregiving (as in the Involvement Evaluation Questionnaire--IEQ-EU) and caregiver psychic distress on the one hand, and caregiver's/patient's socio-demographics, clinical features and indices of quality of care, on the other hand, compare with the pattern in the literature? METHOD: Consecutive family caregivers of outpatients with schizophrenia were interviewed with the IEQ-EU. Patients were interviewed with measures of needs for care, service satisfaction, quality of life (QOL) and psychopathology. RESULTS: There were 121 caregivers (66.1% men, aged 39.8). The IEQ domain scores (total: 46.9; tension: 13.4; supervision: 7.9; worrying: 12.9; and urging: 16.4) were in the middle of the range for the EU data. In regression analyses, higher burden subscale scores were variously associated with caregiver lower level of education, patient's female gender and younger age, as well as patient's lower subjective QOL and needs for hospital care, and not involving the patient in outdoor activities. Disruptive behavior was the greatest determinant of global rating of burden. CONCLUSION: Our results indicate that, despite differences in service set-up and culture, the IEQ-EU can be used in Kuwait as it has been used in the western world, to describe the pattern of scores on the dimensions of caregiving. Differences with the international data reflect peculiarities of culture and type of service. Despite generous national social welfare provisions, experience of burden was the norm and was significantly associated with patient's disruptive behavior. The results underscore the need for provision of community-based programs and continued intervention with the families in order to improve the quality of care.","BMC Psychiatry, 10(71","Kuwait",2010,"Schizophrenia","Not Specified","IEQ-EU","Not Specified","PRO study","Cross-sectional"]
[49,"Cichowski, S. B., et al. (2015). \"Standard compared with mnemonic counseling for fecal incontinence: a randomized controlled trial.\" Obstet Gynecol 125(5): 1063-1070.",null,"Cichowski, S. B., et al.","Standard compared with mnemonic counseling for fecal incontinence: a randomized controlled trial","OBJECTIVE: To estimate whether women who underwent mnemonic counseling had better recall of fecal incontinence therapies at 2 months and if mnemonic counseling resulted in greater satisfaction with physician counseling and improvement in quality of life when compared with a group who underwent standard counseling. METHODS: Counseling-naive women with fecal incontinence were recruited from an academic urogynecology clinic. Women underwent physical examinations, completed the Quality of the Physician-Patient Interaction, recorded fecal incontinence treatment options they recalled, and completed the Fecal Incontinence Severity Index and Manchester Health Questionnaire immediately after counseling and again at 2 months. RESULTS: Ninety women consented to participate, were randomized, and completed baseline questionnaires. At baseline, women did not differ in age, ethnicity, education, Fecal Incontinence Severity Index, or Manchester Health Questionnaire scores. After counseling, the mnemonic group reported higher satisfaction on Quality of the Physician-Patient Interaction (66.4+/-6.5 compared with 62.2+/-10.7, P=.03). Ninety percent (81/90) of women followed up at 2 months. Our primary endpoint, 2-month recall of fecal incontinence treatments, was not different between groups (2.3+/-1.6 mnemonic counseling compared with 1.8+/-1.0 standard counseling; P=.08). Secondary endpoints for the mnemonic group reported greater improvement on total Manchester Health Questionnaire (P=.02), emotional (P=.03), sleep (0.045), role limitations (P<.01), and physical limitations (P=.04) when compared with the standard group. CONCLUSION: Fecal incontinence counseling with a mnemonic aid did not improve recall at 2 months but improved patient satisfaction and quality of life at 2 months.","Obstet Gynecol, 125(5): 1063-1070","Mexico",2015,"Fecal incontinence","Counselling","QPPI","Women","PRO study","RCT"]
[50,"Compen, F. R., et al. (2015). \"Study protocol of a multicenter randomized controlled trial comparing the effectiveness of group and individual internet-based Mindfulness-Based Cognitive Therapy with treatment as usual in reducing psychological distress in cancer patients: the BeMind study.\" BMC Psychol 3: 27.",null,"Compen, F. R., et al.","Study protocol of a multicenter randomized controlled trial comparing the effectiveness of group and individual internet-based Mindfulness-Based Cognitive Therapy with treatment as usual in reducing psychological distress in cancer patients: the BeMind study","BACKGROUND: Mindfulness-based interventions have shown to reduce psychological distress in cancer patients. The accessibility of mindfulness-based interventions for cancer patients could be further improved by providing mindfulness using an individual internet-based format. The aim of this study is to test the effectiveness of a Mindfulness-Based Cognitive Therapy (MBCT) group intervention for cancer patients in comparison with individual internet-based MBCT and treatment as usual (TAU). METHODS/DESIGN: A three-armed multicenter randomized controlled trial comparing group-based MBCT to individual internet-based MBCT and TAU in cancer patients who suffer from at least mild psychological distress (Hospital Anxiety and Depression Scale (HADS) >/= 11). Measurements will be conducted prior to randomization (baseline), post-treatment and at 3 months and 9 months post-treatment. Participants initially allocated to TAU are subsequently randomized to either group- or individual internet-based MBCT and will receive a second baseline measurement after 3 months. Thus, the three-armed comparison will have a time span of approximately 3 months. The two-armed intervention comparison includes a 9-month follow-up and will also consist of participants randomized to the intervention after TAU. Primary outcome will be post-treatment psychological distress (HADS). Secondary outcomes are fear of cancer recurrence (Fear of Cancer Recurrence Inventory), rumination (Rumination and Reflection Questionnaire), positive mental health (Mental Health Continuum - Short Form), and cost-effectiveness (health-related quality of life (EuroQol -5D and Short Form-12) and health care usage (Trimbos and iMTA questionnaire on Costs associated with Psychiatric illness). Potential predictors: DSM-IV-TR mood/anxiety disorders (SCID-I) and neuroticism (NEO-Five Factor Inventory) will be measured. Mediators of treatment effect: mindfulness skills, (Five-Facets of Mindfulness Questionnaire- Short Form), working alliance (Working Alliance Inventory) and group cohesion (Group Cohesion Questionnaire) will also be measured. DISCUSSION: This trial will provide valuable information on the clinical and cost-effectiveness of group versus internet-based MBCT versus TAU for distressed cancer patients. TRIAL REGISTRATION: Clinicaltrials.gov NCT02138513. Registered 6 May 2014.","BMC Psychol, 3(27","Netherlands",2015,"Cancer","Cognitive Therapy","GCQ","Not Specified","PRO study","RCT"]
[51,"McKinstry, B., et al. (2002). \"Telephone consultations to manage requests for same-day appointments: a randomised controlled trial in two practices.\" Br J Gen Pract 52(477): 306-310.",null,"McKinstry, B., et al.","Telephone consultations to manage requests for same-day appointments: a randomised controlled trial in two practices","BACKGROUND: General practitioners (GPs) in the United Kingdom have recently begun to adopt the use of telephone consultation during daytime surgery as a means of managing demand, particularly requests for same-day appointments. However, it is not known whether the strategy actually reduces GP workload. AIM: To investigate how the use of telephone consultations impacts on the management of requests for same-day appointments, on resource use, indicators of clinical care, and patient perceptions of consultations. DESIGN OF STUDY: Randomised controlled trial. SETTING: All patients (n = 388) seeking same-day appointments in each surgery in two urban practices (total population = 10,420) over a four-week period. METHOD: The primary outcome measure was use of doctor time for the index telephone or face-to-face consultation. Secondary outcomes were subsequent use of investigations and of services in the two-week period following consultation, frequency of blood pressure measurement and antibiotic prescriptions, and number of problems considered at consultation. Patient perceptions were measured by the Patient Enablement Instrument (PEI) and reported willingness to use telephone consultations in the future. RESULTS: Telephone consultations took less time (8.2 minutes versus 6.7 minutes; diff = 1.5, 95% confidence interval [CI] = 0.6 to 2.4, P = 0.002). Patients consulting by telephone reconsulted the GP more frequently in the two weeks that followed (0.6 consultations versus 0.4 consultations; diff = 0.2, 95% CI = 0.0 to 0.3, P = 0.01). Blood pressure was measured more often in the group of patients managed face-to-face (25/188 [13.3%] versus 12/181 [6.6%]; diff = 6.7%, 95% CI = 0.6% to 12.7%). There was no significant difference in patient perceptions or other secondary outcomes. CONCLUSION: Use of telephone consultations for same-day appointments was associated with time saving, and did not result in lower PEI scores. Possibly, however, this short-term saving was offset by higher re-consultation and less use of opportunistic health promotion.","Br J Gen Pract, 52(477): 306-310","UK",2002,"Not Specified","Tele-communications","PEI","Not Specified","PRO study","RCT"]
[52,"Slade, M., et al. (2014). \"The development and evaluation of a five-language multi-perspective standardised measure: clinical decision-making involvement and satisfaction (CDIS).\" BMC Health Serv Res 14: 323.",null,"Slade, M., et al.","The development and evaluation of a five-language multi-perspective standardised measure: clinical decision-making involvement and satisfaction (CDIS)","BACKGROUND: The aim of this study was to develop and evaluate a brief quantitative five-language measure of involvement and satisfaction in clinical decision-making (CDIS) - with versions for patients (CDIS-P) and staff (CDIS-S) - for use in mental health services. METHODS: An English CDIS was developed by reviewing existing measures, focus groups, semistructured interviews and piloting. Translations into Danish, German, Hungarian and Italian followed the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Task Force principles of good practice for translation and cultural adaptation. Psychometricevaluation involved testing the measure in secondary mental health services in Aalborg, Debrecen, London, Naples, Ulm and Zurich. RESULTS: After appraising 14 measures, the Control Preference Scale and Satisfaction With Decision-making English-language scales were modified and evaluated in interviews (n = 9), focus groups (n = 22) and piloting (n = 16). Translations were validated through focus groups (n = 38) and piloting (n = 61). A total of 443 service users and 403 paired staff completed CDIS. The Satisfaction sub-scale had internal consistency of 0.89 (0.86-0.89 after item-level deletion) for staff and 0.90 (0.87-0.90) for service users, both continuous and categorical (utility) versions were associated with symptomatology and both staff-rated and service userrated therapeutic alliance (showing convergent validity), and not with social disability (showing divergent validity), and satisfaction predicted staff-rated (OR 2.43, 95%CI 1.54- 3.83 continuous, OR 5.77, 95%CI 1.90-17.53 utility) and service user-rated (OR 2.21, 95%CI 1.51-3.23 continuous, OR 3.13, 95%CI 1.10-8.94 utility) decision implementation two months later. The Involvement sub-scale had appropriate distribution and no floor or ceiling effects, was associated with stage of recovery, functioning and quality of life (staff only) (showing convergent validity), and not with symptomatology or social disability (showing divergent validity), and staff-rated passive involvement by the service user predicted implementation (OR 3.55, 95%CI 1.53-8.24). Relationships remained after adjusting for clustering by staff. CONCLUSIONS: CDIS demonstrates adequate internal consistency, no evidence of item redundancy, appropriate distribution, and face, content, convergent, divergent and predictive validity. It can be recommended for research and clinical use. CDIS-P and CDIS-S in all 3 five languages can be downloaded at http://www.cedar-net.eu/instruments. TRIAL REGISTRATION: ISRCTN75841675.","BMC Health Serv Res, 14(323","UK",2014,"Mental Health","Not Specified","CDIS,SWD","Not Specified","Tool Validation","Cross-sectional"]
[53,"Kim, T., et al. (2001). \"The economic impact of methicillin-resistant Staphylococcus aureus in Canadian hospitals.\" Infect Control Hosp Epidemiol 22(2): 99-104.",null,"Kim, T., et al.","The economic impact of methicillin-resistant Staphylococcus aureus in Canadian hospitals","OBJECTIVES: To determine the costs associated with the management of hospitalized patients with methicillin-resistant Staphylococcus aureus (MRSA), and to estimate the economic burden associated with MRSA in Canadian hospitals. DESIGN: Patient-specific costs were used to determine the attributable cost of MRSA associated with excess hospitalization and concurrent treatment. Excess hospitalization for infected patients was identified using the Appropriateness Evaluation Protocol, a criterion-based chart review process to determine the need for each day of hospitalization. Concurrent treatment costs were identified through chart review for days in isolation, antimicrobial therapy, and MRSA screening tests. The economic burden to Canadian hospitals was estimated based on 3,167,521 hospital discharges for 1996 and 1997 and an incidence of 4.12 MRSA cases per 1,000 admissions. SETTING: A tertiary-care, university-affiliated teaching hospital in Toronto, Ontario, Canada. PATIENTS: Inpatients with at least one culture yielding MRSA between April 1996 and March 1998. RESULTS: A total of 20 patients with MRSA infections and 79 colonized patients (with 94 admissions) were identified. This represented a rate of 2.9 MRSA cases per 1,000 admissions. The mean number of additional hospital days attributable to MRSA infection was 14, with 11 admissions having at least 1 attributable day. The total attributable cost to treat MRSA infections was $287,200, or $14,360 per patient The cost for isolation and management of colonized patients was $128,095, or $1,363 per admission. Costs for MRSA screening in the hospital were $109,813. Assuming an infection rate of 10% to 20%, we determined the costs associated with MRSA in Canadian hospitals to be $42 million to $59 million annually. CONCLUSIONS: These results indicate that there is a substantial economic burden associated with MRSA in Canadian hospitals. These costs will continue to rise if the incidence of MRSA increases further.","Infect Control Hosp Epidemiol, 22(2): 99-104","Canada",2001,"MRSA","Hospitalisation","AEP","Adults","Costs,Resource Use","Cross-sectional"]
[54,"Hamilton, W., et al. (2007). \"The effect of patient self-completion agenda forms on prescribing and adherence in general practice: a randomized controlled trial.\" Fam Pract 24(1): 77-83.",null,"Hamilton, W., et al.","The effect of patient self-completion agenda forms on prescribing and adherence in general practice: a randomized controlled trial","BACKGROUND: What the patient wants from a general practice consultation and what the doctor believes they want are not always the same thing. This mismatch may lead to unwanted and unnecessary prescribing. AIM: To study the effect of a one-page form completed by patients before their consultation and given to the doctor at the start of the consultation, in terms of a reduction in prescribing, satisfaction with the consultation and adherence with prescribed medication. DESIGN: Randomized controlled trial. SETTING: Ten general practices in Devon and Dorset, UK. METHODS: Unselected patients attending general practice appointments were randomised to receive (or not) a self-completed agenda form (SCAF) asking five questions, including whether the patient considered they should receive a prescription. RESULTS: Approximately 4125 patients were offered entry; 3124 (76%) agreed to randomisation. In 1783 (57%) of these prescribing or satisfaction outcomes were identified. 457 of 811 (56.4%) of SCAF patients received a prescription, at a median (IQR) cost of pound 5.60 (inter-quartile range pound 2.12- pound 16.10), compared with 418 of 799 (52.3%) of controls, at a median cost of pound 5.94 ( pound 2.46- pound 18.90); both results non-significant (P=0.10 for prescribing and 0.30 for cost). Satisfaction was also similar in both groups: mean satisfaction score in SCAFs 5.37 and in controls 5.40 (P=0.64), as was adherence: at 12 weeks, adherence of 75% or greater was reported by 92 of 136 SCAF patients (68%) and 105 of 145 controls (72%) (P=0.31). CONCLUSION: The negative result could have two explanations. Either the intervention did not achieve the intention of communicating the patients' agendas, or if it did, patients may have been persuaded by doctors' explanations in the consultation.","Fam Pract, 24(1): 77-83","UK",2007,"Not Specified","Medication","SCAF","Not Specified","PRO study","RCT"]
[56,"Sanchez-Garcia, S., et al. (2008). \"The hospital appropriateness evaluation protocol in elderly patients: a technique to evaluate admission and hospital stay.\" Scand J Caring Sci 22(2): 306-313.",null,"Sanchez-Garcia, S., et al.","The hospital appropriateness evaluation protocol in elderly patients: a technique to evaluate admission and hospital stay","BACKGROUND: Aging of the population represents one of the main challenges for health systems because of the increase in the demand for hospital services. To be able to count on tools that allow an objective evaluation of hospital-resource use becomes indispensable for health systems. OBJECTIVE: To evaluate the reliability and validity of the Appropriateness Evaluation Protocol (AEP) regarding the appropriateness of admissions and hospital stays in elderly patients. In a scenario of scarce resources, to have a valid instrument will make it possible to evaluate the process of care in our growing elderly population in a standardized way. METHODS: We carried out a retrospective study of 144 randomly chosen elderly patients admitted to the hospital with 394 even-numbered hospital-stay days. For the reliability analysis between the pair of nurses with the AEP and the pair of specialists, the details of the hospital admissions and the stay days were obtained from the clinical files. Criteria validity was conducted by pairs of physicians, including two internists, two general surgeons and two geriatricians. Only the agreements were compared with agreements of the AEP-trained nurses. Disagreements were excluded from the final analysis. RESULTS: Inter-rater (inter-reviewer) agreement of hospital admissions and days spent by the patient presented a kappa coefficient of >0.70, while these admissions and hospital-stay days was >0.70. Sensitivity and positive predictor value to detect inappropriate admissions were not calculated because no agreement existed on inappropriate admissions. Specificity and negative predictive value to detect appropriate admission was >94.0% and >98.0%. Sensitivity and positive predictor value to detect inappropriate hospital-stay days was >44.0% and >10.0%, while specificity and negative predictor value for detecting appropriate hospital-stay days was >79.0% and >88.0%. CONCLUSIONS: AEP's high-reliability and moderate-validity results with regard to clinical judgement positions it as a useful instrument for appropriate hospitalization screening in elderly patients.","Scand J Caring Sci, 22(2): 306-313","Mexico",2008,"Not Specified","Hospitalisation","AEP","Elderly","Tool Validation","Cross-sectional"]
[57,"Lauria, F. N. and C. Angeletti (2003). \"The impact of nosocomial infections on hospital care costs.\" Infection 31 Suppl 2: 35-43.",null,"Lauria, F. N. and C. Angeletti","The impact of nosocomial infections on hospital care costs","Estimating costs due to nosocomial infection (NI) requires the incremental costs associated with NI diagnosis and treatment must be distinguished from those attributable to the management of the original healthcare problems. We carried out a review of the analyses of additional costs resulting from NIs and the evaluation of the methods used to estimate these costs, in order to perform a cost benefit analysis of NI prevention activities. Characteristics of additional costs for main NIs were initially considered. Secondly, a review of methods for estimating the incremental costs was performed. Finally, a cost effectiveness analysis of NI prevention activities was performed. Few studies estimated the incidence of NLs and assessed the economic burden they cause. Investigators generally estimated only direct additional costs. Implicit physician assessment, unmatched group comparison, matched control and appropriateness evaluation protocol (AEP)-based methods are the methodologies used to estimate incremental days of stay due to NIs. Different studies show possible benefits, in terms of health and cost savings, when hospital-acquired infections are prevented. However, there is a need for further studies to evaluate in greater detail the variables related to costs attributable to these infections and to enhance the control strategies. Moreover, a structured surveillance and control program of NI is the single most effective tool for prevention.","Infection, 31 Suppl 2(35-43","Italy",2003,"Nosocomical infection","Preventative Services","AEP","Not Specified","Costs","Cross-sectional"]
[58,"Wensing, M., et al. (2008). \"The Patients Assessment Chronic Illness Care (PACIC) questionnaire in The Netherlands: a validation study in rural general practice.\" BMC Health Serv Res 8: 182.",null,"Wensing, M., et al.","The Patients Assessment Chronic Illness Care (PACIC) questionnaire in The Netherlands: a validation study in rural general practice","BACKGROUND: Many patients with chronic illness receive health care in primary care settings, so a challenge is to provide well-structured chronic care in these settings. Our aim was to develop and test a Dutch version of the PACIC questionnaire, a measure for patient reported structured chronic care. METHODS: Observational study in 165 patients with diabetes or COPD from four general practices (72% response rate). Patients completed a written questionnaire, which included instruments for assessing chronic illness care (PACIC), evaluations of general practice (Europep), enablement (PEI), and individual characteristics. RESULTS: The patients had a mean age of 68.0 years and 47% comprised of women. Twenty-two to 35% of responding patients did not provide answers to specific items in the PACIC. In 11 items the lowest answering category was used by 30% or more of the responders and in 6 items the highest answering category was used by this number of responders. Principal factor analysis identified the previously defined five domains reasonably well. Cronbach's alpha per domain varied from 0.71 to 0.83, and the intraclass coefficient from 0.66 to 0.91. Diabetes patients reported higher presence of structured chronic care for 14 out of the 20 PACIC items. The effect of patient evaluations of general practice on the PACIC score was positive (b = 0.72, p < 0.004), but the effect of patient enablement on the PACIC score was negative (b = -1.13, p < 0.000). CONCLUSION: A translated and validated Dutch version of the PACIC questionnaire is now available. Further research on its validity is recommended.","BMC Health Serv Res, 8(182","Netherlands",2008,"Not Specified","Not Specified","PEI","Adults,Elderly","Tool Validation","Cross-sectional"]
[59,"Jacob, M. E., et al. (2016). \"The preventive services use self-efficacy (PRESS) scale in older women: development and psychometric properties.\" BMC Health Serv Res 16: 71.",null,"Jacob, M. E., et al.","The preventive services use self-efficacy (PRESS) scale in older women: development and psychometric properties","BACKGROUND: Preventive services offered to older Americans are currently under-utilized despite considerable evidence regarding their health and economic benefits. Individuals with low self-efficacy in accessing these services need to be identified and provided self-efficacy enhancing interventions. Scales measuring self-efficacy in the management of chronic diseases exist, but do not cover the broad spectrum of preventive services and behaviors that can improve the health of older adults, particularly older women who are vulnerable to poorer health and lesser utilization of preventive services. This study aimed to evaluate the psychometric properties of a new preventive services use self-efficacy scale, by measuring its internal consistency reliability, assessing internal construct validity by exploring factor structure, and examining differences in self-efficacy scores according to participant characteristics. METHODS: The Preventive Services Use Self-Efficacy (PRESS) Scale was developed by an expert panel at the University of Pittsburgh Center for Aging and Population Health - Prevention Research Center. It was administered to 242 women participating in an ongoing trial and the data were analyzed to assess its psychometric properties. An exploratory factor analysis with a principal axis factoring approach and orthogonal varimax rotation was used to explore the underlying structure of the items in the scale. The internal consistency of the subscales was assessed using Cronbach's alpha coefficient. RESULTS: The exploratory factor analysis defined five self-efficacy factors (self-efficacy for exercise, communication with physicians, self-management of chronic disease, obtaining screening tests, and getting vaccinations regularly) formed by 16 items from the scale. The internal consistency of the subscales ranged from .81 to .94. Participants who accessed a preventive service had higher self-efficacy scores in the corresponding sub-scale than those who did not. CONCLUSIONS: The 16-item PRESS scale demonstrates preliminary validity and reliability in measuring self-efficacy in the use of preventive services among older women. It can potentially be used to evaluate the impact of interventions designed to improve self-efficacy in the use of preventive services in community-dwelling older women.","BMC Health Serv Res, 16(71","USA",2016,"General Poor Health","Preventative Services","PRESS","Elderly,Women","Tool Validation","Cross-sectional"]
[60,"Barr, P. J., et al. (2014). \"The psychometric properties of CollaboRATE: a fast and frugal patient-reported measure of the shared decision-making process.\" J Med Internet Res 16(1): e2.",null,"Barr, P. J., et al.","The psychometric properties of CollaboRATE: a fast and frugal patient-reported measure of the shared decision-making process","BACKGROUND: Patient-centered health care is a central component of current health policy agendas. Shared decision making (SDM) is considered to be the pinnacle of patient engagement and methods to promote this are becoming commonplace. However, the measurement of SDM continues to prove challenging. Reviews have highlighted the need for a patient-reported measure of SDM that is practical, valid, and reliable to assist implementation efforts. In consultation with patients, we developed CollaboRATE, a 3-item measure of the SDM process. OBJECTIVE: There is a need for scalable patient-reported measure of the SDM process. In the current project, we assessed the psychometric properties of CollaboRATE. METHODS: A representative sample of the US population were recruited online and were randomly allocated to view 1 of 6 simulated doctor-patient encounters in January 2013. Three dimensions of SDM were manipulated in the encounters: (1) explanation of the health issue, (2) elicitation of patient preferences, and (3) integration of patient preferences. Participants then completed CollaboRATE (possible scores 0-100) in addition to 2 other patient-reported measures of SDM: the 9-item Shared Decision Decision Making Questionnaire (SDM-Q-9) and the Doctor Facilitation subscale of the Patient's Perceived Involvement in Care Scale (PICS). A subsample of participants was resurveyed between 7 and 14 days after the initial survey. We assessed CollaboRATE's discriminative, concurrent, and divergent validity, intrarater reliability, and sensitivity to change. RESULTS: The final sample consisted of 1341 participants. CollaboRATE demonstrated discriminative validity, with a significant increase in CollaboRATE score as the number of core dimensions of SDM increased from zero (mean score: 46.0, 95% CI 42.4-49.6) to 3 (mean score 85.8, 95% CI 83.2-88.4). CollaboRATE also demonstrated concurrent validity with other measures of SDM, excellent intrarater reliability, and sensitivity to change; however, divergent validity was not demonstrated. CONCLUSIONS: The fast and frugal nature of CollaboRATE lends itself to routine clinical use. Further assessment of CollaboRATE in real-world settings is required.","J Med Internet Res, 16(1): e2","USA",2014,"Not Specified","Not Specified","PICS,SDM-Q-9,CollaboRATE","Adolescent,Adults","Tool Validation","Cross-sectional"]
[61,"Haughney, J., et al. (2007). \"The use of a modification of the Patient Enablement Instrument in asthma.\" Prim Care Respir J 16(2): 89-92.",null,"Haughney, J., et al.","The use of a modification of the Patient Enablement Instrument in asthma","AIM: To ascertain if the Patient Enablement Instrument (PEI) could be adapted for use in asthma management, and to use it to evaluate \"enablement\" in patients with asthma randomised to either a fixed or adjustable medication dosing regime. METHODS: The original Patient Enablement Instrument was modified by making a minor change to the opening statement. 228 adults with asthma from 72 UK general practices were recruited to the study. The internal and external consistencies of the modified PEI were assessed. Individual scores were compared across treatment groups. RESULTS: The modified PEI had high internal consistency. There was a significant correlation between modified PEI total score and change in Mini Asthma Quality of Life Questionnaire. A significantly greater proportion of patients using adjustable medication dosing had a clinically relevant treatment benefit. CONCLUSIONS: The Patient Enablement Instrument can be used to measure \"enablement\" in asthma.","Prim Care Respir J, 16(2): 89-92","UK",2007,"Asthma","Medication","PEI","Not Specified","Tool Validation","Cross-sectional"]
[62,"Zoutman, D., et al. (1998). \"Total and attributable costs of surgical-wound infections at a Canadian tertiary-care center.\" Infect Control Hosp Epidemiol 19(4): 254-259.",null,"Zoutman, D., et al.","Total and attributable costs of surgical-wound infections at a Canadian tertiary-care center","OBJECTIVE: To determine the total and attributable costs of surgical-wound infections in a Canadian teaching hospital. DESIGN: Retrospective incidence series study with chart review and examination of resource utilization attributable to wound infection. The charts of inpatients with wound infections were examined using the Appropriateness Evaluation Protocol (AEP), a validated chart review instrument designed to determine appropriateness of care, modified for wound infections. SETTING: A university referral center in Canada. PATIENTS: Medical records were abstracted from patients with wound infections who underwent an inpatient clean or clean-contaminated procedure during 1991. MEASUREMENTS: During the wound-infection treatment period, the hospital costs associated with providing care were tabulated for all inpatient days and for outpatient and emergency visits. Costs taken into account included nursing salary and benefits, nonphysician professional services, operating room time, laboratory, pharmacy, supplies, ancillary tests, and hotel costs. RESULTS: We identified 108 wound infections. Twenty-two patients required 28 surgical procedures related to a wound infection. Inpatient days totalled 1,116, costing $394,337. Fifty-five emergency and 42 clinic visits occurred, costing $27,193. By applying the AEP to the inpatient days, 833 days, or 10.2 days per case, were directly attributable to the wound infection. The hospital costs for inpatient care attributable to wound infections were $321,533 in total, or $3,937 per infection. Costs were distributed as follows: nursing, 51%; hotel, 14%; pharmacy, 10%; laboratory, 9%; emergency and outpatient clinic, 6%; professional services, 5%; operating room, 3%; and ancillary tests, 2%. CONCLUSIONS: Wound infections contribute markedly to extra days of hospitalization and related costs. The AEP method is applied easily to determine attributable days of care and costs of wound infections, which are necessary to calculate the cost-benefit of infection control programs.","Infect Control Hosp Epidemiol, 19(4): 254-259","Canada",1998,"Surgical-wound infections","Wound cleaning","AEP","Adults","Costs,Resource Use","Cross-sectional"]
[63,"Woodhams, V., et al. (2012). \"Triumph of hope over experience: learning from interventions to reduce avoidable hospital admissions identified through an Academic Health and Social Care Network.\" BMC Health Serv Res 12: 153.",null,"Woodhams, V., et al.","Triumph of hope over experience: learning from interventions to reduce avoidable hospital admissions identified through an Academic Health and Social Care Network","BACKGROUND: Internationally health services are facing increasing demands due to new and more expensive health technologies and treatments, coupled with the needs of an ageing population. Reducing avoidable use of expensive secondary care services, especially high cost admissions where no procedure is carried out, has become a focus for the commissioners of healthcare. METHOD: We set out to identify, evaluate and share learning about interventions to reduce avoidable hospital admission across a regional Academic Health and Social Care Network (AHSN). We conducted a service evaluation identifying initiatives that had taken place across the AHSN. This comprised a literature review, case studies, and two workshops. RESULTS: We identified three types of intervention: pre-hospital; within the emergency department (ED); and post-admission evaluation of appropriateness. Pre-hospital interventions included the use of predictive modelling tools (PARR - Patients at risk of readmission and ACG - Adjusted Clinical Groups) sometimes supported by community matrons or virtual wards. GP-advisers and outreach nurses were employed within the ED. The principal post-hoc interventions were the audit of records in primary care or the application of the Appropriateness Evaluation Protocol (AEP) within the admission ward. Overall there was a shortage of independent evaluation and limited evidence that each intervention had an impact on rates of admission. CONCLUSIONS: Despite the frequency and cost of emergency admission there has been little independent evaluation of interventions to reduce avoidable admission. Commissioners of healthcare should consider interventions at all stages of the admission pathway, including regular audit, to ensure admission thresholds don't change.","BMC Health Serv Res, 12(153","UK",2012,"Not Specified","Hospitalisation","AEP","Not Specified","Costs,Resource Use","Cross-sectional"]
[64,"Wakefield, D. S., et al. (1987). \"Use of the appropriateness evaluation protocol for estimating the incremental costs associated with nosocomial infections.\" Med Care 25(6): 481-488.",null,"Wakefield, D. S., et al.","Use of the appropriateness evaluation protocol for estimating the incremental costs associated with nosocomial infections","Existing methods for estimating additional days of hospital stay due to nosocomial infections (NI) have a number of documented limitations. An alternative method described in this paper uses the Appropriateness Evaluation Protocol (AEP) to determine whether each day of acute inpatient care is appropriate based on the need for care of the NI, original cause of hospitalization (OC), or combined NI-OC requirements. Using this method to identify specific days of hospitalization due to Staphylococcus aureus nosocomial infection, we find: 1) length of stay is increased for only a minority of patients (38%); 2) an average of 20 additional days of stay occurred for patients with 1 or more days attributed to NI; and 3) an average of 52% of length of stay of patients with 1 or more days attributed to NI can be attributed to the NI. Application of the AEP-based method is a useful alternative for identifying additional days of stay due to NI.","Med Care, 25(6): 481-488","USA",1987,"MRSA","Hospitalisation","AEP","Children","Resource Use","Cross-sectional"]
[65,"Wallace, P., et al. (2004). \"Virtual outreach: a randomised controlled trial and economic evaluation of joint teleconferenced medical consultations.\" Health Technol Assess 8(50): 1-106, iii-iv.",null,"Wallace, P., et al.","Virtual outreach: a randomised controlled trial and economic evaluation of joint teleconferenced medical consultations","OBJECTIVES: To test the hypotheses that virtual outreach would reduce offers of hospital follow-up appointments and reduce numbers of medical interventions and investigations, reduce numbers of contacts with the health care system, have a positive impact on patient satisfaction and enablement, and lead to improvements in patient health status. To perform an economic evaluation of virtual outreach. DESIGN: A randomised controlled trial comparing joint teleconsultations between GPs, specialists and patients with standard outpatient referral. It was accompanied by an economic evaluation. SETTING: The trial was centred on the Royal Free Hampstead NHS Trust, London, and the Royal Shrewsbury Hospital Trust in Shropshire. The project teams recruited and trained a total of 134 GPs from 29 practices and 20 consultant specialists. PARTICIPANTS: In total, 3170 patients were referred, of whom 2094 consented to participate in the study and were eligible for inclusion. In all, 1051 patients were randomised to the virtual outreach group and 1043 to standard outpatient appointments. The patients were followed 6 months after their index consultation. INTERVENTIONS: Patients randomised to virtual outreach underwent a joint teleconsultation, in which they attended the general practice surgery where they and their GP consulted with a hospital specialist via a videolink between the hospital and the practice. MAIN OUTCOME MEASURES: Outcome measures included offers of follow-up outpatient appointments, numbers of tests, investigations, procedures, treatments and contacts with primary and secondary care, patient satisfaction (Ware Specific Visit Questionnaire), enablement (Patient Enablement Instrument) and quality of life (Short Form-12 and Child Health Questionnaire). An economic evaluation of the costs and consequences of the intervention was undertaken. Sensitivity analysis was used to test the robustness of the results. RESULTS: Patients in the virtual outreach group were more likely to be offered a follow-up appointment. Significant differences in effects were observed between the two sites and across different specialities. Virtual outreach increased the offers of follow-up appointments more in Shrewsbury than in London, and more in ENT and orthopaedics than in the other specialities. Fewer tests and investigations were ordered in the virtual outreach group, by an average of 0.79 per patient. In the 6-month period following the index consultation, there were no significant differences overall in number of contacts with general practice, outpatient visits, accident and emergency contacts, inpatient stays, day surgery and inpatient procedures or prescriptions between the randomised groups. Tests of interaction indicated that virtual outreach decreased the number of tests and investigations, particularly in patients referred to gastroenterology, and increased the number of outpatient visits, particularly in those referred to orthopaedics. Patient satisfaction was greater after a virtual outreach consultation than after a standard outpatient consultation, with no heterogeneity between specialities or sites. However, patient enablement after the index consultation, and the physical and psychological scores of the Short Form-12 for adults and the scores on the Child Health Questionnaire for children under 16, did not differ between the randomised groups at 6 months' follow-up. NHS costs over 6 months were greater for the virtual outreach consultations than for conventional outpatients, pound 724 and pound 625 per patient, respectively. The index consultation accounted for this excess. Cost and time savings to patients were found. Estimated productivity losses were also less in the virtual outreach group. CONCLUSIONS: Virtual outreach consultations result in significantly higher levels of patient satisfaction than standard outpatient appointments and lead to substantial reductions in numbers of tests and investigations, but they are variably associated with increased rates of offer of follow-up according to speciality and site. Changes in costs and technological advances may improve the relative position of virtual consultations in future. The extent to which virtual outreach is implemented will probably be dependent on factors such as patient demand, costs, and the attitudes of staff working in general practice and hospital settings. Further research could involve long-term follow-up of patients in the virtual outreach trial to determine downstream outcomes and costs; further study into the effectiveness and costs of virtual outreach used for follow-up appointments, rather than first-time referrals; and whether the costs of virtual outreach could be substantially reduced without adversely affecting the quality of the consultation if nurses or other members of the primary care team were to undertake the hosting of the joint teleconsultations in place of the GP. Qualitative work into the attitudes of the patients, GPs and hospital specialists would also be valuable.","Health Technol Assess, 8(50): 1-106, iii-iv","UK",2004,"Not Specified","Tele-communications","PEI","Children,Adults","Resource Use","Clinical Trial"]

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["Acronym","Full name"]
["AEP","Appropriateness Evaluation Protocol"]
["BCQ","Barriers to Care Questionnaire"]
["CDIS","Control Preference Scale"]
["CollaboRATE","Decision-Making Process Questionnaire"]
["EC-17","Effective Consumer Scale"]
["GCQ","Group Cohesion Questionnaire"]
["HAQ-II","Helping Alliance Questionnaire"]
["HCCQ","Health Care Climate Questionnaire "]
["IEQ-EU","Involvement Evaluation Questionnaire"]
["MBS","Melnyk's Barriers Scale"]
["PDIS","Patient-Doctor Interaction Scale"]
["PEI","Patient Enablement Instrument"]
["PEPPI-5","5-item Perceived Efficacy in Patient-Physician Interactions"]
["PICS","Patient's Perceived Involvement in Care Scale"]
["PPS","Patient Perception Survey"]
["PRESS","Preventive Services Use Self-Efficacy Scale"]
["PS-PVQ","Patient's Viewpoint Questionnaire "]
["QPPI","Quality of the Physician-Patient Interaction"]
["SCAF","Self-completed Agenda Form"]
["SDM-Q-9","Shared Decision Decision Making Questionnaire"]
["SWD","Satisfaction with Decision-Making scale"]

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[65,"Full citation","DOI","Authors","Title","Abstract","Citation","Locations","Year","Diseases","Interventions","PROtools","Subpopulations","Study types","Study methodologies","LocationsTags","SubpopulationsTags","DiseaseTags","InterventionsTags","StudytypesTags","StudyMethodologyTags","PROtoolTags","DateBand","C1","C2","C3","C4","C5"]
[1,"Johnson,B. R.,et al. (2006). \"A chairside aid for shared decision making in dentistry: a randomized controlled trial.\" J Dent Educ 70(2): 133-141.",null,"Johnson,B. R.,et al.","A chairside aid for shared decision making in dentistry: a randomized controlled trial","The concept of shared decision making (SDM) is an important emerging trend in clinical medicine but has received little or no attention in the dental literature. Decision aids can play a useful role in SDM by helping patients and clinicians choose among reasonable alternative treatment options. The purpose of this study was to develop and test an Endodontic Decision Board (EndoDB) for chairside use to help clarify treatment alternatives,benefits,risks,prognosis,and costs when root canal therapy or extraction of a tooth was indicated. The hypothesis was that the use of the EndoDB would lead to improved patient knowledge,greater satisfaction with the decision-making process,and no difference in anxiety when compared to the standard discussion and informed consent process (usual care). The EndoDB was tested in a randomized controlled trial in a postgraduate endodontics clinic. After treatment discussion,a brief questionnaire was completed by the patient to measure knowledge,satisfaction,and anxiety. Patients in the EndoDB group (n=32) demonstrated a small,but statistically significant,increase in knowledge (t-test; difference=+0.37; p=0.03) compared to the usual care group (n=35). There was no difference between groups in the measures of satisfaction or anxiety (Mann-Whitney U-test; p>0.05). Decision aids may emerge as a useful tool to facilitate SDM and evidence-based clinical practice.","J Dent Educ,70(2): 133-141","USA",2006,"Oral Health","Tooth extraction","SWD","Not Specified","PRO study","RCT","USA","Not Specified","Oral Health","Tooth extraction","PRO study","RCT","SWD","2005:2009"]
[2,"Bower,P.,et al. (2015). \"A cluster randomised controlled trial and process evaluation of a training programme for mental health professionals to enhance user involvement in care planning in service users with severe mental health issues (EQUIP): study protocol for a randomised controlled trial.\" Trials 16: 348.",null,"Bower,P.,et al.","A cluster randomised controlled trial and process evaluation of a training programme for mental health professionals to enhance user involvement in care planning in service users with severe mental health issues (EQUIP): study protocol for a randomised controlled trial","BACKGROUND: Involving service users in planning their care is at the centre of policy initiatives to improve mental health care quality in England. Whilst users value care planning and want to be more involved in their own care,there is substantial empirical evidence that the majority of users are not fully involved in the care planning process. Our aim is to evaluate the effectiveness and cost-effectiveness of training for mental health professionals in improving user involvement with the care planning processes. METHODS/DESIGN: This is a cluster randomised controlled trial of community mental health teams in NHS Trusts in England allocated either to a training intervention to improve user and carer involvement in care planning or control (no training and care planning as usual). We will evaluate the effectiveness of the training intervention using a mixed design,including a 'cluster cohort' sample,a 'cluster cross-sectional' sample and process evaluation. Service users will be recruited from the caseloads of care co-ordinators. The primary outcome will be change in self-reported involvement in care planning as measured by the validated Health Care Climate Questionnaire. Secondary outcomes include involvement in care planning,satisfaction with services,medication side-effects,recovery and hope,mental health symptoms,alliance/engagement,well-being and quality of life. Cost- effectiveness will also be measured. A process evaluation informed by implementation theory will be undertaken to assess the extent to which the training was implemented and to gauge sustainability beyond the time-frame of the trial. DISCUSSION: It is hoped that the trial will generate data to inform mental health care policy and practice on care planning. TRIAL REGISTRATION NUMBER: ISRCTN16488358 (14 May 2014).","Trials,16(348","UK",2015,"Mental Health","HCP Training","HCCQ","Mental Health Carers","Cost-effectiveness","RCT","UK","Mental Health Carers","Mental Health","HCP Training","Cost-effectiveness","RCT","HCCQ","2015:2018"]
[3,"Howie,J. G.,et al. (1998). \"A comparison of a Patient Enablement Instrument (PEI) against two established satisfaction scales as an outcome measure of primary care consultations.\" Fam Pract 15(2): 165-171.",null,"Howie,J. G.,et al.","A comparison of a Patient Enablement Instrument (PEI) against two established satisfaction scales as an outcome measure of primary care consultations","OBJECTIVES: We aimed to compare a new primary care outcome measure-the Patient Enablement Instrument (PEI)-against two established satisfaction measures [the Medical Interview Satisfaction Scale (MISS) and the Consultation Satisfaction Questionnaire (CSQ)]. Specifically,we sought (i) to test whether enablement and satisfaction are related or separate concepts; and (ii) to assess whether the internal consistency of the PEI might be enhanced by the inclusion of items from the satisfaction instruments. METHODS: Questionnaire forms containing the three instruments in a variety of combinations were distributed to a total of 818 patients attending for routine surgery consultations in three urban general practices of varying socio-economic mix. The main outcome measures were: scores on the PEI; scores on the CSQ,the MISS and their individual components; rank correlations between scores on the PEI and scores on the CSQ,the MISS and their component subscales; and Cronbach's alpha coefficient for the PEI. RESULTS: Overall mean scores,expressed as percentages of maximum scores attainable,were 44.1% for the PEI,76.9% for the CSQ and 77.6% for the MISS. Rank correlations between PEI scores and scores for the complete CSQ and MISS instruments were 0.48 (P < 0.01) and 0.47 (P < 0.01),respectively. Correlations of PEI scores with individual component scores on the CSQ were generally lower and ranged from 0.14 to 0.53; correlations of PEI scored with MISS component scores were also generally lower and ranged from 0.21 to 0.53. Internal consistency of the PEI items (assessed by Cronbach's alpha coefficient) was lowered when items from the CSQ or MISS were added. CONCLUSIONS: The study shows that 'enablement' is a primary care outcome measure which is related to but is different from general satisfaction.","Fam Pract,15(2): 165-171","UK",1998,"Not Specified","Surgery","PEI","Not Specified","Tool Validation","Cross-sectional","UK","Not Specified","Not Specified","Surgery","Tool Validation","Cross-sectional","PEI","1995:1999"]
[4,"Julian,S.,et al. (2007). \"An integrated care pathway for menorrhagia across the primary-secondary interface: patients' experience,clinical outcomes,and service utilisation.\" Qual Saf Health Care 16(2): 110-115.",null,"Julian,S.,et al.","An integrated care pathway for menorrhagia across the primary-secondary interface: patients' experience,clinical outcomes,and service utilisation","BACKGROUND: \"Referral\" characterises a significant area of interaction between primary and secondary care. Despite advantages,it can be inflexible,and may lead to duplication. OBJECTIVE: To examine the outcomes of an integrated model that lends weight to general practitioner (GP)-led evidence based care. DESIGN: A prospective,non-random comparison of two services: women attending the new (Bridges) pathway compared with those attending a consultant-led one-stop menstrual clinic (OSMC). Patients' views were examined using patient career diaries,health and clinical outcomes,and resource utilisation. Follow-up was for 8 months. SETTING: A large teaching hospital and general practices within one primary care trust (PCT). RESULTS: Between March 2002 and June 2004,99 women in the Bridges pathway were compared with 94 women referred to the OSMC by GPs from non-participating PCTs. The patient career diary demonstrated a significant improvement in the Bridges group for patient information,fitting in at the point of arrangements made for the patient to attend hospital (ease of access) (p<0.001),choice of doctor (p = 0.020),waiting time for an appointment (p<0.001),and less \"limbo\" (patient experience of non-coordination between primary and secondary care) (p<0.001). At 8 months there were no significant differences between the two groups in surgical and medical treatment rates or in the use of GP clinic appointments. Significantly fewer (traditional) hospital outpatient appointments were made in the Bridges group than in the OSMC group (p<0.001). CONCLUSION: A general practice-led model of integrated care can significantly reduce outpatient attendance while improving patient experience,and maintaining the quality of care.","Qual Saf Health Care,16(2): 110-115","UK",2007,"Menorrhagia","Not Specified","Patient career diary","Women","PRO study","Cross-sectional","UK","Women","Menorrhagia","Not Specified","PRO study","Cross-sectional","Patient career diary","2005:2009"]
[5,"Fried,R. A.,et al. (1994). \"Appropriateness of hospital use by family physicians.\" J Am Board Fam Pract 7(3): 229-235.",null,"Fried,R. A.,et al.","Appropriateness of hospital use by family physicians","BACKGROUND: Reducing inappropriate hospital admissions could lead to lower total health care costs without compromising the quality of care. Research suggests that a sizeable portion of hospital admissions are inappropriate. Other studies indicate that family physicians use health care resources,including hospitalizations,less often than other primary care physicians. To gain additional insight into family physicians' decisions to admit patients,we performed an exploratory study using the Appropriateness Evaluation Protocol,a validated,clinically based utilization review instrument. METHODS: We assessed admissions by community-based and residency-based family physicians to a single university-affiliated hospital during calendar year 1988. A total of 905 patients were admitted to the hospital by family physicians during the study period. Of these,889 records had complete data. Each was reviewed for appropriateness of admission. We calculated percentages of inappropriate admissions and used logistic regression to ascertain variables that were significant predictors of inappropriateness. RESULTS: Overall,5.4 percent of admissions were categorized as inappropriate. Omitting obstetric cases,the rate was 10.5 percent. Inappropriate admissions did not cluster around a small number of diagnoses or diagnosis-related groups. Using logistic regression,we found that urgency of admission,patient insurance status,and residency-based physician admission versus community-based physician admission were significant predictors of inappropriate hospital use. Of the inappropriate admissions,70 percent were so rated because diagnostic procedures or treatments could have been performed on an outpatient basis. CONCLUSIONS: In contrast with other studies for which physician specialty was not controlled,family physicians less frequently admitted patients inappropriately. Predictors of inappropriateness differed from those found in other studies. Changes in hospital systems,in addition to educational efforts directed toward individual physicians,hold promise as a strategy for reducing inappropriate hospital use.","J Am Board Fam Pract,7(3): 229-235","USA",1994,"Not Specified","Hospitalisation","AEP","Adults","Resource Use","Cross-sectional","USA","Adults","Not Specified","Hospitalisation","Resource Use","Cross-sectional","AEP","1990:1994"]
[6,"Katz,M.,et al. (2001). \"Appropriateness of pediatric admissions to a tertiary care facility in Israel.\" Isr Med Assoc J 3(7): 501-503.",null,"Katz,M.,et al.","Appropriateness of pediatric admissions to a tertiary care facility in Israel","BACKGROUND: Appropriateness of hospital admission has both clinical and economic relevance,especially in light of the growing pressure for increased efficiency of health services utilization. In Israel,the number of referrals and use of the emergency room continue to rise along with an increase in hospital admissions and the number of inappropriate admissions. Using evaluation protocols,such as the Pediatric Appropriateness Evaluation Protocol,international studies have shown that 10-30% of hospital admissions are medically unnecessary. Inappropriate hospitalizations have an economic impact as well as medical and psychological effects on the child and the family. OBJECTIVES: To assess the extent and characteristics of inappropriate pediatric admissions to a tertiary care facility in Israel. METHODS: We conducted a prospective study using chart review of pediatric admissions to Soroka University Medical Center on 18 randomly selected days in 1993,and evaluated the appropriateness of admissions using the PAEP. RESULTS: Of the 221 pediatric admissions 18% were evaluated as inappropriate. The main reason for such an evaluation was that the problem could have been managed on an ambulatory basis. Inappropriate admissions were associated with hospitals stays of 2 or less days,children older than 1 year of age,Jewish children,and self-referrals to the pediatric emergency room. CONCLUSIONS: The assessment and identification of characteristics of inappropriate hospital admissions can serve as indicators of problems in healthcare management and as a basis for improving quality of care and developing appropriate medical decision-making processes.","Isr Med Assoc J,3(7): 501-503","Israel",2001,"Not Specified","Hospitalisation","AEP","Children","Resource Use","Cross-sectional","Israel","Children","Not Specified","Hospitalisation","Resource Use","Cross-sectional","AEP","2000:2004"]
[7,"Kreger,B. E. and J. D. Restuccia (1989). \"Assessing the need to hospitalize children: pediatric appropriateness evaluation protocol.\" Pediatrics 84(2): 242-247.",null,"Kreger,B. E. and J. D. Restuccia","Assessing the need to hospitalize children: pediatric appropriateness evaluation protocol","Rapidly increasing hospital costs have necessitated use review of hospitalized patients to improve the appropriateness (medical necessity) of hospital use. The development and testing of the Pediatric Appropriateness Evaluation Protocol,an objective,criteria-based instrument intended to assist physicians and use reviewers in making decisions regarding appropriateness of pediatric hospital admissions and days of care,are described.","Pediatrics,84(2): 242-247","USA",1989,"Not Specified","Hospitalisation","AEP","Children","Resource Use","Cross-sectional","USA","Children","Not Specified","Hospitalisation","Resource Use","Cross-sectional","AEP","1960:1989"]
[8,"Goncalves-Pereira,M.,et al. (2017). \"Assessment of the consequences of caregiving in psychosis: a psychometric comparison of the Zarit Burden Interview (ZBI) and the Involvement Evaluation Questionnaire (IEQ).\" Health Qual Life Outcomes 15(1): 63.",null,"Goncalves-Pereira,M.,et al.","Assessment of the consequences of caregiving in psychosis: a psychometric comparison of the Zarit Burden Interview (ZBI) and the Involvement Evaluation Questionnaire (IEQ)","BACKGROUND: The Zarit Burden Interview (ZBI) was originally developed to assess the level of subjective burden in caregivers of people with dementia. The Involvement Evaluation Questionnaire (IEQ) is amongst the leading scales to assess caregiving consequences in severe mental illness. We aimed to compare the psychometric properties of the ZBI,a generic tool,and of the IEQ,a more specific tool to assess the consequences of caregiving in schizophrenia and related disorders. METHODS: Secondary analyses of a 16-week,randomized controlled trial of a psychoeducational intervention in 223 primary caregivers of patients with schizophrenia or schizoaffective disorder. Psychometric properties (internal consistency,convergent and discriminative validity,and sensitivity to change) were evaluated for both ZBI and IEQ. RESULTS: Internal consistency was good and similar for both scales (ZBI: 0.91,95% CI: 0.89,0.94; IEQ: 0.86,95% CI: 0.83,0.89). Convergent validity was relevant for similar domains (e.g. ZBI total score vs IEQ-tension r = 0.69,95% CI: 0.61,0.75) and at least moderate for the rest of domains (ZBI total score,personal strain and role strain vs IEQ-urging and supervision). Discriminative validity against psychological distress and depressive symptoms was good (Area Under the Curve [AUC]: 0.77,95% CI: 0.71,0.83; and 0.69,95% CI: 0.63,0.78 - for ZBI against GHQ-28 and CES-D respectively; and AUC: 0.72,95% CI: 0.65,0.78; and 0.69,95% CI: 0.62,0.77 - for IEQ against GHQ-28 and CES-D respectively). AUCs against the reference criteria did not differ significantly between the two scales. After the intervention,both scales showed a significant decrease at endpoint (p-values < 0.001) with similar standardised effect sizes for change (-0.36,95% CI: -0.58,-0.15 - for ZBI; -0.39,95% CI: -0.60,-0.18 - for IEQ). CONCLUSIONS: Both ZBI and IEQ have shown satisfactory psychometric properties to assess caregiver burden in this sample. We provided further evidence on the performance of the ZBI as a general measure of subjective burden. TRIAL REGISTRATION: ( ISRCTN32545295 ).","Health Qual Life Outcomes,15(1): 63","Portugal,Spain",2017,"Dementia","HCP Training","IEQ-EU","Not Specified","Tool Validation","RCT","Portugal,Spain","Not Specified","Dementia","HCP Training","Tool Validation","RCT","IEQ-EU","2015:2018"]
[9,"Seid,M.,et al. (2009). \"Barriers to care questionnaire: reliability,validity,and responsiveness to change among parents of children with asthma.\" Acad Pediatr 9(2): 106-113.",null,"Seid,M.,et al.","Barriers to care questionnaire: reliability,validity,and responsiveness to change among parents of children with asthma","BACKGROUND: Although it is well known which groups of children are more vulnerable to poor health care access,quality,and outcomes,less is known about how and why this occurs. Barriers to care-sociobehavioral processes that interfere with successful interaction with the health care system--may be a link between vulnerability and access,experiences,and outcomes. OBJECTIVE: The aim of this study was to examine the reliability,validity,and responsiveness to change of the Barriers to Care Questionnaire (BCQ) in a sample of children with persistent asthma recruited from federally qualified health centers. METHOD: Children (N = 252; aged 2-14 years) with persistent asthma and their parents (93.7% mother,83.3% Hispanic,76.9% Spanish speaking; 72.6% less than a high school diploma),enrolled in a clinical trial,and completed the BCQ,questions relating to access to care,the Parent's Perceptions of Primary Care Measure,and the Pediatric Quality of Life Inventory 4.0 (PedsQL) at baseline and 3 months. RESULTS: The BCQ demonstrated internal consistency reliability. Supporting construct validity,barriers to care were worse for children without health insurance or an identified provider and who had problems with care or foregone care. Higher barriers correlated with poorer primary care and lower patient health-related quality of life. The BCQ was responsive to change,showing within- and between-subject differences for subjects with improved realized access from baseline to 3 months. CONCLUSION: The BCQ is a reliable,valid,and responsive measure of barriers to care for vulnerable children with asthma. Barriers to care were associated with poorer access,lower primary care quality,and worse health-related quality of life.","Acad Pediatr,9(2): 106-113","USA",2009,"Asthma","Not Specified","BCQ","Children","Tool Validation","Cross-sectional","USA","Children","Asthma","Not Specified","Tool Validation","Cross-sectional","BCQ","2005:2009"]
[10,"Bloom,K. C.,et al. (2004). \"Barriers to prenatal care for homeless pregnant women.\" J Obstet Gynecol Neonatal Nurs 33(4): 428-435.",null,"Bloom,K. C.,et al.","Barriers to prenatal care for homeless pregnant women","OBJECTIVE: The purpose of this study was to explore and describe the barriers to prenatal care for homeless pregnant women. DESIGN: A descriptive survey with written questionnaires. PARTICIPANTS: About 183 pregnant homeless women live in Northeast Florida in any given month. More than 250 surveys were distributed to homeless pregnant women via agencies that provide shelter and/or services to homeless people in Northeast Florida. Forty-seven surveys were returned,representing 25.7% of the estimated population. MAIN OUTCOME MEASURE: Barriers to prenatal care were measured using Melnyk's Barriers Scale,a 27-item Likert-type scale. RESULTS: Of the respondents,75.61% perceived barriers to prenatal care. Site-related factors were the most significant,followed by provider/client relationship,inconvenience,fear,and cost. CONCLUSIONS: Although prenatal care is available to all pregnant women in Northeast Florida,barriers to accessing this care for homeless pregnant women are significant and need to be addressed by health care providers and administrators. Additional qualitative study of these issues is warranted.","J Obstet Gynecol Neonatal Nurs,33(4): 428-435","USA",2004,"Not Specified","Not Specified","MBS","Pregnant,Women","PRO study","Cross-sectional","USA","Pregnant,Women","Not Specified","Not Specified","PRO study","Cross-sectional","MBS","2000:2004"]
[11,"Henley,L.,et al. (1991). \"Bed use in the medical wards of Red Cross War Memorial Children's Hospital,Cape Town.\" S Afr Med J 80(10): 487-490.",null,"Henley,L.,et al.","Bed use in the medical wards of Red Cross War Memorial Children's Hospital,Cape Town","OBJECTIVE: To determine extent of appropriate (medically necessary) and inappropriate bed use and level of care (LOC) needed by patients admitted to hospital. DESIGN: A cross-sectional,descriptive survey. SETTING: Medical wards of Red Cross War Memorial Children's Hospital (RCCH),a teaching hospital of the University of Cape Town. MEASUREMENT AND RESULTS: A 25% sample of beds was selected randomly each day for 12 consecutive days during September-October 1990. Data were collected using a questionnaire based on the Pediatric Appropriateness Evaluation Protocol and the Delay Tool. A subjective measure of LOC was developed. Questionnaires were completed for 171 admissions and 365 patient days; 98% of admissions and 79.5% of patient days were medically justified,and 49% of admissions needed tertiary care. The remaining 51% could have been treated by general paediatricians (17%) or medical officers (32%) in community hospitals. Of delays (unnecessary patient days) 62% were hospital-related,20% were family-related and 18% were related to inadequate lower level institutional care and outpatient services. CONCLUSION: RCCH is functioning as a general,specialist and super-specialist hospital. Its future role as a tertiary referral centre will depend on adequate provision of community-based care. Further cost-benefit research is needed to address areas of inappropriate bed use identified in this study.","S Afr Med J,80(10): 487-490","South Africa",1991,"Not Specified","Hospitalisation","AEP","Children","Resource Use","Cross-sectional","South Africa","Children","Not Specified","Hospitalisation","Resource Use","Cross-sectional","AEP","1990:1994"]
[12,"Egan,E. A.,et al. (2015). \"Building the bridge from pediatric to adult diabetes care: making the connection.\" Diabetes Educ 41(4): 432-443.",null,"Egan,E. A.,et al.","Building the bridge from pediatric to adult diabetes care: making the connection","PURPOSE: The purpose of this study was to evaluate the effectiveness of a structured transition program by measuring clinical and psychometric properties related to transition and adherence to follow-up. Transition of emerging adults with type 1 diabetes can be problematic. This natural progression to adult health care is often delayed,leading to transition at less than optimal times. Implementation of a transition program will improve the transition process for emerging adults with type 1 diabetes. METHODS: Mixed-method,prospective longitudinal study involving collaboration between pediatric and adult providers. Subjects age 18 to 28 years were identified for transition. Transition was facilitated via joint appointment with pediatric and adult health care providers. Participants completed pre- and posttransition surveys measuring diabetes-related distress (Diabetes Distress Scale [DDS]),quality of life (Diabetes Quality of Life Youth-Short Form [DQOLY-SF]),and perceived health care provider autonomy support (Health Care Climate Questionnaire [HCCQ]). Primary outcome was adherence to follow-up. Secondary outcomes evaluated correlations in DDS,DQOLY-SF,HCCQ,and A1C. Chart review assessed acute complications,A1C,and adherence to follow-up. RESULTS: Adherence to follow-up was 100%. This study found that correlations between DQOLY-SF and DDS and correlations between DDS and A1C were highly significant during the pretransition phase. This study also indicated that the same correlations were highly significant following transition. Paired t test indicated a statistically significant reduction in diabetes distress from pre- to posttransition evaluations and an increase in HCCQ. Content comparative analysis of open-ended questions further illustrated issues related to transition. CONCLUSION: Use of a structured transition process with joint appointments and transition coordinator improves adherence to follow-up and reduces diabetes-related distress.","Diabetes Educ,41(4): 432-443","USA",2015,"Diabetes","Not Specified","HCCQ","Adults","PRO study","Longitudinal Observation","USA","Adults","Diabetes","Not Specified","PRO study","Longitudinal Observation","HCCQ","2015:2018"]
[13,"Carelle,N.,et al. (2002). \"Changing patient perceptions of the side effects of cancer chemotherapy.\" Cancer 95(1): 155-163.",null,"Carelle,N.,et al.","Changing patient perceptions of the side effects of cancer chemotherapy","BACKGROUND: Quality-of-life (QoL) issues have become increasingly important as the number of newly diagnosed patients with cancer increases and survival improves. In 1983,Coates et al. reported a survey of patient perceptions of the side effects of cancer chemotherapy and showed the importance of including patient feedback for the accurate assessment of QoL (Eur J Cancer Clin Oncol. 1983;19:203-208.). The authors carried out a similar survey in 100 patients with cancer with the objectives of 1) investigating the changes in patient perceptions that have occurred and 2) evaluating the impact of new treatments on the profile of chemotherapy side effects among patients receiving anticancer drugs. METHODS: One hundred patients attending the outpatient Medical Oncology Department of the Pitie Salpetriere Hospital Group were surveyed between August 1998 and February 2000 by trained interviewers who were blinded to the patients' treatment. Patients identified all side effects associated with their treatment using a set of 45 cards that named physical side effects (Group A) and a set of 27 cards that named nonphysical side effects (Group B),and the patients ranked these side effects according to severity. The top 5 cards from each group were then combined,and the resulting 10 cards were rated again by severity,regardless of group. Results were analyzed for the entire cohort and for demographic,social,and clinical subgroups. RESULTS: The participants included 65 women and 35 men; the most common malignancies were breast carcinoma (40 patients),gastrointestinal carcinoma (19 patients),lung carcinoma (7 patients),and ovarian carcinoma (9 patients). Patients rated affects my family or partner as the most severe side effect,alopecia was second,and fatigue was the third most severe. Effects on work or home responsibilities,effects on social activities,and loss of interest in sex were ranked fourth,fifth,and sixth,respectively. The results contrasted with those of Coates et al.,in which affects my family or partner was ranked 10th,and fatigue was ranked 8th. CONCLUSIONS: Patient perceptions of the side effects of cancer chemotherapy have changed markedly. In the current study,fatigue and psychosocial QoL concerns predominated,compared with emesis,nausea,and negative reactions to the treatment visit in the original survey. The current findings are consistent with the progress that has been made in reducing certain chemotherapy-associated toxicities. Fatigue,however,although it often is related to anemia and is treatable with recombinant human erythropoietin,remains a major concern. The emotional,social,and sexual consequences of cancer treatment present continuing challenges in efforts to optimize QoL and to develop effective supportive care.","Cancer,95(1): 155-163","France,USA",2002,"Cancer","Chemotherapy","PPS","Adults","PRO study","Cross-sectional","France,USA","Adults","Cancer","Chemotherapy","PRO study","Cross-sectional","PPS","2000:2004"]
[14,"Chen,J. Y.,et al. (2016). \"Clinical and patient-reported outcomes of Chinese patients undergoing haemodialysis in hospital or in the community: A 1-year longitudinal study.\" Nephrology (Carlton) 21(7): 617-623.",null,"Chen,J. Y.,et al.","Clinical and patient-reported outcomes of Chinese patients undergoing haemodialysis in hospital or in the community: A 1-year longitudinal study","AIM: Little is known about the effect of haemodialysis (HD) setting on outcomes of patients with end stage renal disease (ESRD). The study aimed at comparing clinical outcomes and patient-reported outcomes (PRO) of patients on community-based (CBHD) and hospital-based haemodialysis (HBHD). METHODS: A prospective cohort of Chinese ESRD patients receiving HBHD (n = 89) or CBHD (n = 117) in Hong Kong were followed up for 12 months. Subjects were assessed on clinical outcomes of dialysis adequacy (Kt/V) and blood haemoglobin and PRO of health-related quality of life (SF-12v2),general health condition (Global Rating Scale (GRS)) and confidence to cope with their illness (Patient Enablement Instrument (PEI)). Differences between groups were analyzed by independent t-tests for the SF-12v2,GRS and PEI scores. chi(2) tests were used to analyze the difference in proportion of patients reaching the targets of Kt/V and blood haemoglobin and with GRS > 0 and PEI > 0. Multiple linear and logistic regressions were performed to assess the adjusted difference-in-difference estimation. RESULTS: The mean PEI and GRS scores of CBHD patients at 12 months were significantly higher than those of HBHD patients. CBHD patients had significantly greater improvement in self-efficacy and were more likely to be enabled after 12 months than the HBHD patients. CONCLUSION: The study showed similar clinical outcomes and PRO between CBHD and HBHD but CBHD was more effective than HBHD in promoting patient enablement over a 12-month period. The results suggest added value for patients receiving CBHD and support the transfer of HD care from the hospital to the community.","Nephrology (Carlton),21(7): 617-623","China",2016,"Renal Disease","Haemodialysis","PEI","Not Specified","PRO study","Cross-sectional","China","Not Specified","Renal Disease","Haemodialysis","PRO study","Cross-sectional","PEI","2015:2018"]
[15,"Mort,E. A. (1996). \"Clinical decision-making in the face of scientific uncertainty: hormone replacement therapy as an example.\" J Fam Pract 42(2): 147-151.",null,"Mort,E. A.","Clinical decision-making in the face of scientific uncertainty: hormone replacement therapy as an example","There is widespread variation in the prescribing patterns of postmenopausal hormone replacement therapy. While some degree of variation is expected,the systematic variation according to geographic region,physician gender,and medical specialty raises questions about how clinical decisions are made. This paper explores the determinants of these practice patterns,specifically the contribution of patients' preferences,scientific uncertainty,and physicians' recommendations. A role for collaborative decision-making is described and the use of decision-support tools is discussed. The primary care setting is proposed as the ideal context in which to study collaborative decision-making. Additional research is needed to more fully elucidate the value of collaborative decision-making with respect to clinical and quality-of-life outcomes,patient satisfaction with decision-making,and costs.","J Fam Pract,42(2): 147-151","USA",1996,"Menopause","Hormone replacement therapy","SWD","Women","PRO study","Cross-sectional","USA","Women","Menopause","Hormone replacement therapy","PRO study","Cross-sectional","SWD","1995:1999"]
[16,"Santos-Eggimann,B.,et al. (1997). \"Comparing results of concurrent and retrospective designs in a hospital utilization review.\" Int J Qual Health Care 9(2): 115-120.",null,"Santos-Eggimann,B.,et al.","Comparing results of concurrent and retrospective designs in a hospital utilization review","Hospital utilization reviews are performed on the basis of lists of explicit criteria,such as the Appropriateness Evaluation Protocol,both concurrently and retrospectively,in an increasing number of settings as part of efforts to improve the performance of hospitals and to reduce health care costs. Retrospective data collection has advantages in terms of expenses and ease of sampling,but relies on the quality of medical records. We report on a comparison between concurrent and retrospective data collection performed simultaneously and independently by two reviewers on the same hospital stays in the regional St-Loup Hospital. Results suggest that retrospective data collection produces higher rates of inappropriate hospital utilization,due to a limited number of criteria that are recorded concurrently,but are not found in the retrospective reading of medical records. These results should encourage a further investigation of the comparability between concurrent and retrospective designs in other settings.","Int J Qual Health Care,9(2): 115-120","Switzerland",1997,"Not Specified","Hospitalisation","AEP","Adults","Resource Use","Cross-sectional","Switzerland","Adults","Not Specified","Hospitalisation","Resource Use","Cross-sectional","AEP","1995:1999"]
[17,"VandenBergh,M. F.,et al. (1996). \"Cost-effectiveness of perioperative mupirocin nasal ointment in cardiothoracic surgery.\" Infect Control Hosp Epidemiol 17(12): 786-792.",null,"VandenBergh,M. F.,et al.","Cost-effectiveness of perioperative mupirocin nasal ointment in cardiothoracic surgery","OBJECTIVE: To assess the cost-effectiveness of perioperative intranasal application of mupirocin calcium ointment in cardiothoracic surgery. DESIGN: Cost-effectiveness analysis based on results of an intervention study with historical controls. SETTING: University Hospital Rotterdam,a tertiary referral center for cardiac and pulmonary surgery. PATIENTS: Consecutive patients undergoing cardiothoracic surgery between August 1,1989,and February 1,1991 (control group,n = 928),and between March 1,1991,and August 1,1992 (intervention group,n = 868). INTERVENTION: Perioperative nasal application of mupirocin calcium ointment started on the day before surgery,continued for 5 days,twice daily. RESULTS: Postoperative costs were increased significantly in patients with a surgical-site infection (SSI),compared with uninfected patients (P < .001). Mean SSI-attributable costs were estimated at $16,878 (95% confidence interval,$15,575-$18,181). The incidence of SSIs was 7.3% in the control group and 2.8% in the intervention group,mupirocin effectiveness being 62%. The costs of mupirocin were $11 per patient. Thus,the savings per SSI prevented were $16,633. To validate this comparative estimate of SSI-attributable costs,a noncomparative analysis of the postoperative length of stay (POLS) was performed,according to the Appropriateness Evaluation Protocol. Approximately 50% of the comparative SSI-attributable POLS were judged SSI-attributable in the noncomparative analysis. Sensitivity analyses,testing for the robustness of our conclusions,indicated that the presented model is rather insensitive to variations in the incidence of SSIs and for the effectiveness and costs of mupirocin. SSI-attributable costs were shown to be the only variable with substantial effect on the cost-effectiveness ratio. Perioperative mupirocin would result in net costs instead of savings only if SSI-attributable costs were less than $245. CONCLUSIONS: SSIs in patients undergoing cardiothoracic surgery are associated with a substantial increase in postoperative costs. Provided that perioperative mupirocin reduces the SSI rate,this measure will be highly cost-effective in most centers providing cardiothoracic surgical services.","Infect Control Hosp Epidemiol,17(12): 786-792","Netherlands",1996,"Cardiovascular","Surgery","AEP","Adults","Costs","Cross-sectional","Netherlands","Adults","Cardiovascular","Surgery","Costs","Cross-sectional","AEP","1995:1999"]
[18,"Stacey,D.,et al. (2012). \"Decision coaching to prepare patients for making health decisions: a systematic review of decision coaching in trials of patient decision AIDS.\" Med Decis Making 32(3): E22-33.",null,"Stacey,D.,et al.","Decision coaching to prepare patients for making health decisions: a systematic review of decision coaching in trials of patient decision AIDS","BACKGROUND: Decision coaching is individualized,nondirective facilitation of patient preparation for shared decision making. PURPOSE: To explore characteristics and effectiveness of decision coaching evaluated within trials of patient decision aids (PtDAs) for health decisions. DATA SOURCES: A subanalysis of trials included in the 2011 Cochrane Review of PtDAs. STUDY SELECTION: Eligible trials allowed the effectiveness of decision coaching to be compared with another intervention and/or usual care. DATA EXTRACTION: Two reviewers independently screened 86 trials,extracted data,and appraised quality. DATA SYNTHESIS: Ten trials were eligible. Decision coaching was provided by genetic counselors,nurses,pharmacists,physicians,psychologists,or health educators. Coaching compared with usual care (n = 1 trial) improved knowledge. Coaching plus PtDA compared with usual care (n = 4) improved knowledge and participation in decision making without reported dissatisfaction. Coaching compared with PtDA alone (n = 4) increased values-choice agreement and improved satisfaction with the decision-making process without any difference in knowledge or participation in decision making. Coaching plus PtDA compared with PtDA alone (n = 4) had no difference in knowledge,values-choice agreement,participation in decision making,or satisfaction with the process. Decision coaching plus PtDA was more cost-effective compared with PtDA alone or usual care (n = 1). LIMITATIONS: Methodological quality,number of trials,and description of decision coaching. CONCLUSIONS: Compared with usual care,decision coaching improved knowledge. However,the improvement in knowledge was similar when coaching was compared with PtDA alone. Outcomes for other comparisons are more variable,some trials showing positive effects and other trials reporting no difference. Given the small number of trials and variability in results,further research is required to determine the effectiveness of decision coaching.","Med Decis Making,32(3): E22-33","Canada",2012,"Not Specified","Decision Aids","SWD","Not Specified","Systematic Review","Review","Canada","Not Specified","Not Specified","Decision Aids","Systematic Review","Review","SWD","2010:2014"]
[19,"Wallace,P.,et al. (2002). \"Design and performance of a multi-centre randomised controlled trial and economic evaluation of joint tele-consultations [ISRCTN54264250].\" BMC Fam Pract 3: 1.",null,"Wallace,P.,et al.","Design and performance of a multi-centre randomised controlled trial and economic evaluation of joint tele-consultations [ISRCTN54264250]","BACKGROUND: Appropriate information flow is crucial to the care of patients,particularly at the interface between primary and secondary care. Communication problems can result from inadequate organisation and training,There is a major expectation that information and communication technologies may offer solutions,but little reliable evidence. This paper reports the design and performance of a multi-centre randomised controlled trial (RCT),unparalleled in telemedicine research in either scale or range of outcomes. The study investigated the effectiveness and cost implications in rural and inner-city settings of using videoconferencing to perform joint tele-consultations as an alternative to general practitioner referral to the hospital specialist in the outpatient clinic. METHODS: Joint tele-consultation services were established in both the Royal Free Hampstead NHS Trust in inner London,and the Royal Shrewsbury Hospitals Trust,in Shropshire. All the patients who gave consent to participate were randomised either to joint tele-consultation or to a routine outpatients appointment. The principal outcome measures included the frequency of decision by the specialist to offer a follow-up outpatient appointment,patient satisfaction (Ware Specific Questionnaire),wellbeing (SF12) and enablement (PEI),numbers of tests,investigations,procedures and treatments. RESULTS: A total of 134 general practitioners operating from 29 practices participated in the trial,referring a total of 3170 patients to 20 specialists in ENT medicine,general medicine (including endocrinology,and rheumatology),gastroenterology,orthopaedics,neurology and urology. Of these,2094 patients consented to participate in the study and were correctly randomised. There was a 91% response rate to the initial assessment questionnaires,and analysis showed equivalence for all key characteristics between the treatment and control groups. CONCLUSION: We have designed and performed a major multi-centre trial of teleconsultations in two contrasting centres. Many problems were overcome to enable the trial to be carried out,with a considerable development and learning phase. A lengthier development phase might have enabled us to improve the patient selection criteria,but there is a window of opportunity for these developments,and we believe that our approach was appropriate,allowing the evaluation of the technology before its widespread implementation.","BMC Fam Pract,3(1","UK",2002,"Not Specified","Tele-communications","PEI","Not Specified","Costs","RCT","UK","Not Specified","Not Specified","Tele-communications","Costs","RCT","PEI","2000:2004"]
[20,"Loblaw,D. A.,et al. (1999). \"Development and testing of a visit-specific patient satisfaction questionnaire: the Princess Margaret Hospital Satisfaction With Doctor Questionnaire.\" J Clin Oncol 17(6): 1931-1938.",null,"Loblaw,D. A.,et al.","Development and testing of a visit-specific patient satisfaction questionnaire: the Princess Margaret Hospital Satisfaction With Doctor Questionnaire","PURPOSE: To develop a psychometrically sound patient-satisfaction-with-physician questionnaire that can be used in an outpatient oncology setting. PATIENTS AND METHODS: The questionnaire was developed by a four-step process involving a total of 277 cancer patients. The item-generation process utilized input from 95 oncology outpatients,three medical researchers,and the relevant literature. Items were tested by 70 of the above patients. Initial item reduction was achieved by input from another eight patients. Factor analysis and validity testing used data derived from a different group of 174 oncology outpatients. Convergent validity was tested by correlating the Princess Margaret Hospital Patient Satisfaction with Doctor Questionnaire (PMH/PSQ-MD) with Rubin et al's Physician subscale of the Patient's Viewpoint Questionnaire (PS-PVQ) and Smith et al's Patient-Doctor Interaction Scale (PDIS). Divergent validity was tested by comparing these questionnaires with Spitzer's quality of life (QOL) questionnaire. RESULTS: The final PMH/PSQ-MD is a 29-item self-administered questionnaire with four response categories and a \"does not apply\" category. Four domains were confirmed by factor analysis: (1) information exchange,(2) interpersonal skills,(3) empathy,and (4) quality of time. The questionnaire has an overall Cronbach's alpha of 0.97; the values for each domain are,respectively,0.92,0.90,0. 88,and 0.88. The PMH/PSQ-MD correlated well with both the PDIS and the PS-PVQ (P <.001 for both). Divergent validity was confirmed with Spitzer's QOL questionnaire. CONCLUSION: The PMH/PSQ-MD is an outpatient satisfaction questionnaire specific to the patient-physician interaction that has shown excellent internal consistency,is feasible,and has strong support for validity in this oncology population.","J Clin Oncol,17(6): 1931-1938","Canada",1999,"Cancer","Not Specified","PDIS,PS-PVQ","Adults,Elderly","Tool Validation","Cross-sectional","Canada","Adults,Elderly","Cancer","Not Specified","Tool Validation","Cross-sectional","PDIS,PS-PVQ","1995:1999"]
[21,"Fujishima-Hachiya,A. and T. Inoue (2012). \"Development and validation of a disease-specific scale to assess psychosocial well-being of patients living with unruptured intracranial aneurysm.\" J Neurosci Nurs 44(6): 317-328.",null,"Fujishima-Hachiya,A. and T. Inoue","Development and validation of a disease-specific scale to assess psychosocial well-being of patients living with unruptured intracranial aneurysm","Although the detection rate for unruptured intracranial aneurysm (UIA) has improved since the 1990s,the quality of life and psychosocial status of patients living with UIA have been negatively affected. However,a comprehensive assessment tool for UIA patients is still awaited. This study aimed to develop and validate a disease-specific scale to assess UIA patients' psychosocial well-being in their daily lives. On the basis of previous qualitative research,52 items on a six-dimension scale were generated. After a pilot study,statistical analysis was conducted to examine construct validity-including convergent validity,discriminant and known-group validity,and internal reliability. Between 2010 and 2011,124 patients across three hospitals in Japan were tested using a tentative scale. As a result of exploratory factor analysis,we identified 25 items based on five conceptually derived dimensions (psychological stability,trust in healthcare resources,satisfaction with the decision-making process,positive perception of self-management,and confidence in UIA knowledge) as a final psychosocial well-being scale for UIA patients (UIA-PW scale). Cronbach's alpha coefficients for each subscale ranged between .76 and .90,with .83 for the total score,which indicated satisfactory internal consistency. The total score for the UIA-PW scale correlated significantly with the existing quality of life and mental health scales,but it is important to note that psychological stability and positive perception of self-management were negatively correlated. Although additional investigation is needed,the UIA-PW scale shows reasonable validity and reliability in assessing psychosocial well-being of patients living with UIA.","J Neurosci Nurs,44(6): 317-328","Japan",2012,"Intracranial Aneurysm","Not Specified","SWD","Not Specified","Tool Validation","Clinical Trial","Japan","Not Specified","Intracranial Aneurysm","Not Specified","Tool Validation","Clinical Trial","SWD","2010:2014"]
[22,"Wan,E. Y.,et al. (2017). \"Effectiveness of a multidisciplinary risk assessment and management programme-diabetes mellitus (RAMP-DM) on patient-reported outcomes.\" Endocrine 55(2): 416-426.",null,"Wan,E. Y.,et al.","Effectiveness of a multidisciplinary risk assessment and management programme-diabetes mellitus (RAMP-DM) on patient-reported outcomes","Little is known about how the patient-reported outcomes is influenced by multidisciplinary-risk-assessment-and-management-programme for patients with diabetes mellitus (RAMP-DM). This paper aims to evaluate the effectiveness of RAMP-DM on patient-reported outcomes. This was a prospective longitudinal study on 1039 diabetes mellitus patients (714/325 RAMP-DM/non-RAMP-DM) managed in primary care setting. 536 and 402 RAMP-DM participants,and 237 and 187 non-RAMP-DM participants were followed up at 12 and 24 months with completed survey,respectively. Patient-reported outcomes included health-related quality of life,change in global health condition and patient enablement measured by Short Form-12 Health Survey version-2 (SF-12v2),Global Rating Scale,Patient Enablement Instrument respectively. The effects of RAMP-DM on patient-reported outcomes were evaluated by mixed effect models. Subgroup analysis was performed by stratifying haemoglobin A1c (HbA1c) (optimal HbA1c < 7 % and suboptimal HbA1c >/= 7 %). RAMP-DM with suboptimal HbA1c was associated with greater improvement in SF-12v2 physical component summary score at 12-month (coefficient:3.80; P-value < 0.05) and 24-month (coefficient:3.82;P-value < 0.05),more likely to feel more enabled at 12-month (odds ratio: 2.57; P-value < 0.05),and have improved in GRS at 24-month (odds ratio:4.05; P-value < 0.05) compared to non-RAMP-DM participants. However,there was no significant difference in patient-reported outcomes between RAMP-DM and non-RAMP-DM participants with optimal HbA1c. Participation in RAMP-DM is effective in improving physical component of HRQOL,Global Rating Scale and patient enablement among diabetes mellitus patients with suboptimal HbA1c,but not in those with optimal HbA1c. Patients with sub-optimal diabetes mellitus control should be the priority target population for RAMP-DM. This observational study design may have potential bias in the characteristics between groups,and randomized clinical trial is needed to confirm the results.","Endocrine,55(2): 416-426","China",2017,"Diabetes","Risk-assessment and Management","PEI","Not Specified","PRO study","Longitudinal Observation","China","Not Specified","Diabetes","Risk-assessment and Management","PRO study","Longitudinal Observation","PEI","2015:2018"]
[23,"Tavakoli,N.,et al. (2015). \"Evaluation of Appropriate and Inappropriate Admission and Hospitalization Days According to Appropriateness Evaluation Protocol (AEP).\" Arch Iran Med 18(7): 430-434.",null,"Tavakoli,N.,et al.","Evaluation of Appropriate and Inappropriate Admission and Hospitalization Days According to Appropriateness Evaluation Protocol (AEP)","BACKGROUND: Inappropriate admission and hospitalization days are the factors that impose more costs to hospitals. By considering current condition of hospitals,it is vital to have an insight into the data on inappropriate admission and hospitalization days in order to eliminate obstacles to the proper and appropriate hospitalization. METHODS: In this study,198 patients who were admitted to receive surgical or non-surgical treatment in Sina public hospital were selected. An appropriateness Evaluation Protocol (AEP) was used for data collection. The validity of AEP is well established by the preceding studies. In order to achieve the study objectives,binary logistic regression test was used. RESULTS: According to our findings,39.4% of hospitalization days and 16.2% of admissions are inappropriate. In this study,inappropriate admission was observed among married patients eight times more than among single ones. Inappropriate hospitalization days were 12 times more prevalent among patients from provinces than among those from Tehran. With increasing age of the patient the probability of inappropriate admission decreases slightly,i.e. the probability of inappropriate admission decreases 10% as the age increases one year. The number of hospitalization days was significantly correlated to the following parameters: type of admission,patient's city of residence,type of treatment,and length of stay (P < 0.05). CONCLUSION: Regarding the results of this study,a large number of admissions and specially hospitalization days are inappropriate. According to other studies,with suitable programming many inappropriate admissions and hospitalization days are preventable.","Arch Iran Med,18(7): 430-434","Iran",2015,"Not Specified","Hospitalisation","AEP","Not Specified","Resource Use","Cross-sectional","Iran","Not Specified","Not Specified","Hospitalisation","Resource Use","Cross-sectional","AEP","2015:2018"]
[24,"Wong,C. K.,et al. (2016). \"Evaluation of patient-reported outcomes data in structured diabetes education intervention: 2-year follow-up data of patient empowerment programme.\" Endocrine 54(2): 422-432.",null,"Wong,C. K.,et al.","Evaluation of patient-reported outcomes data in structured diabetes education intervention: 2-year follow-up data of patient empowerment programme","To examine the effects of a structured group-based education programme,patient empowerment programme (PEP),compared with usual care on 2-year changes in patient-reported outcomes (PRO) in patients with diabetes mellitus (DM). A prospective observational study of 715 patients (PEP/non-PEP: 390/325) was conducted to complete the baseline PRO survey and followed up for 2 years. Health-related quality of life (HRQOL) was measured using the short-form 12 at baseline and annually at two follow-up assessments,which yielded physical and mental component summary and SF-6D preference-based scores. Perceived control over diabetes and general health status were measured using the patient enablement instrument (PEI) and global rating scale (GRS) at follow-ups. When compared with non-PEP,PEP participants significantly reported improvement in health condition (GRS score > 0; 24.55 % vs 10.16 %; odds ratio = 2.502; P = 0.018) in 2 years and enabled the self-perceived control over diabetes (PEI score > 0; 72.20 % vs 38.40 %; odds ratio = 3.25; P < 0.001) in 1-year follow-up but no sustained effects in year 2 (52.65 % vs 39.04 %; odds ratio = 1.366; P = 0.265). There were no significant differences between PEP and non-PEP groups in the changes in quality of life scores (all P > 0.05) at 1 year. Although HRQOL scores deteriorated over 2-year period in both groups,PEP participants reported similar changes in HRQOL scores to that of non-PEP. PEP for DM patients preserved self-perceived disease control and health condition,whereas PEP participants perceived their HRQOL similar to that of non-PEP participants. Findings of PRO should be considered alongside clinical outcomes when evaluating the overall benefits of PEP.","Endocrine,54(2): 422-432","China",2016,"Diabetes","Empowerment Program","PEI","Not Specified","PRO study","Cross-sectional","China","Not Specified","Diabetes","Empowerment Program","PRO study","Cross-sectional","PEI","2015:2018"]
[25,"Chang,P.,et al. (2011). \"Expanded prostate cancer index composite for clinical practice: development and validation of a practical health related quality of life instrument for use in the routine clinical care of patients with prostate cancer.\" J Urol 186(3): 865-872.",null,"Chang,P.,et al.","Expanded prostate cancer index composite for clinical practice: development and validation of a practical health related quality of life instrument for use in the routine clinical care of patients with prostate cancer","PURPOSE: Measuring the health related quality of life of patients with prostate cancer in routine clinical practice is hindered by the lack of instruments enabling efficient,real-time,point of care scoring of multiple health related quality of life domains. Thus,we developed an instrument for this purpose. MATERIALS AND METHODS: The Expanded Prostate Cancer Index Composite for Clinical Practice is a 1-page,16-item questionnaire that we constructed to measure urinary incontinence,urinary irritation,and the bowel,sexual and hormonal health related quality of life domains. We eliminated conceptually overlapping items from the 3-page Expanded Prostate Cancer Index Composite-26 and revised the questionnaire format to mirror the AUA symptom index,thereby enabling practitioners to calculate health related quality of life scores at the point of care. We administered the Expanded Prostate Cancer Index Composite for Clinical Practice to a new cohort of patients with prostate cancer in community based and academic oncology,radiation,and urology practices to evaluate instrument validity as well as ease of use in clinical practice. RESULTS: A total of 175 treated and 132 untreated subjects with prostate cancer completed the Expanded Prostate Cancer Index Composite for Clinical Practice. The domain scores of the Expanded Prostate Cancer Index Composite for Clinical Practice correlated highly with the respective domain scores from longer versions of the Expanded Prostate Cancer Index Composite (r>/=0.93 for all domains). The Expanded Prostate Cancer Index Composite for Clinical Practice showed high internal consistency (Cronbach's alpha 0.64-0.84) and sensitivity to prostate cancer treatment related effects (p<0.05 in each of 5 health related quality of life domains). Patients completed the Expanded Prostate Cancer Index Composite for Clinical Practice efficiently (96% in less than 10 minutes and with 11% missing items). It was deemed very convenient by clinicians in 87% of routine clinical encounters and clinicians accurately scored completed questionnaires 94% of the time. CONCLUSIONS: The Expanded Prostate Cancer Index Composite for Clinical Practice is a valid instrument that enables patient reported,health related quality of life to be measured efficiently and accurately at the point of care,and thereby facilitates improved emphasis and management of patient reported outcomes.","J Urol,186(3): 865-872","USA",2011,"Cancer","Not Specified","PEI","Adults,Elderly","Tool Validation","Cross-sectional","USA","Adults,Elderly","Cancer","Not Specified","Tool Validation","Cross-sectional","PEI","2010:2014"]
[26,"Ashman,A. M.,et al. (2017). \"Factors Associated with Effective Nutrition Interventions for Pregnant Indigenous Women: A Systematic Review.\" J Acad Nutr Diet 117(8): 1222-1253.e1222.",null,"Ashman,A. M.,et al.","Factors Associated with Effective Nutrition Interventions for Pregnant Indigenous Women: A Systematic Review","INTRODUCTION: Indigenous people continue to experience health disparities relative to non-Indigenous populations. Interventions to improve nutrition during pregnancy in these groups may improve health outcomes for mothers and their infants. The effectiveness of existing nutrition intervention programs has not been reviewed previously. OBJECTIVE: The objective was to identify interventions targeting improving nutrition-related outcomes for pregnant Indigenous women residing in Organisation for Economic Co-operation and Development countries,and to identify positive factors contributing to successful programs. METHODS: Thirteen electronic databases were searched up until October 2015. Key words identified studies intervening to improve nutrition-related outcomes for pregnant Indigenous women. Two reviewers assessed articles for inclusion and study quality and extracted data. Only studies published in English were included. Data were summarized narratively. RESULTS: Abstracts and titles were screened (n=2,566) and 315 full texts were reviewed for eligibility. This review included 27 articles from 20 intervention programs from Australia,Canada,and the United States. The most prevalent measurable outcomes were birth weight (n=9) and breastfeeding initiation/duration (n=11). Programs with statistically significant results for these outcomes employed the following nutrition activities: individual counseling/education (n=8); delivery by senior Indigenous woman (n=2),peer counselor (n=3),or other Indigenous health worker (n=4); community-wide interventions (n=2); media campaigns (n=2); delivery by non-Indigenous health professional (n=3); and home visits (n=3). CONCLUSIONS: Heterogeneity of included studies made it challenging to make firm recommendations regarding program success. Authors of included studies recommended community consultation be included when designing studies and working with communities at all stages of the research process. Individualized counseling/education can contribute to successful program outcomes,as can the use of Indigenous workers to deliver program content. Limitations of some studies included a lack of details on interventions and the use of nonrandom control groups. Future studies should include detailed descriptions of intervention components and include appropriate evaluation protocols.","J Acad Nutr Diet,117(8): 1222-1253.e1222","USA",2017,"Not Specified","Nutrition","AEP","Pregnant,Women","Systematic Review","Systematic Review","USA","Pregnant,Women","Not Specified","Nutrition","Systematic Review","Systematic Review","AEP","2015:2018"]
[27,"Merom,D.,et al. (1998). \"Factors associated with inappropriate hospitalization days in internal medicine wards in Israel: a cross-national survey.\" Int J Qual Health Care 10(2): 155-162.",null,"Merom,D.,et al.","Factors associated with inappropriate hospitalization days in internal medicine wards in Israel: a cross-national survey","BACKGROUND: The high costs of health care mandate a quality control system that ensures efficient utilization of hospitalization days. OBJECTIVES: To obtain a national estimate of the rate of inappropriate hospitalization days in medical wards and to identify the variables associated with inappropriateness. DESIGN: A 1-day cross-national survey. SETTING: A sample of internal medicine wards in all public hospitals in Israel. SURVEY POPULATION: The survey population included all patients hospitalized in the ward for at least 24 hours on the survey day. INSTRUMENTS: We used an adapted version of the appropriateness evaluation protocol (AEP) (Gertman and Restuccia). Reviewers were final year medical students trained to work with the AEP. Final classification of inappropriate days was done by one of the senior investigators. OUTCOME MEASURE: Utilization of hospitalization days according to the AEP. RESULTS: A total of 1003 hospitalization days in 33 medical wards in 24 hospitals was surveyed. Of this,182 (18.1%) of the days were found to be inappropriate. In multiple logistic regression analysis,variables significantly associated with inappropriate days were government versus other hospital ownership (OR,1.51; CI,1.15-1.96),diagnosis on admission of acute cardiac event versus other diagnosis (OR,0.46; CI,0.27-0.77),and period (first,second or final third) of the stay (OR,1.61; CI,1.29-2.03). In 62.6% of the 'inappropriate days',continuation of hospitalization was justified (72% were patients awaiting tests or consultation). In 6.7% of the total days surveyed,no justification for continuation of hospitalization was found. CONCLUSION: The percentage of inappropriate days found in this study is similar to the means found in studies that were conducted in other countries. Awaiting procedures and consultation is a major cause of inappropriate days and may be an important target for intervention.","Int J Qual Health Care,10(2): 155-162","Israel",1998,"Not Specified","Hospitalisation","AEP","Adults","Resource Use","Cross-sectional","Israel","Adults","Not Specified","Hospitalisation","Resource Use","Cross-sectional","AEP","1995:1999"]
[28,"Menand,E.,et al. (2015). \"French Multicenter Evaluation of the Appropriateness of Admission to the Emergency Department of the Over-80s.\" J Nutr Health Aging 19(6): 681-687.",null,"Menand,E.,et al.","French Multicenter Evaluation of the Appropriateness of Admission to the Emergency Department of the Over-80s","BACKGROUND: Persons over 80 represents 40% of patients in French emergency services. We assessed the appropriateness of these admissions and sought to identify risk factors for inappropriate hospital stays. METHODS: The appropriateness of admission was assessed in a prospective,cross-sectional,multicenter study in eight hospitals in France by means of the Appropriateness Evaluation Protocol (French version,AEPf) during two non-consecutive periods of four weeks in 2010. We analyzed admission of patients aged 80 and over who were admitted to the hospital after a stay in the emergency department of the same hospital. Demographics and morbidity factors were recorded as were administrative hospitalization data to identify risk factors associated with inappropriate admissions. We also evaluated the economic impact of inappropriate admissions. For cost analysis,all variables were obtained from anonymized hospital reports of a diagnosis-related group system used for funding of the hospitals by health insurance. RESULTS: During two different periods,1577 patients were included. 139 (8.8%) hospital admissions were inappropriate according to explicit criteria of the AEPf,but 18 of these (1.1%) were in fact considered appropriate by the physician responsible for the admission,leading to 121 (7.7%) inappropriate admissions. Multivariate logistic regression showed that patients with heart disease were less often subject to inappropriate admission (odds ratio OR= 0.36 [0.23; 0.56],p < 0.001),as also were patients who usually lived in a nursing home (OR = 0.53 [0.30; 0.87],p = 0.018) and patients with higher Acute Physiology Scores (OR = 0.97 [0.95; 0.99],p < 0.001). Inappropriate admission increased when patients had a syndrome as the main diagnosis (OR = 1.81 [1.81; 2.83],p = 0.010). By contrast,cognitive functions,gait and balance disturbance or falls,behavioral disorders and method of transport to the emergency department did not change the probability of inappropriateness. The median cost of the hospital stay of an older patient was 3 606.5 [2 498.1; 4 994.2] euros for inappropriate admissions. CONCLUSION: Inappropriate emergency admissions of older patients were infrequent. None of the geriatric syndromes were linked with the phenomenon and principle causes were severity of illness,mention of a cardiac disease,unclear pattern of consultation and institutionalized way of life.","J Nutr Health Aging,19(6): 681-687","France",2015,"Not Specified","Hospitalisation","AEP","Elderly","Resource Use","Cross-sectional","France","Elderly","Not Specified","Hospitalisation","Resource Use","Cross-sectional","AEP","2015:2018"]
[29,"ten Klooster,P. M.,et al. (2012). \"Further validation of the 5-item Perceived Efficacy in Patient-Physician Interactions (PEPPI-5) scale in patients with osteoarthritis.\" Patient Educ Couns 87(1): 125-130.",null,"ten Klooster,P. M.,et al.","Further validation of the 5-item Perceived Efficacy in Patient-Physician Interactions (PEPPI-5) scale in patients with osteoarthritis","OBJECTIVE: To examine the structural validity,internal consistency,test-retest reliability,and construct validity of the 5-item Perceived Efficacy in Patient-Physician Interactions (PEPPI-5) scale in patients with osteoarthritis (OA). METHODS: A cross-sectional sample of 224 outpatients with OA completed a survey containing the Dutch PEPPI-5 and other standardized measures assessing perceived health-management skills,general self-efficacy,social support,and health-related quality of life. A subsample of 100 patients completed the PEPPI-5 again approximately 3 weeks later. RESULTS: Confirmatory factor analysis demonstrated good fit for a unidimensional model of the PEPPI-5. Additionally,the scale showed high internal consistency (alpha=0.92) and fair test-retest reliability (ICC=0.68). As hypothesized,the PEPPI-5 was strongly correlated with perceived health-management skills,moderately with social support and psychosocial aspects of health,and not with physical aspects of health. Contrary to expectations,however,it was not correlated with general self-efficacy. CONCLUSION: The Dutch PEPPI-5 demonstrated adequate validity and reliability in patients with OA. PRACTICE IMPLICATIONS: The PEPPI-5 is a brief and appropriate tool for measuring self-efficacy of patients with OA to interact with their physicians. Additional research into its sensitivity to change is needed before it can be confidently recommended as an outcome measure in intervention studies.","Patient Educ Couns,87(1): 125-130","Netherlands",2012,"Osteoarthritis","Not Specified","PEPPI-5","Adults","Tool Validation","Cross-sectional","Netherlands","Adults","Osteoarthritis","Not Specified","Tool Validation","Cross-sectional","PEPPI-5","2010:2014"]
[30,"van Andel,P.,et al. (2003). \"Group cohesion and working alliance: prediction of treatment outcome in cardiac patients receiving cognitive behavioral group psychotherapy.\" Psychother Psychosom 72(3): 141-149.",null,"van Andel,P.,et al.","Group cohesion and working alliance: prediction of treatment outcome in cardiac patients receiving cognitive behavioral group psychotherapy","BACKGROUND: Various definitions of both group cohesion and working alliance are used in theories on group psychotherapy,making the study of their relative contribution to the treatment outcome difficult. In this study,two different,nonoverlapping questionnaires were used to explore the relationship between group cohesion,working alliance and treatment outcome in a time-limited,structured cognitive behavioral group psychotherapy aiming at the reduction of coronary risk factors. METHODS: After having undergone percutaneous transluminal coronary angioplasty,42 patients were treated with the aim to reduce exhaustion,anxiety,hostility and depression. The newly developed Group Cohesion Questionnaire (GCQ) and the Helping Alliance Questionnaire (HAQ-II,measuring the bond between individual patients and the group psychotherapist) were administered after the fifth and tenth treatment session. Exhaustion,quality of life,anxiety,blood pressure and heart rate were measured before and after treatment. To test the relationship between the GCQ,the HAQ-II and outcome variables,Pearson Product-Moment correlations and hierarchical regression was applied. RESULTS: Principal Component Analysis of the GCQ yielded two dimensions,the bond with the group as a whole and the bond with other group members. Hierarchical regression showed that both the bond with other group members and working alliance contributed significantly and independently to the prediction of posttreatment systolic and diastolic blood pressure as well as posttreatment quality of life (confidence). CONCLUSIONS: Conceptually and empirically,group cohesion and the working alliance may be considered to represent different relationships in a psychotherapy group,contributing in different ways to the treatment outcome in cardiac patients receiving cognitive behavioral group psychotherapy.","Psychother Psychosom,72(3): 141-149","Netherlands",2003,"Heart Disease","Cognitive Therapy","GCQ,HAQ-II","Adults","PRO study","Cross-sectional","Netherlands","Adults","Heart Disease","Cognitive Therapy","PRO study","Cross-sectional","GCQ,HAQ-II","2000:2004"]
[31,"Visaya,M. A. (2010). \"Hemodialysis patients' perceptions of home hemodialysis and self-care.\" Cannt j 20(2): 23-28.",null,"Visaya,M. A.","Hemodialysis patients' perceptions of home hemodialysis and self-care","Home hemodialysis (HHD) is an optimal option for patients requiring renal replacement therapy. It has been noted through research that this type of therapy is more cost-effective than in-centre therapies,and the benefits to patients are well documented (Harwood & Leitch,2006). As stated by the Ministry of Health and Long-Term Care (MoHLTC),a total of 40% of renal failure patients are expected to do home dialysis (either peritoneal dialysis or HHD) by the year 2010 (Kashani & Motiwala,2007). Even though the literature indicates that the numbers of those doing home dialysis are declining every year,there is no evidence to demonstrate why the numbers are declining. A quantitative cross-sectional descriptive study was conducted using the Patient Perception Survey and the Jo Pre-Training Assessment Tool (JPAT) to assess in-centre hemodialysis patients' perceptions regarding home dialysis,as well as their self-care ability. The two frameworks utilized were the Theory of Planned Behavior and Orem's Theory of Self-Care. According to the Theory of Planned Behavior,the 26 patients out of 49 who had positive perceptions regarding home dialysis would be expected to participate in home dialysis. However,according to the patients' responses to the domains within the JPAT,only eight out of the 26 would be considered suitable to participate in home dialysis. Only two of the domains,communication and social support,were found to be significantly related to patients'perceptions regarding home dialysis. Health care professionals need to implement interventions that incorporate assessment of communication and social support when addressing home dialysis therapy with a patient with end-stage renal disease (ESRD).","Cannt j,20(2): 23-28","Canada",2010,"Renal Disease","Haemodialysis","PPS","Adults,Elderly","PRO study","Cross-sectional","Canada","Adults,Elderly","Renal Disease","Haemodialysis","PRO study","Cross-sectional","PPS","2010:2014"]
[32,"Martinez-Mas,E.,et al. (1994). \"How many days of hospitalization for an appendectomy?\" Int J Qual Health Care 6(4): 347-352.",null,"Martinez-Mas,E.,et al.","How many days of hospitalization for an appendectomy?","The length of stay (LOS) of a surgical procedure is influenced both by the real need for medical and nursing care of the patient and also by the practice style of each unit,which can include unjustified stays. The aim of this work was to estimate the appropriate LOS for appendectomy and its differences with the LOS observed in practice. Two hundred and forty-nine medical records (249 admission days and 1447 successive stays) for patients over 6 years old who had had an appendectomy in 1992 were classified by Diagnosis Related Groups (DRG) and reviewed using the Appropriateness Evaluation Protocol. 1.6% of admission days and 31.7% of successive stays were assessed inappropriate. The appropriate LOS for appendectomy was 4.7 days as opposed to 6.8 days of observed LOS. For the DRG 167 (76.3% of the sample) appropriate LOS was 3.4 days (observed LOS 4.9 days). These results suggest the existence of an important proportion of avoidable hospital stays and provides a simple and low cost methodology for assessing the suitability of local hospitalization practices.","Int J Qual Health Care,6(4): 347-352","Spain",1994,"Not Specified","Appendectomy","AEP","Adults","Resource Use","Cross-sectional","Spain","Adults","Not Specified","Appendectomy","Resource Use","Cross-sectional","AEP","1990:1994"]
[33,"Rosenfeld,R. M.,et al. (2000). \"Impact of tympanostomy tubes on child quality of life.\" Arch Otolaryngol Head Neck Surg 126(5): 585-592.",null,"Rosenfeld,R. M.,et al.","Impact of tympanostomy tubes on child quality of life","BACKGROUND: The objective benefits of tympanostomy tubes for otitis media are well established,but the subjective impact of surgery on child quality of life (QOL) has not been systematically studied. OBJECTIVES: To determine the subjective impact of tympanostomy tubes on child QOL,and to compare the variability in QOL before surgery with that observed after surgery. DESIGN: Prospective,observational,before-and-after trial. SETTING: Fourteen referral-based pediatric otolaryngology practices in the United States. PATIENTS: Consecutive (64%) and convenience (36%) sample of 248 children (median age,1.4 years) with otitis media scheduled for bilateral tympanostomy tube placement as an isolated surgical procedure. INTERVENTION: Tympanostomy tubes were inserted as part of routine clinical care. Validated measures of QOL (OM-6 survey),satisfaction with health care decision (Satisfaction With Decision Scale),and satisfaction with office visit; surveys were completed at baseline (visit 1),at surgery (visit 2),and after surgery (visit 3). MAIN OUTCOME MEASURES: Short-term changes in QOL before surgery (visit 1 to visit 2) and after surgery (visit 2 to visit 3). RESULTS: Changes in QOL before surgery were mostly trivial,and were smaller than changes observed after surgery (P<.001). Large,moderate,and small improvements in QOL occurred after surgery in 56%,15%,and 8% of children,respectively. Physical symptoms,caregiver concerns,emotional distress,and hearing loss were most improved,but significant changes were also seen for activity limitations and speech impairment. Trivial changes occurred in 17% of children,and 4% had poorer QOL. Predictors of poorer QOL were otorrhea 3 or more days (10% of variance) and decreased satisfaction with surgical decision (3% of variance). Hearing status,child age,type of otitis media (recurrent vs chronic),and office visit satisfaction were unrelated to outcome. CONCLUSIONS: Tympanostomy tubes produce large short-term improvements in QOL for most children. The best outcomes occur when postoperative otorrhea is absent or minimal,and when parents are satisfied with their initial decision to have surgery. Further research is needed to document the long-term impact of tubes on child QOL.","Arch Otolaryngol Head Neck Surg,126(5): 585-592","USA",2000,"Otitis Media","Tympanostomy tubes","SWD","Children","PRO study","Clinical Trial","USA","Children","Otitis Media","Tympanostomy tubes","PRO study","Clinical Trial","SWD","2000:2004"]
[34,"Pileggi,C.,et al. (2004). \"Inappropriate hospital use by patients needing urgent medical attention in Italy.\" Public Health 118(4): 284-291.",null,"Pileggi,C.,et al.","Inappropriate hospital use by patients needing urgent medical attention in Italy","The purpose of this study was to determine the extent of inappropriate admissions and days of stay in acute beds of patients who were admitted to hospital after attending the emergency department for urgent medical attention in Italy. The medical records of all adult patients (aged 16 years and over) on one randomly preselected day during the period January-December 2001 were reviewed. The retrospective application was made using the Appropriateness Evaluation Protocol list of criteria. Overall,28.4 and 75.7% of hospital admissions and days of stay,respectively,were judged to be inappropriate. Results of the multiple logistic regression analysis indicated that inappropriate admission was significantly more likely in patients who lived closer to hospital,in younger patients,in patients from lower socio-economic classes,and in patients who did not receive diagnostic procedures in the emergency department. The proportion of patients whose admission was considered inappropriate was significantly lower in medical specialties wards. The number of inappropriate hospitalisation days was significantly higher in younger patients,in those admitted inappropriately,and in patients sampled close to discharge (during the final-third of his/her stay). The number of inappropriate hospitalisation days was significantly lower in patients admitted to surgical and traumatology/orthopaedics and medical specialties wards. Our findings indicate the need for specific interventions to reduce the prevalence of inappropriate hospital use and to modify physicians' attitudes and behaviours.","Public Health,118(4): 284-291","Italy",2004,"Not Specified","Hospitalisation","AEP","Adults","Resource Use","Cross-sectional","Italy","Adults","Not Specified","Hospitalisation","Resource Use","Cross-sectional","AEP","2000:2004"]
[35,"Rader, T., et al. (2011). \"Influencing health equity: role of the effective consumer scale in measuring skills and abilities in a middle income country.\" J Rheumatol 38(8): 1798-1802.",null,"Rader, T., et al.","Influencing health equity: role of the effective consumer scale in measuring skills and abilities in a middle income country","The 2008 World Health Report emphasizes the need for patient-centered primary care service delivery models in which patients are equal partners in the planning and management of their health. It is argued that this involvement will lead to improved management of disease, improved health outcomes and patient satisfaction, better informed decision-making, increased compliance with healthcare decisions, and better resource utilization. This article investigates the domains captured by the Effective Consumer Scale (EC-17) in relation to vulnerable population groups that experience health inequity. Particular focus is paid to the domain of health literacy as an area fundamental to patients' involvement in managing their condition and negotiating the healthcare system. In examining the possible influence of Outcome Measures in Rheumatology Clinical Trials (OMERACT) on health equity, we used the recent translation and validation of the EC-17 scale into Spanish and tested Argentina as an example. Future plans to use the EC-17 with vulnerable groups include formal collaboration and needs assessment with the community to tailor an intervention to meet its needs in a culturally relevant manner. Some systematic reviews have questioned whether interventions to improve effective consumer skills are appropriate in vulnerable populations. We propose that these populations may have the most to gain from such interventions since they might be expected to have relatively lower skills and health literacy than other groups.","J Rheumatol, 38(8): 1798-1802","Canada",2011,"Rheumatoid Arthritis","Not Specified","EC-17","Not Specified","Tool Validation","Cross-sectional","Canada","Not Specified","Rheumatoid Arthritis","Not Specified","Tool Validation","Cross-sectional","EC-17","2010:2014"]
[36,"Demir, C., et al. (2002). \"Investigation of the correlation between inappropriate hospitalization and hospital stay rate: an application in medical clinics of a military hospital.\" Mil Med 167(10): 817-820.",null,"Demir, C., et al.","Investigation of the correlation between inappropriate hospitalization and hospital stay rate: an application in medical clinics of a military hospital","BACKGROUND: Medical services play a major role in hospital facilities. Along with the medical applications and diagnoses, physicians affect the hospital costs by 70% to 80%. Therefore, the hospital administrators should establish some systems that can modify the current application models of physicians. OBJECTIVE: This study aimed to investigate the appropriateness of hospitalization days and length of stay of the patients in 13 internal clinics in a military hospital. STUDY DESIGN: 5,205 patient days belonging to 416 patients were evaluated by Appropriateness Evaluation Protocol. Patients' data were retrospectively collected by using a \"data collection form\" through patients' files and then were evaluated by frequencies and percentage distributions. RESULTS: The unnecessary hospitalization rate and unnecessary stay rate were 4.8% and 15.75%, respectively. The highest unnecessary hospitalization rates were in nuclear medicine (50%). CONCLUSION: It was concluded that the inappropriate hospitalization rate and inappropriate stay rates were 4.8% and 15.75%, respectively.","Mil Med, 167(10): 817-820","Turkey",2002,"Not Specified","Hospitalisation","AEP","Military","Resource Use","Cross-sectional","Turkey","Military","Not Specified","Hospitalisation","Resource Use","Cross-sectional","AEP","2000:2004"]
[37,"Baker, R., et al. (1999). \"Measuring patients' attitudes to care across the primary/secondary interface: the development of the patient career diary.\" Qual Health Care 8(3): 154-160.",null,"Baker, R., et al.","Measuring patients' attitudes to care across the primary/secondary interface: the development of the patient career diary","BACKGROUND: A growing number of new ways of organising services across the primary/secondary interface are being introduced and evaluated. The principal motive for such reorganisation is to improve the efficiency of health care. However, unless the impact of the new services on patients is investigated and taken into account, it is possible that patients' reactions could be negative, a factor that could lead to unexpected consequences in the use and costs of services. OBJECTIVE: To develop a measure of patients' attitudes towards care across the interface between primary and secondary care. DESIGN: Generation of questions to be included in the measure from a qualitative study of patients' experiences of care across the interface; administration of pilot versions of the measure to samples of patients referred to secondary care; refinement of questions guided by analysis of response patterns, principal components analysis and internal consistency; administration of the final version of the patient career diary in complete form retrospectively to patients referred to secondary care, and one section alone to patients attending outpatient departments for follow up appointments. Face validity was assessed by analysis of open comments in a sample of 50 diaries, and review of the diary by 34 health professionals. Construct validity was assessed by investigation of levels of correlation between components of each section of the diary and the components of the healthcare section overall. SETTING: In the final field test, patients were attending various hospital services, including cardiology, dermatology, neurology, gynaecology, general surgery, general medicine, ophthalmology, trauma and orthopaedics, and gastroenterology. RESULTS: The final version of the diary included 109 questions in seven sections: general practitioner (GP) visits and referral, other GP visits, first outpatient visit, other outpatient visits, inpatient stay and discharge, care after discharge, and care overall. Response rates were poor for retrospective completion of the entire diary, but excellent when a section was given separately. Principal components analysis confirmed that components relating to issues identified as important to patients in the qualitative study had been included in the diary. Levels of internal consistency were good, and comments of patients and health professionals supported validity. CONCLUSION: The patient career diary is a valid and reliable measure of patients' attitudes to care across the interface. It should be given in sections to ensure adequate response rates, and is suitable for use in the evaluation or quality of patterns of care across the interface. In future, the impact on patients of new ways of organising services across the interface should be investigated by use of measures such as the patient career diary.","Qual Health Care, 8(3): 154-160","UK",1999,"Not Specified","Not Specified","Patient career diary","Not Specified","Tool Validation","Cross-sectional","UK","Not Specified","Not Specified","Not Specified","Tool Validation","Cross-sectional","Patient career diary","1995:1999"]
[38,"Kemper, K. J. (1988). \"Medically inappropriate hospital use in a pediatric population.\" N Engl J Med 318(16): 1033-1037.",null,"Kemper, K. J.","Medically inappropriate hospital use in a pediatric population","To assess the extent of inappropriate hospital use in pediatric inpatients, I modified the Appropriateness Evaluation Protocol (AEP)--developed to assess inappropriate hospital use in adults--to apply to children and used it to evaluate pediatric inpatients retrospectively for every 10th day, from July 1982 to July 1983, at the University of Wisconsin Hospital. Of 1098 patient-days evaluated, 21.4 percent were judged to represent inappropriate hospital use on the basis of the protocol's criteria. The rate of inappropriate use varied according to admitting specialty, ranging from 7 of 70 days (10 percent) for pulmonary medicine to 43 of 61 days (70 percent) for neurology (P less than 0.005). There was a tendency toward lower rates of inappropriate use in uninsured patients (6 of 44 days [14 percent] vs. 226 of 1038 days [22 percent] in patients with Medicaid or private insurance, P = 0.13), and rates were lower in younger children (74 of 432 days [17 percent] in children less than or equal to 5 years of age vs. 162 of 656 days [25 percent] in children greater than 5 years of age, P less than 0.005). There was no variation according to sex, day of the week, or month. Contrary to expectations, inappropriate use decreased with increased lengths of stay (for stays of 1 day, 8 of 13 days were inappropriate [61 percent]; for stays of 2 to 6 days, 118 of 410 days were inappropriate [29 percent]; for 7 to 13 days, 58 of 291 [20 percent]; and for greater than or equal to 14 days, 51 of 362 [14 percent], P less than 0.001). I conclude that there is a substantial rate of inappropriate hospital use in pediatrics and that such use is more likely during short admissions than during long ones. Cost-containment efforts directed at limiting the length of hospitalization may therefore not reduce inappropriate hospital use in this population.","N Engl J Med, 318(16): 1033-1037","USA",1988,"Not Specified","Neurology,Pulmonary Medicine","AEP","Children","Resource Use","Cross-sectional","USA","Children","Not Specified","Neurology,Pulmonary Medicine","Resource Use","Cross-sectional","AEP","1960:1989"]
[39,"Kemper, K. and B. Forsyth (1988). \"Medically unnecessary hospital use in children seropositive for human immunodeficiency virus.\" Jama 260(13): 1906-1909.",null,"Kemper, K. and B. Forsyth","Medically unnecessary hospital use in children seropositive for human immunodeficiency virus","Stimulated by reports that some children who are seropositive for human immunodeficiency virus (HIV+) have been abandoned in the hospital, we studied the extent of, and reasons for, medically unnecessary hospital use at Yale-New Haven (Conn) Hospital among HIV+ children. We reviewed inpatient stays for all HIV+ children hospitalized through Oct 31, 1987. Hospital days were judged to be unnecessary if they failed to meet any of the criteria on the Pediatric Appropriateness Evaluation Protocol. Among 34 children eligible for the study, 54% of their hospital days were judged medically unnecessary; 59% of the children had at least one such day. Unnecessary use was 100% for one-day stays (all for gamma-globulin infusions) and 58% for stays longer than three weeks, with 94% of those unnecessary days being secondary to placement problems. The rate of unnecessary days has declined from 64% of all hospital days in 1983 and 1984 to 30% in 1987 as a result of improved outpatient services and access to foster care. Improved medical and social services could substantially reduce the cost of medically unnecessary hospital care in HIV+ children.","Jama, 260(13): 1906-1909","USA",1988,"HIV","Hospitalisation","AEP","Children","Resource Use","Cross-sectional","USA","Children","HIV","Hospitalisation","Resource Use","Cross-sectional","AEP","1960:1989"]
[40,"Sangha, O., et al. (2002). \"Metric properties of the appropriateness evaluation protocol and predictors of inappropriate hospital use in Germany: an approach using longitudinal patient data.\" Int J Qual Health Care 14(6): 483-492.",null,"Sangha, O., et al.","Metric properties of the appropriateness evaluation protocol and predictors of inappropriate hospital use in Germany: an approach using longitudinal patient data","BACKGROUND: The German health care system, renowned for its unrestricted access, high quality care, and comprehensive coverage, is challenged by increasing health care costs. This has been attributed partly to inefficiencies in the in-patient sector, but has been studied little. Attempts at quality improvement need to relate costs to outcomes. Until now, there has been no standardized methodology to evaluate the appropriateness of hospital care. OBJECTIVE: To develop and evaluate the metric properties of a method to assess inappropriate hospital care in Germany based on a widely used measure, the Appropriateness Evaluation Protocol (AEP). METHODS: The original AEP was translated and adapted to reflect differences in the provision of health care in Germany. Psychometric testing was performed in a stratified sample of all patients admitted to the Departments of Medicine and Surgery of a 400-bed teaching hospital during 1 year. Three board-certified physicians participated in each department to evaluate intra-rater reliability, while two additional independent physicians judged inter-rater reliability. RESULTS: Inter-rater agreement for the evaluation of hospital days among surgical patients was 84% (80-87%), with an average kappa value of 0.58 (0.48-0.68). Corresponding figures for patients in medicine were 76% (73-80%) with a K value of 0.42 (0.34-0.42). Inter-rater agreement for hospital admissions and K was 74% (62-86%) and 0.44 (0.21-0.67) in surgery, and 92% (85-100%) and 0.31 (0-0.80) in medicine, respectively. Thirty-three per cent of all admissions and 28% of consecutive hospital days were judged inappropriate in surgery; among medicine patients, reviewers found 6% of admissions and 33% of hospital days inappropriate. Time since admission was the strongest predictor of inappropriate hospital use adjusted for length of stay, comorbidity, age, and gender.","Int J Qual Health Care, 14(6): 483-492","USA",2002,"Not Specified","Surgery","AEP","Not Specified","Resource Use","Cross-sectional","USA","Not Specified","Not Specified","Surgery","Resource Use","Cross-sectional","AEP","2000:2004"]
[41,"Li, W., et al. (2011). \"Natural Orifice Translumenal Endoscopic Surgery (NOTES): patients' perceptions and attitudes.\" Dig Dis Sci 56(8): 2415-2422.",null,"Li, W., et al.","Natural Orifice Translumenal Endoscopic Surgery (NOTES): patients' perceptions and attitudes","BACKGROUND: Natural orifice translumenal endoscopic surgery (NOTES) has generated a surge of enthusiasm among researchers by virtue of its challenge to the dogma and potential benefits. However, no data is available in the medical literature about NOTES' acceptance by patients in Asia. The aim of the study is to survey patients' perceptions and attitudes towards NOTES. METHODS: It is a questionnaire-based multi-center study on inpatient subjects with various gastrointestinal disorders from 14 hospitals in 12 cities of China. Procedural details with the benefits and risks of NOTES, laparoscopic surgery, and conventional surgery were explained to all registered candidates. They were required to choose and cite reasons for adopting one of the above three surgical techniques as the preferred mode of treatment. The reasons for selection of the surgical treatment were: safety, efficacy, cost, postoperative pain, abdominal wounds, and scarring. RESULTS: There were 1,797 cases, including 976 (54.3%) males and 821 females (45.7%). Based on their comprehension of the procedure, 802 (44.6%) patients opted for NOTES, 757 (42.1%) for laparoscopic surgery, and 238 (13.2%) for conventional surgery. NOTES was mainly selected by the young and educated persons, especially females and by those with past exposure to laparoscopy or conventional surgery. The choice of treatment was significantly correlated with age (P=0.0021), education (P=0.0209), past medical history (laparoscopy, P=0.0134; open surgery, P<0.0001), and department of admission (P=0.0173). The preference for NOTES was based on safety (37.3%), cost (17.6%), elimination of postoperative scars (16.1%), abdominal wounds (16.0%), and efficacy (13.1%). CONCLUSIONS: The vast majority of patients prefer mini-invasive surgery to conventional surgery. The potential recipients of NOTES are educated and younger age groups. However, a few consider NOTES as a safe and effective intervention at present.","Dig Dis Sci, 56(8): 2415-2422","China",2011,"Gastrointestinal disorders","Surgery","PPS","Adolescent,Adults","PRO study","Cross-sectional","China","Adolescent,Adults","Gastrointestinal disorders","Surgery","PRO study","Cross-sectional","PPS","2010:2014"]
[42,"Paterson, C., et al. (2010). \"Outcomes of traditional Chinese medicine (traditional acupuncture) treatment for people with long-term conditions.\" Complement Ther Clin Pract 16(1): 3-9.",null,"Paterson, C., et al.","Outcomes of traditional Chinese medicine (traditional acupuncture) treatment for people with long-term conditions","A set of outcome questionnaires has been developed to measure the range of treatment effects of traditional acupuncture. In this descriptive outcome study we validated these questionnaires in a busy National Health Service funded acupuncture clinic serving communities of diverse socio-economic circumstances. Some of the questionnaires performed better than others in this setting but EQ-5D and MYMOP-qual both showed statistically and clinically significant improvement in physical and psychological health after six weeks and six months, in all categories of disease and degrees of chronicity. Both the written qualitative data and the Patient Enablement Instrument (PEI) demonstrated considerable patient enablement and, for some patients, the acquisition of new coping and self-care strategies.The questionnaires were feasible to administer, acceptable to patients and clinic staff, and provided robust and detailed quantitative and qualitative outcome data of use for service provision, future planning, and as a basis for further cost-effectiveness studies.","Complement Ther Clin Pract, 16(1): 3-9","UK",2010,"Not Specified","Acupuncture","PEI","Not Specified","Tool Validation","Cross-sectional","UK","Not Specified","Not Specified","Acupuncture","Tool Validation","Cross-sectional","PEI","2010:2014"]
[43,"Seid, M., et al. (2004). \"Parents' reports of barriers to care for children with special health care needs: development and validation of the barriers to care questionnaire.\" Ambul Pediatr 4(4): 323-331.",null,"Seid, M., et al.","Parents' reports of barriers to care for children with special health care needs: development and validation of the barriers to care questionnaire","OBJECTIVE: To describe the development and validation of the Barriers to Care Questionnaire (BCQ). METHODS: The 39-item BCQ was developed through review of the literature, focus groups, and cognitive interviews of Spanish- and English-speaking parents of children with chronic health conditions. Barriers to care are conceptualized as a multidimensional construct consisting of pragmatics, health knowledge and beliefs, expectations about care, skills, and marginalization. The BCQ was field tested in 3 samples of children with special health care needs (CSHCN). RESULTS: Response rate for the field test was 77.2%. There were minimal missing data (0.08%), no floor effects, and minimal ceiling effects (3.8%, total scale). Internal consistency reliability (alpha) for the BCQ total scale was.95 and subscale alpha ranged from.75 to.91. The BCQ total scale and subscales correlated in the expected direction with validated measures of primary care characteristics and health-related quality of life. BCQ scores were higher (fewer barriers) for children with a primary care physician and for those who reported no problems getting care or foregone care. CONCLUSION: The BCQ is a feasible, reliable, and valid instrument for measuring barriers to care for CSHCN. Its use may inform efforts to support consumer choice, enhance provider accountability, and spur quality improvement.","Ambul Pediatr, 4(4): 323-331","USA",2004,"Chronic conditions","Not Specified","BCQ","Children","Tool Validation","Cross-sectional","USA","Children","Chronic conditions","Not Specified","Tool Validation","Cross-sectional","BCQ","2000:2004"]
[44,"Fullwood, C., et al. (2013). \"Patients' experiences of shared decision making in primary care practices in the United kingdom.\" Med Decis Making 33(1): 26-36.",null,"Fullwood, C., et al.","Patients' experiences of shared decision making in primary care practices in the United kingdom","BACKGROUND: Shared decision making (SDM) and patient self-management support are key components of US and UK policy for chronic disease management, whereby SDM is seen as enhancing physician-patient negotiation around self-management. The WISE trial is implementing training in self-management support for primary care physicians in one UK region. This article describes preintervention levels of patient-reported SDM and explores how this varies with patient and practice characteristics. METHODS: We analyzed baseline data from a cluster randomized controlled trial for 2965 patients with diabetes, chronic obstructive pulmonary disease, and irritable bowel syndrome (IBS) from 29 family practices. Patient-level measures included self-report of chronic conditions, SDM (Health Care Climate Questionnaire [HCCQ]), health status, and demographic characteristics. Area and practice characteristics included chronic disease workload and socioeconomic deprivation. RESULTS: The mean SDM score was 75 (out of 100), but the range was wide. The mean score was lower for IBS patients but did not vary with other disease conditions. Younger patients and those with poorer health status reported lower degrees of SDM. No associations were found with practice characteristics. LIMITATIONS: The study was restricted to one socioeconomically deprived region, and hence results may not be nationally representative of the United Kingdom. Ceiling effects on SDM scores may limit the utility of the HCCQ. CONCLUSIONS: Lower ratings from some patient groups may reflect differences in expectations rather than differences in physician behavior. Overall levels of SDM were high, and no patient or practice characteristic represented a serious barrier to SDM. However, we cannot say to what extent SDM in this chronic population addressed self-management issues rather than clinical care. More nuanced measures of SDM are required that distinguish between different forms of care.","Med Decis Making, 33(1): 26-36","UK",2013,"Various","Not Specified","HCCQ,SDM-Q-9","Not Specified","PRO study","RCT","UK","Not Specified","Various","Not Specified","PRO study","RCT","HCCQ,SDM-Q-9","2010:2014"]
[45,"Tierney, E. P., et al. (2008). \"Photodynamic therapy for actinic keratoses: survey of patient perceptions of treatment satisfaction and outcomes.\" J Cosmet Laser Ther 10(2): 81-86.",null,"Tierney, E. P., et al.","Photodynamic therapy for actinic keratoses: survey of patient perceptions of treatment satisfaction and outcomes","BACKGROUND: While there are many available treatments for actinic keratoses (AKs), patient-preferred treatment options remain undefined. OBJECTIVE: To quantify patient perceptions and preferences in the management of AKs, including comparison of photodynamic therapy (PDT) with other therapies. METHODS: A self-administered questionnaire was mailed to 45 patients who had received PDT for AKs in 2005-2006 in the Henry Ford Health System. A series of indicators for each treatment were surveyed, including: recovery time, cosmetic appearance, patient cost, effectiveness, patient satisfaction, treatment option preference, and perceived burden of treatment. RESULTS: A total of 39 of the 45 patients participated (86.7%). A patient's reported recovery time was significantly more likely to be 1 week or less for PDT when compared with cryotherapy (p = 0.02) and surgical excision (p = 0.02). Borderline significance was found for the improved cosmetic outcome in PDT vs. surgical excision (p = 0.058) and for patient satisfaction with PDT compared with 5-fluorouracil (p = 0.058). Patients significantly preferred PDT to 5-fluorouracil (p<0.001) or imiquimod (p = 0.031). CONCLUSION: While the effectiveness of lesion clearance with PDT for AKs has been well proven in the literature, this is the first study to evaluate patient perception of the effectiveness, side-effect profile and benefits of PDT relative to several standard treatment approaches for AKs. PDT was found to have equivalent or improved recovery times, cosmetic outcomes, patient satisfaction and preference as a treatment for AKs by patients compared with other options.","J Cosmet Laser Ther, 10(2): 81-86","USA",2008,"Cancer","Psychodynamic Therapy","PPS","Adults","PRO study","Cross-sectional","USA","Adults","Cancer","Psychodynamic Therapy","PRO study","Cross-sectional","PPS","2005:2009"]
[46,"Wills, C. E. and M. Holmes-Rovner (2003). \"Preliminary validation of the Satisfaction With Decision scale with depressed primary care patients.\" Health Expect 6(2): 149-159.",null,"Wills, C. E. and M. Holmes-Rovner","Preliminary validation of the Satisfaction With Decision scale with depressed primary care patients","OBJECTIVE: To conduct a preliminary validation of the Satisfaction With Decision (SWD) scale with depressed primary care patients. DESIGN: Cross-sectional observational pilot study using a postal survey. SETTING AND PARTICIPANTS: Depressed primary care patients (n = 97) who recently had made a new decision about antidepressant medication use completed surveys regarding their treatment decisions. MAIN VARIABLES: Measures included patient-reported satisfaction with decision, decisional conflict, knowledge about depression and treatment, decision involvement, pain and health status, antidepressant medication efficacy, and satisfaction with health services. RESULTS: The SWD scale had good internal consistency reliability (alpha = 0.85). Evidence for construct validity was confirmed via a hypothesized pattern of relationships between the SWD scale and other measures. Decision satisfaction was associated with several issues of relevance for designing patient-centred decision support interventions: (1) knowledge about depression and treatment; (2) involvement in health-related decisions; and (3) aiding evaluation of trade-offs among pros and cons of treatment. CONCLUSIONS: The results of this pilot study show that the SWD scale appears to be a psychometrically sound and practical measure for research with this population. Additional research is needed on the theoretical nature of decision satisfaction and developing and testing patient-centred decision support interventions for depression treatment.","Health Expect, 6(2): 149-159","USA",2003,"Depression","Antidepressants","SWD","Not Specified","Tool Validation","Cross-sectional","USA","Not Specified","Depression","Antidepressants","Tool Validation","Cross-sectional","SWD","2000:2004"]
[47,"Morgan, M. W., et al. (2000). \"Randomized, controlled trial of an interactive videodisc decision aid for patients with ischemic heart disease.\" J Gen Intern Med 15(10): 685-693.",null,"Morgan, M. W., et al.","Randomized, controlled trial of an interactive videodisc decision aid for patients with ischemic heart disease","OBJECTIVE: To determine the effect of the Ischemic Heart Disease Shared Decision-Making Program (IHD SDP) an interactive videodisc designed to assist patients in the decision-making process involving treatment choices for ischemic heart disease, on patient decision-making. DESIGN: Randomized, controlled trial. SETTING: The Toronto Hospital, University of Toronto, Toronto, Ontario, Canada. PARTICIPANTS: Two hundred forty ambulatory patients with MEASUREMENTS AND MAIN RESULTS: The primary outcome was patient satisfaction with the decision-making process. This was measured using the 12-item Decision-Making Process Questionnaire that was developed and validated in a randomized trial of the benign prostatic hyperplasia SDP. Secondary outcomes included patient knowledge (measured using 20 questions about knowledge deemed necessary for an informed treatment decision), treatment decision, patient-angiographer agreement on decision, and general health scores. Outcomes were measured at the time of treatment decision and/or at 6 months follow-up. Shared decision-making program scores were similar for the intervention and control group (71% and 70%, respectively; 95% confidence interval [CI] for 1% difference, -3% to 7%). The intervention group had higher knowledge scores (75% vs 62%; 95% CI for 13% difference, 8% to 18%). The intervention group chose to pursue revascularization less often (58% vs 75% for the controls; 95% CI for 17% difference, 4% to 31%). At 6 months, 52% of the intervention group and 66% of the controls had undergone revascularization (95% CI for 14% difference, 0% to 28%). General health and angina scores were not different between the groups at 6 months. Exposure to the IHD SDP resulted in more patient-angiographer disagreement about treatment decisions. CONCLUSIONS: There was no significant difference in satisfaction with decision-making process scores between the IHD SDP and usual practice groups. The IHD SDP patients were more knowledgeable, underwent less revascularization (interventional therapies), and demonstrated increased patient decision-making autonomy without apparent impact on quality of life.","J Gen Intern Med, 15(10): 685-693","Canada",2000,"Heart Disease","Decision Aids","SWD","Not Specified","PRO study","RCT","Canada","Not Specified","Heart Disease","Decision Aids","PRO study","RCT","SWD","2000:2004"]
[48,"Zahid, M. A. and J. U. Ohaeri (2010). \"Relationship of family caregiver burden with quality of care and psychopathology in a sample of Arab subjects with schizophrenia.\" BMC Psychiatry 10: 71.",null,"Zahid, M. A. and J. U. Ohaeri","Relationship of family caregiver burden with quality of care and psychopathology in a sample of Arab subjects with schizophrenia","BACKGROUND: Although the burden experienced by families of people with schizophrenia has long been recognized as one of the most important consequences of the disorder, there are no reports from the Arab world. Following the example of the five-nation European (EPSILON) study, we explored the following research question: How does the relationship between domains of caregiving (as in the Involvement Evaluation Questionnaire--IEQ-EU) and caregiver psychic distress on the one hand, and caregiver's/patient's socio-demographics, clinical features and indices of quality of care, on the other hand, compare with the pattern in the literature? METHOD: Consecutive family caregivers of outpatients with schizophrenia were interviewed with the IEQ-EU. Patients were interviewed with measures of needs for care, service satisfaction, quality of life (QOL) and psychopathology. RESULTS: There were 121 caregivers (66.1% men, aged 39.8). The IEQ domain scores (total: 46.9; tension: 13.4; supervision: 7.9; worrying: 12.9; and urging: 16.4) were in the middle of the range for the EU data. In regression analyses, higher burden subscale scores were variously associated with caregiver lower level of education, patient's female gender and younger age, as well as patient's lower subjective QOL and needs for hospital care, and not involving the patient in outdoor activities. Disruptive behavior was the greatest determinant of global rating of burden. CONCLUSION: Our results indicate that, despite differences in service set-up and culture, the IEQ-EU can be used in Kuwait as it has been used in the western world, to describe the pattern of scores on the dimensions of caregiving. Differences with the international data reflect peculiarities of culture and type of service. Despite generous national social welfare provisions, experience of burden was the norm and was significantly associated with patient's disruptive behavior. The results underscore the need for provision of community-based programs and continued intervention with the families in order to improve the quality of care.","BMC Psychiatry, 10(71","Kuwait",2010,"Schizophrenia","Not Specified","IEQ-EU","Not Specified","PRO study","Cross-sectional","Kuwait","Not Specified","Schizophrenia","Not Specified","PRO study","Cross-sectional","IEQ-EU","2010:2014"]
[49,"Cichowski, S. B., et al. (2015). \"Standard compared with mnemonic counseling for fecal incontinence: a randomized controlled trial.\" Obstet Gynecol 125(5): 1063-1070.",null,"Cichowski, S. B., et al.","Standard compared with mnemonic counseling for fecal incontinence: a randomized controlled trial","OBJECTIVE: To estimate whether women who underwent mnemonic counseling had better recall of fecal incontinence therapies at 2 months and if mnemonic counseling resulted in greater satisfaction with physician counseling and improvement in quality of life when compared with a group who underwent standard counseling. METHODS: Counseling-naive women with fecal incontinence were recruited from an academic urogynecology clinic. Women underwent physical examinations, completed the Quality of the Physician-Patient Interaction, recorded fecal incontinence treatment options they recalled, and completed the Fecal Incontinence Severity Index and Manchester Health Questionnaire immediately after counseling and again at 2 months. RESULTS: Ninety women consented to participate, were randomized, and completed baseline questionnaires. At baseline, women did not differ in age, ethnicity, education, Fecal Incontinence Severity Index, or Manchester Health Questionnaire scores. After counseling, the mnemonic group reported higher satisfaction on Quality of the Physician-Patient Interaction (66.4+/-6.5 compared with 62.2+/-10.7, P=.03). Ninety percent (81/90) of women followed up at 2 months. Our primary endpoint, 2-month recall of fecal incontinence treatments, was not different between groups (2.3+/-1.6 mnemonic counseling compared with 1.8+/-1.0 standard counseling; P=.08). Secondary endpoints for the mnemonic group reported greater improvement on total Manchester Health Questionnaire (P=.02), emotional (P=.03), sleep (0.045), role limitations (P<.01), and physical limitations (P=.04) when compared with the standard group. CONCLUSION: Fecal incontinence counseling with a mnemonic aid did not improve recall at 2 months but improved patient satisfaction and quality of life at 2 months.","Obstet Gynecol, 125(5): 1063-1070","Mexico",2015,"Fecal incontinence","Counselling","QPPI","Women","PRO study","RCT","Mexico","Women","Fecal incontinence","Counselling","PRO study","RCT","QPPI","2015:2018"]
[50,"Compen, F. R., et al. (2015). \"Study protocol of a multicenter randomized controlled trial comparing the effectiveness of group and individual internet-based Mindfulness-Based Cognitive Therapy with treatment as usual in reducing psychological distress in cancer patients: the BeMind study.\" BMC Psychol 3: 27.",null,"Compen, F. R., et al.","Study protocol of a multicenter randomized controlled trial comparing the effectiveness of group and individual internet-based Mindfulness-Based Cognitive Therapy with treatment as usual in reducing psychological distress in cancer patients: the BeMind study","BACKGROUND: Mindfulness-based interventions have shown to reduce psychological distress in cancer patients. The accessibility of mindfulness-based interventions for cancer patients could be further improved by providing mindfulness using an individual internet-based format. The aim of this study is to test the effectiveness of a Mindfulness-Based Cognitive Therapy (MBCT) group intervention for cancer patients in comparison with individual internet-based MBCT and treatment as usual (TAU). METHODS/DESIGN: A three-armed multicenter randomized controlled trial comparing group-based MBCT to individual internet-based MBCT and TAU in cancer patients who suffer from at least mild psychological distress (Hospital Anxiety and Depression Scale (HADS) >/= 11). Measurements will be conducted prior to randomization (baseline), post-treatment and at 3 months and 9 months post-treatment. Participants initially allocated to TAU are subsequently randomized to either group- or individual internet-based MBCT and will receive a second baseline measurement after 3 months. Thus, the three-armed comparison will have a time span of approximately 3 months. The two-armed intervention comparison includes a 9-month follow-up and will also consist of participants randomized to the intervention after TAU. Primary outcome will be post-treatment psychological distress (HADS). Secondary outcomes are fear of cancer recurrence (Fear of Cancer Recurrence Inventory), rumination (Rumination and Reflection Questionnaire), positive mental health (Mental Health Continuum - Short Form), and cost-effectiveness (health-related quality of life (EuroQol -5D and Short Form-12) and health care usage (Trimbos and iMTA questionnaire on Costs associated with Psychiatric illness). Potential predictors: DSM-IV-TR mood/anxiety disorders (SCID-I) and neuroticism (NEO-Five Factor Inventory) will be measured. Mediators of treatment effect: mindfulness skills, (Five-Facets of Mindfulness Questionnaire- Short Form), working alliance (Working Alliance Inventory) and group cohesion (Group Cohesion Questionnaire) will also be measured. DISCUSSION: This trial will provide valuable information on the clinical and cost-effectiveness of group versus internet-based MBCT versus TAU for distressed cancer patients. TRIAL REGISTRATION: Clinicaltrials.gov NCT02138513. Registered 6 May 2014.","BMC Psychol, 3(27","Netherlands",2015,"Cancer","Cognitive Therapy","GCQ","Not Specified","PRO study","RCT","Netherlands","Not Specified","Cancer","Cognitive Therapy","PRO study","RCT","GCQ","2015:2018"]
[51,"McKinstry, B., et al. (2002). \"Telephone consultations to manage requests for same-day appointments: a randomised controlled trial in two practices.\" Br J Gen Pract 52(477): 306-310.",null,"McKinstry, B., et al.","Telephone consultations to manage requests for same-day appointments: a randomised controlled trial in two practices","BACKGROUND: General practitioners (GPs) in the United Kingdom have recently begun to adopt the use of telephone consultation during daytime surgery as a means of managing demand, particularly requests for same-day appointments. However, it is not known whether the strategy actually reduces GP workload. AIM: To investigate how the use of telephone consultations impacts on the management of requests for same-day appointments, on resource use, indicators of clinical care, and patient perceptions of consultations. DESIGN OF STUDY: Randomised controlled trial. SETTING: All patients (n = 388) seeking same-day appointments in each surgery in two urban practices (total population = 10,420) over a four-week period. METHOD: The primary outcome measure was use of doctor time for the index telephone or face-to-face consultation. Secondary outcomes were subsequent use of investigations and of services in the two-week period following consultation, frequency of blood pressure measurement and antibiotic prescriptions, and number of problems considered at consultation. Patient perceptions were measured by the Patient Enablement Instrument (PEI) and reported willingness to use telephone consultations in the future. RESULTS: Telephone consultations took less time (8.2 minutes versus 6.7 minutes; diff = 1.5, 95% confidence interval [CI] = 0.6 to 2.4, P = 0.002). Patients consulting by telephone reconsulted the GP more frequently in the two weeks that followed (0.6 consultations versus 0.4 consultations; diff = 0.2, 95% CI = 0.0 to 0.3, P = 0.01). Blood pressure was measured more often in the group of patients managed face-to-face (25/188 [13.3%] versus 12/181 [6.6%]; diff = 6.7%, 95% CI = 0.6% to 12.7%). There was no significant difference in patient perceptions or other secondary outcomes. CONCLUSION: Use of telephone consultations for same-day appointments was associated with time saving, and did not result in lower PEI scores. Possibly, however, this short-term saving was offset by higher re-consultation and less use of opportunistic health promotion.","Br J Gen Pract, 52(477): 306-310","UK",2002,"Not Specified","Tele-communications","PEI","Not Specified","PRO study","RCT","UK","Not Specified","Not Specified","Tele-communications","PRO study","RCT","PEI","2000:2004"]
[52,"Slade, M., et al. (2014). \"The development and evaluation of a five-language multi-perspective standardised measure: clinical decision-making involvement and satisfaction (CDIS).\" BMC Health Serv Res 14: 323.",null,"Slade, M., et al.","The development and evaluation of a five-language multi-perspective standardised measure: clinical decision-making involvement and satisfaction (CDIS)","BACKGROUND: The aim of this study was to develop and evaluate a brief quantitative five-language measure of involvement and satisfaction in clinical decision-making (CDIS) - with versions for patients (CDIS-P) and staff (CDIS-S) - for use in mental health services. METHODS: An English CDIS was developed by reviewing existing measures, focus groups, semistructured interviews and piloting. Translations into Danish, German, Hungarian and Italian followed the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Task Force principles of good practice for translation and cultural adaptation. Psychometricevaluation involved testing the measure in secondary mental health services in Aalborg, Debrecen, London, Naples, Ulm and Zurich. RESULTS: After appraising 14 measures, the Control Preference Scale and Satisfaction With Decision-making English-language scales were modified and evaluated in interviews (n = 9), focus groups (n = 22) and piloting (n = 16). Translations were validated through focus groups (n = 38) and piloting (n = 61). A total of 443 service users and 403 paired staff completed CDIS. The Satisfaction sub-scale had internal consistency of 0.89 (0.86-0.89 after item-level deletion) for staff and 0.90 (0.87-0.90) for service users, both continuous and categorical (utility) versions were associated with symptomatology and both staff-rated and service userrated therapeutic alliance (showing convergent validity), and not with social disability (showing divergent validity), and satisfaction predicted staff-rated (OR 2.43, 95%CI 1.54- 3.83 continuous, OR 5.77, 95%CI 1.90-17.53 utility) and service user-rated (OR 2.21, 95%CI 1.51-3.23 continuous, OR 3.13, 95%CI 1.10-8.94 utility) decision implementation two months later. The Involvement sub-scale had appropriate distribution and no floor or ceiling effects, was associated with stage of recovery, functioning and quality of life (staff only) (showing convergent validity), and not with symptomatology or social disability (showing divergent validity), and staff-rated passive involvement by the service user predicted implementation (OR 3.55, 95%CI 1.53-8.24). Relationships remained after adjusting for clustering by staff. CONCLUSIONS: CDIS demonstrates adequate internal consistency, no evidence of item redundancy, appropriate distribution, and face, content, convergent, divergent and predictive validity. It can be recommended for research and clinical use. CDIS-P and CDIS-S in all 3 five languages can be downloaded at http://www.cedar-net.eu/instruments. TRIAL REGISTRATION: ISRCTN75841675.","BMC Health Serv Res, 14(323","UK",2014,"Mental Health","Not Specified","CDIS,SWD","Not Specified","Tool Validation","Cross-sectional","UK","Not Specified","Mental Health","Not Specified","Tool Validation","Cross-sectional","CDIS,SWD","2010:2014"]
[53,"Kim, T., et al. (2001). \"The economic impact of methicillin-resistant Staphylococcus aureus in Canadian hospitals.\" Infect Control Hosp Epidemiol 22(2): 99-104.",null,"Kim, T., et al.","The economic impact of methicillin-resistant Staphylococcus aureus in Canadian hospitals","OBJECTIVES: To determine the costs associated with the management of hospitalized patients with methicillin-resistant Staphylococcus aureus (MRSA), and to estimate the economic burden associated with MRSA in Canadian hospitals. DESIGN: Patient-specific costs were used to determine the attributable cost of MRSA associated with excess hospitalization and concurrent treatment. Excess hospitalization for infected patients was identified using the Appropriateness Evaluation Protocol, a criterion-based chart review process to determine the need for each day of hospitalization. Concurrent treatment costs were identified through chart review for days in isolation, antimicrobial therapy, and MRSA screening tests. The economic burden to Canadian hospitals was estimated based on 3,167,521 hospital discharges for 1996 and 1997 and an incidence of 4.12 MRSA cases per 1,000 admissions. SETTING: A tertiary-care, university-affiliated teaching hospital in Toronto, Ontario, Canada. PATIENTS: Inpatients with at least one culture yielding MRSA between April 1996 and March 1998. RESULTS: A total of 20 patients with MRSA infections and 79 colonized patients (with 94 admissions) were identified. This represented a rate of 2.9 MRSA cases per 1,000 admissions. The mean number of additional hospital days attributable to MRSA infection was 14, with 11 admissions having at least 1 attributable day. The total attributable cost to treat MRSA infections was $287,200, or $14,360 per patient The cost for isolation and management of colonized patients was $128,095, or $1,363 per admission. Costs for MRSA screening in the hospital were $109,813. Assuming an infection rate of 10% to 20%, we determined the costs associated with MRSA in Canadian hospitals to be $42 million to $59 million annually. CONCLUSIONS: These results indicate that there is a substantial economic burden associated with MRSA in Canadian hospitals. These costs will continue to rise if the incidence of MRSA increases further.","Infect Control Hosp Epidemiol, 22(2): 99-104","Canada",2001,"MRSA","Hospitalisation","AEP","Adults","Costs,Resource Use","Cross-sectional","Canada","Adults","MRSA","Hospitalisation","Costs,Resource Use","Cross-sectional","AEP","2000:2004"]
[54,"Hamilton, W., et al. (2007). \"The effect of patient self-completion agenda forms on prescribing and adherence in general practice: a randomized controlled trial.\" Fam Pract 24(1): 77-83.",null,"Hamilton, W., et al.","The effect of patient self-completion agenda forms on prescribing and adherence in general practice: a randomized controlled trial","BACKGROUND: What the patient wants from a general practice consultation and what the doctor believes they want are not always the same thing. This mismatch may lead to unwanted and unnecessary prescribing. AIM: To study the effect of a one-page form completed by patients before their consultation and given to the doctor at the start of the consultation, in terms of a reduction in prescribing, satisfaction with the consultation and adherence with prescribed medication. DESIGN: Randomized controlled trial. SETTING: Ten general practices in Devon and Dorset, UK. METHODS: Unselected patients attending general practice appointments were randomised to receive (or not) a self-completed agenda form (SCAF) asking five questions, including whether the patient considered they should receive a prescription. RESULTS: Approximately 4125 patients were offered entry; 3124 (76%) agreed to randomisation. In 1783 (57%) of these prescribing or satisfaction outcomes were identified. 457 of 811 (56.4%) of SCAF patients received a prescription, at a median (IQR) cost of pound 5.60 (inter-quartile range pound 2.12- pound 16.10), compared with 418 of 799 (52.3%) of controls, at a median cost of pound 5.94 ( pound 2.46- pound 18.90); both results non-significant (P=0.10 for prescribing and 0.30 for cost). Satisfaction was also similar in both groups: mean satisfaction score in SCAFs 5.37 and in controls 5.40 (P=0.64), as was adherence: at 12 weeks, adherence of 75% or greater was reported by 92 of 136 SCAF patients (68%) and 105 of 145 controls (72%) (P=0.31). CONCLUSION: The negative result could have two explanations. Either the intervention did not achieve the intention of communicating the patients' agendas, or if it did, patients may have been persuaded by doctors' explanations in the consultation.","Fam Pract, 24(1): 77-83","UK",2007,"Not Specified","Medication","SCAF","Not Specified","PRO study","RCT","UK","Not Specified","Not Specified","Medication","PRO study","RCT","SCAF","2005:2009"]
[55,"Barr, D. A. (1995). \"The effects of organizational structure on primary care outcomes under managed care.\" Ann Intern Med 122(5): 353-359.",null,"Barr, D. A.","The effects of organizational structure on primary care outcomes under managed care","The advent of managed care in the United States brings with it more and larger organizations involved in providing primary care. Studies of organizations in general suggest that large managed care organizations will have difficulty providing high-quality primary care largely because of their complexity and the fragmentation of their work force. Existing data confirm that these organizations have shortcomings in both patient and physician satisfaction. There are few data to indicate whether such organizations can mitigate these problems by saving costs through economies of scale. To offset their inherent weaknesses, large primary care organizations need to ensure patients' accessibility to their physicians, the continuity of the physician-patient relationship, a care environment conducive to a high-quality physician-patient interaction, and the clinical autonomy of physicians. Much additional research needs to be done to further understand these issues.","Ann Intern Med, 122(5): 353-359","USA",1995,"Not Specified","Not Specified","QPPI","Not Specified","Narrative Review","Review","USA","Not Specified","Not Specified","Not Specified","Narrative Review","Review","QPPI","1995:1999"]
[56,"Sanchez-Garcia, S., et al. (2008). \"The hospital appropriateness evaluation protocol in elderly patients: a technique to evaluate admission and hospital stay.\" Scand J Caring Sci 22(2): 306-313.",null,"Sanchez-Garcia, S., et al.","The hospital appropriateness evaluation protocol in elderly patients: a technique to evaluate admission and hospital stay","BACKGROUND: Aging of the population represents one of the main challenges for health systems because of the increase in the demand for hospital services. To be able to count on tools that allow an objective evaluation of hospital-resource use becomes indispensable for health systems. OBJECTIVE: To evaluate the reliability and validity of the Appropriateness Evaluation Protocol (AEP) regarding the appropriateness of admissions and hospital stays in elderly patients. In a scenario of scarce resources, to have a valid instrument will make it possible to evaluate the process of care in our growing elderly population in a standardized way. METHODS: We carried out a retrospective study of 144 randomly chosen elderly patients admitted to the hospital with 394 even-numbered hospital-stay days. For the reliability analysis between the pair of nurses with the AEP and the pair of specialists, the details of the hospital admissions and the stay days were obtained from the clinical files. Criteria validity was conducted by pairs of physicians, including two internists, two general surgeons and two geriatricians. Only the agreements were compared with agreements of the AEP-trained nurses. Disagreements were excluded from the final analysis. RESULTS: Inter-rater (inter-reviewer) agreement of hospital admissions and days spent by the patient presented a kappa coefficient of >0.70, while these admissions and hospital-stay days was >0.70. Sensitivity and positive predictor value to detect inappropriate admissions were not calculated because no agreement existed on inappropriate admissions. Specificity and negative predictive value to detect appropriate admission was >94.0% and >98.0%. Sensitivity and positive predictor value to detect inappropriate hospital-stay days was >44.0% and >10.0%, while specificity and negative predictor value for detecting appropriate hospital-stay days was >79.0% and >88.0%. CONCLUSIONS: AEP's high-reliability and moderate-validity results with regard to clinical judgement positions it as a useful instrument for appropriate hospitalization screening in elderly patients.","Scand J Caring Sci, 22(2): 306-313","Mexico",2008,"Not Specified","Hospitalisation","AEP","Elderly","Tool Validation","Cross-sectional","Mexico","Elderly","Not Specified","Hospitalisation","Tool Validation","Cross-sectional","AEP","2005:2009"]
[57,"Lauria, F. N. and C. Angeletti (2003). \"The impact of nosocomial infections on hospital care costs.\" Infection 31 Suppl 2: 35-43.",null,"Lauria, F. N. and C. Angeletti","The impact of nosocomial infections on hospital care costs","Estimating costs due to nosocomial infection (NI) requires the incremental costs associated with NI diagnosis and treatment must be distinguished from those attributable to the management of the original healthcare problems. We carried out a review of the analyses of additional costs resulting from NIs and the evaluation of the methods used to estimate these costs, in order to perform a cost benefit analysis of NI prevention activities. Characteristics of additional costs for main NIs were initially considered. Secondly, a review of methods for estimating the incremental costs was performed. Finally, a cost effectiveness analysis of NI prevention activities was performed. Few studies estimated the incidence of NLs and assessed the economic burden they cause. Investigators generally estimated only direct additional costs. Implicit physician assessment, unmatched group comparison, matched control and appropriateness evaluation protocol (AEP)-based methods are the methodologies used to estimate incremental days of stay due to NIs. Different studies show possible benefits, in terms of health and cost savings, when hospital-acquired infections are prevented. However, there is a need for further studies to evaluate in greater detail the variables related to costs attributable to these infections and to enhance the control strategies. Moreover, a structured surveillance and control program of NI is the single most effective tool for prevention.","Infection, 31 Suppl 2(35-43","Italy",2003,"Nosocomical infection","Preventative Services","AEP","Not Specified","Costs","Cross-sectional","Italy","Not Specified","Nosocomical infection","Preventative Services","Costs","Cross-sectional","AEP","2000:2004"]
[58,"Wensing, M., et al. (2008). \"The Patients Assessment Chronic Illness Care (PACIC) questionnaire in The Netherlands: a validation study in rural general practice.\" BMC Health Serv Res 8: 182.",null,"Wensing, M., et al.","The Patients Assessment Chronic Illness Care (PACIC) questionnaire in The Netherlands: a validation study in rural general practice","BACKGROUND: Many patients with chronic illness receive health care in primary care settings, so a challenge is to provide well-structured chronic care in these settings. Our aim was to develop and test a Dutch version of the PACIC questionnaire, a measure for patient reported structured chronic care. METHODS: Observational study in 165 patients with diabetes or COPD from four general practices (72% response rate). Patients completed a written questionnaire, which included instruments for assessing chronic illness care (PACIC), evaluations of general practice (Europep), enablement (PEI), and individual characteristics. RESULTS: The patients had a mean age of 68.0 years and 47% comprised of women. Twenty-two to 35% of responding patients did not provide answers to specific items in the PACIC. In 11 items the lowest answering category was used by 30% or more of the responders and in 6 items the highest answering category was used by this number of responders. Principal factor analysis identified the previously defined five domains reasonably well. Cronbach's alpha per domain varied from 0.71 to 0.83, and the intraclass coefficient from 0.66 to 0.91. Diabetes patients reported higher presence of structured chronic care for 14 out of the 20 PACIC items. The effect of patient evaluations of general practice on the PACIC score was positive (b = 0.72, p < 0.004), but the effect of patient enablement on the PACIC score was negative (b = -1.13, p < 0.000). CONCLUSION: A translated and validated Dutch version of the PACIC questionnaire is now available. Further research on its validity is recommended.","BMC Health Serv Res, 8(182","Netherlands",2008,"Not Specified","Not Specified","PEI","Adults,Elderly","Tool Validation","Cross-sectional","Netherlands","Adults,Elderly","Not Specified","Not Specified","Tool Validation","Cross-sectional","PEI","2005:2009"]
[59,"Jacob, M. E., et al. (2016). \"The preventive services use self-efficacy (PRESS) scale in older women: development and psychometric properties.\" BMC Health Serv Res 16: 71.",null,"Jacob, M. E., et al.","The preventive services use self-efficacy (PRESS) scale in older women: development and psychometric properties","BACKGROUND: Preventive services offered to older Americans are currently under-utilized despite considerable evidence regarding their health and economic benefits. Individuals with low self-efficacy in accessing these services need to be identified and provided self-efficacy enhancing interventions. Scales measuring self-efficacy in the management of chronic diseases exist, but do not cover the broad spectrum of preventive services and behaviors that can improve the health of older adults, particularly older women who are vulnerable to poorer health and lesser utilization of preventive services. This study aimed to evaluate the psychometric properties of a new preventive services use self-efficacy scale, by measuring its internal consistency reliability, assessing internal construct validity by exploring factor structure, and examining differences in self-efficacy scores according to participant characteristics. METHODS: The Preventive Services Use Self-Efficacy (PRESS) Scale was developed by an expert panel at the University of Pittsburgh Center for Aging and Population Health - Prevention Research Center. It was administered to 242 women participating in an ongoing trial and the data were analyzed to assess its psychometric properties. An exploratory factor analysis with a principal axis factoring approach and orthogonal varimax rotation was used to explore the underlying structure of the items in the scale. The internal consistency of the subscales was assessed using Cronbach's alpha coefficient. RESULTS: The exploratory factor analysis defined five self-efficacy factors (self-efficacy for exercise, communication with physicians, self-management of chronic disease, obtaining screening tests, and getting vaccinations regularly) formed by 16 items from the scale. The internal consistency of the subscales ranged from .81 to .94. Participants who accessed a preventive service had higher self-efficacy scores in the corresponding sub-scale than those who did not. CONCLUSIONS: The 16-item PRESS scale demonstrates preliminary validity and reliability in measuring self-efficacy in the use of preventive services among older women. It can potentially be used to evaluate the impact of interventions designed to improve self-efficacy in the use of preventive services in community-dwelling older women.","BMC Health Serv Res, 16(71","USA",2016,"General Poor Health","Preventative Services","PRESS","Elderly,Women","Tool Validation","Cross-sectional","USA","Elderly,Women","General Poor Health","Preventative Services","Tool Validation","Cross-sectional","PRESS","2015:2018"]
[60,"Barr, P. J., et al. (2014). \"The psychometric properties of CollaboRATE: a fast and frugal patient-reported measure of the shared decision-making process.\" J Med Internet Res 16(1): e2.",null,"Barr, P. J., et al.","The psychometric properties of CollaboRATE: a fast and frugal patient-reported measure of the shared decision-making process","BACKGROUND: Patient-centered health care is a central component of current health policy agendas. Shared decision making (SDM) is considered to be the pinnacle of patient engagement and methods to promote this are becoming commonplace. However, the measurement of SDM continues to prove challenging. Reviews have highlighted the need for a patient-reported measure of SDM that is practical, valid, and reliable to assist implementation efforts. In consultation with patients, we developed CollaboRATE, a 3-item measure of the SDM process. OBJECTIVE: There is a need for scalable patient-reported measure of the SDM process. In the current project, we assessed the psychometric properties of CollaboRATE. METHODS: A representative sample of the US population were recruited online and were randomly allocated to view 1 of 6 simulated doctor-patient encounters in January 2013. Three dimensions of SDM were manipulated in the encounters: (1) explanation of the health issue, (2) elicitation of patient preferences, and (3) integration of patient preferences. Participants then completed CollaboRATE (possible scores 0-100) in addition to 2 other patient-reported measures of SDM: the 9-item Shared Decision Decision Making Questionnaire (SDM-Q-9) and the Doctor Facilitation subscale of the Patient's Perceived Involvement in Care Scale (PICS). A subsample of participants was resurveyed between 7 and 14 days after the initial survey. We assessed CollaboRATE's discriminative, concurrent, and divergent validity, intrarater reliability, and sensitivity to change. RESULTS: The final sample consisted of 1341 participants. CollaboRATE demonstrated discriminative validity, with a significant increase in CollaboRATE score as the number of core dimensions of SDM increased from zero (mean score: 46.0, 95% CI 42.4-49.6) to 3 (mean score 85.8, 95% CI 83.2-88.4). CollaboRATE also demonstrated concurrent validity with other measures of SDM, excellent intrarater reliability, and sensitivity to change; however, divergent validity was not demonstrated. CONCLUSIONS: The fast and frugal nature of CollaboRATE lends itself to routine clinical use. Further assessment of CollaboRATE in real-world settings is required.","J Med Internet Res, 16(1): e2","USA",2014,"Not Specified","Not Specified","PICS,SDM-Q-9,CollaboRATE","Adolescent,Adults","Tool Validation","Cross-sectional","USA","Adolescent,Adults","Not Specified","Not Specified","Tool Validation","Cross-sectional","PICS,SDM-Q-9,CollaboRATE","2010:2014"]
[61,"Haughney, J., et al. (2007). \"The use of a modification of the Patient Enablement Instrument in asthma.\" Prim Care Respir J 16(2): 89-92.",null,"Haughney, J., et al.","The use of a modification of the Patient Enablement Instrument in asthma","AIM: To ascertain if the Patient Enablement Instrument (PEI) could be adapted for use in asthma management, and to use it to evaluate \"enablement\" in patients with asthma randomised to either a fixed or adjustable medication dosing regime. METHODS: The original Patient Enablement Instrument was modified by making a minor change to the opening statement. 228 adults with asthma from 72 UK general practices were recruited to the study. The internal and external consistencies of the modified PEI were assessed. Individual scores were compared across treatment groups. RESULTS: The modified PEI had high internal consistency. There was a significant correlation between modified PEI total score and change in Mini Asthma Quality of Life Questionnaire. A significantly greater proportion of patients using adjustable medication dosing had a clinically relevant treatment benefit. CONCLUSIONS: The Patient Enablement Instrument can be used to measure \"enablement\" in asthma.","Prim Care Respir J, 16(2): 89-92","UK",2007,"Asthma","Medication","PEI","Not Specified","Tool Validation","Cross-sectional","UK","Not Specified","Asthma","Medication","Tool Validation","Cross-sectional","PEI","2005:2009"]
[62,"Zoutman, D., et al. (1998). \"Total and attributable costs of surgical-wound infections at a Canadian tertiary-care center.\" Infect Control Hosp Epidemiol 19(4): 254-259.",null,"Zoutman, D., et al.","Total and attributable costs of surgical-wound infections at a Canadian tertiary-care center","OBJECTIVE: To determine the total and attributable costs of surgical-wound infections in a Canadian teaching hospital. DESIGN: Retrospective incidence series study with chart review and examination of resource utilization attributable to wound infection. The charts of inpatients with wound infections were examined using the Appropriateness Evaluation Protocol (AEP), a validated chart review instrument designed to determine appropriateness of care, modified for wound infections. SETTING: A university referral center in Canada. PATIENTS: Medical records were abstracted from patients with wound infections who underwent an inpatient clean or clean-contaminated procedure during 1991. MEASUREMENTS: During the wound-infection treatment period, the hospital costs associated with providing care were tabulated for all inpatient days and for outpatient and emergency visits. Costs taken into account included nursing salary and benefits, nonphysician professional services, operating room time, laboratory, pharmacy, supplies, ancillary tests, and hotel costs. RESULTS: We identified 108 wound infections. Twenty-two patients required 28 surgical procedures related to a wound infection. Inpatient days totalled 1,116, costing $394,337. Fifty-five emergency and 42 clinic visits occurred, costing $27,193. By applying the AEP to the inpatient days, 833 days, or 10.2 days per case, were directly attributable to the wound infection. The hospital costs for inpatient care attributable to wound infections were $321,533 in total, or $3,937 per infection. Costs were distributed as follows: nursing, 51%; hotel, 14%; pharmacy, 10%; laboratory, 9%; emergency and outpatient clinic, 6%; professional services, 5%; operating room, 3%; and ancillary tests, 2%. CONCLUSIONS: Wound infections contribute markedly to extra days of hospitalization and related costs. The AEP method is applied easily to determine attributable days of care and costs of wound infections, which are necessary to calculate the cost-benefit of infection control programs.","Infect Control Hosp Epidemiol, 19(4): 254-259","Canada",1998,"Surgical-wound infections","Wound cleaning","AEP","Adults","Costs,Resource Use","Cross-sectional","Canada","Adults","Surgical-wound infections","Wound cleaning","Costs,Resource Use","Cross-sectional","AEP","1995:1999"]
[63,"Woodhams, V., et al. (2012). \"Triumph of hope over experience: learning from interventions to reduce avoidable hospital admissions identified through an Academic Health and Social Care Network.\" BMC Health Serv Res 12: 153.",null,"Woodhams, V., et al.","Triumph of hope over experience: learning from interventions to reduce avoidable hospital admissions identified through an Academic Health and Social Care Network","BACKGROUND: Internationally health services are facing increasing demands due to new and more expensive health technologies and treatments, coupled with the needs of an ageing population. Reducing avoidable use of expensive secondary care services, especially high cost admissions where no procedure is carried out, has become a focus for the commissioners of healthcare. METHOD: We set out to identify, evaluate and share learning about interventions to reduce avoidable hospital admission across a regional Academic Health and Social Care Network (AHSN). We conducted a service evaluation identifying initiatives that had taken place across the AHSN. This comprised a literature review, case studies, and two workshops. RESULTS: We identified three types of intervention: pre-hospital; within the emergency department (ED); and post-admission evaluation of appropriateness. Pre-hospital interventions included the use of predictive modelling tools (PARR - Patients at risk of readmission and ACG - Adjusted Clinical Groups) sometimes supported by community matrons or virtual wards. GP-advisers and outreach nurses were employed within the ED. The principal post-hoc interventions were the audit of records in primary care or the application of the Appropriateness Evaluation Protocol (AEP) within the admission ward. Overall there was a shortage of independent evaluation and limited evidence that each intervention had an impact on rates of admission. CONCLUSIONS: Despite the frequency and cost of emergency admission there has been little independent evaluation of interventions to reduce avoidable admission. Commissioners of healthcare should consider interventions at all stages of the admission pathway, including regular audit, to ensure admission thresholds don't change.","BMC Health Serv Res, 12(153","UK",2012,"Not Specified","Hospitalisation","AEP","Not Specified","Costs,Resource Use","Cross-sectional","UK","Not Specified","Not Specified","Hospitalisation","Costs,Resource Use","Cross-sectional","AEP","2010:2014"]
[64,"Wakefield, D. S., et al. (1987). \"Use of the appropriateness evaluation protocol for estimating the incremental costs associated with nosocomial infections.\" Med Care 25(6): 481-488.",null,"Wakefield, D. S., et al.","Use of the appropriateness evaluation protocol for estimating the incremental costs associated with nosocomial infections","Existing methods for estimating additional days of hospital stay due to nosocomial infections (NI) have a number of documented limitations. An alternative method described in this paper uses the Appropriateness Evaluation Protocol (AEP) to determine whether each day of acute inpatient care is appropriate based on the need for care of the NI, original cause of hospitalization (OC), or combined NI-OC requirements. Using this method to identify specific days of hospitalization due to Staphylococcus aureus nosocomial infection, we find: 1) length of stay is increased for only a minority of patients (38%); 2) an average of 20 additional days of stay occurred for patients with 1 or more days attributed to NI; and 3) an average of 52% of length of stay of patients with 1 or more days attributed to NI can be attributed to the NI. Application of the AEP-based method is a useful alternative for identifying additional days of stay due to NI.","Med Care, 25(6): 481-488","USA",1987,"MRSA","Hospitalisation","AEP","Children","Resource Use","Cross-sectional","USA","Children","MRSA","Hospitalisation","Resource Use","Cross-sectional","AEP","1960:1989"]
[65,"Wallace, P., et al. (2004). \"Virtual outreach: a randomised controlled trial and economic evaluation of joint teleconferenced medical consultations.\" Health Technol Assess 8(50): 1-106, iii-iv.",null,"Wallace, P., et al.","Virtual outreach: a randomised controlled trial and economic evaluation of joint teleconferenced medical consultations","OBJECTIVES: To test the hypotheses that virtual outreach would reduce offers of hospital follow-up appointments and reduce numbers of medical interventions and investigations, reduce numbers of contacts with the health care system, have a positive impact on patient satisfaction and enablement, and lead to improvements in patient health status. To perform an economic evaluation of virtual outreach. DESIGN: A randomised controlled trial comparing joint teleconsultations between GPs, specialists and patients with standard outpatient referral. It was accompanied by an economic evaluation. SETTING: The trial was centred on the Royal Free Hampstead NHS Trust, London, and the Royal Shrewsbury Hospital Trust in Shropshire. The project teams recruited and trained a total of 134 GPs from 29 practices and 20 consultant specialists. PARTICIPANTS: In total, 3170 patients were referred, of whom 2094 consented to participate in the study and were eligible for inclusion. In all, 1051 patients were randomised to the virtual outreach group and 1043 to standard outpatient appointments. The patients were followed 6 months after their index consultation. INTERVENTIONS: Patients randomised to virtual outreach underwent a joint teleconsultation, in which they attended the general practice surgery where they and their GP consulted with a hospital specialist via a videolink between the hospital and the practice. MAIN OUTCOME MEASURES: Outcome measures included offers of follow-up outpatient appointments, numbers of tests, investigations, procedures, treatments and contacts with primary and secondary care, patient satisfaction (Ware Specific Visit Questionnaire), enablement (Patient Enablement Instrument) and quality of life (Short Form-12 and Child Health Questionnaire). An economic evaluation of the costs and consequences of the intervention was undertaken. Sensitivity analysis was used to test the robustness of the results. RESULTS: Patients in the virtual outreach group were more likely to be offered a follow-up appointment. Significant differences in effects were observed between the two sites and across different specialities. Virtual outreach increased the offers of follow-up appointments more in Shrewsbury than in London, and more in ENT and orthopaedics than in the other specialities. Fewer tests and investigations were ordered in the virtual outreach group, by an average of 0.79 per patient. In the 6-month period following the index consultation, there were no significant differences overall in number of contacts with general practice, outpatient visits, accident and emergency contacts, inpatient stays, day surgery and inpatient procedures or prescriptions between the randomised groups. Tests of interaction indicated that virtual outreach decreased the number of tests and investigations, particularly in patients referred to gastroenterology, and increased the number of outpatient visits, particularly in those referred to orthopaedics. Patient satisfaction was greater after a virtual outreach consultation than after a standard outpatient consultation, with no heterogeneity between specialities or sites. However, patient enablement after the index consultation, and the physical and psychological scores of the Short Form-12 for adults and the scores on the Child Health Questionnaire for children under 16, did not differ between the randomised groups at 6 months' follow-up. NHS costs over 6 months were greater for the virtual outreach consultations than for conventional outpatients, pound 724 and pound 625 per patient, respectively. The index consultation accounted for this excess. Cost and time savings to patients were found. Estimated productivity losses were also less in the virtual outreach group. CONCLUSIONS: Virtual outreach consultations result in significantly higher levels of patient satisfaction than standard outpatient appointments and lead to substantial reductions in numbers of tests and investigations, but they are variably associated with increased rates of offer of follow-up according to speciality and site. Changes in costs and technological advances may improve the relative position of virtual consultations in future. The extent to which virtual outreach is implemented will probably be dependent on factors such as patient demand, costs, and the attitudes of staff working in general practice and hospital settings. Further research could involve long-term follow-up of patients in the virtual outreach trial to determine downstream outcomes and costs; further study into the effectiveness and costs of virtual outreach used for follow-up appointments, rather than first-time referrals; and whether the costs of virtual outreach could be substantially reduced without adversely affecting the quality of the consultation if nurses or other members of the primary care team were to undertake the hosting of the joint teleconsultations in place of the GP. Qualitative work into the attitudes of the patients, GPs and hospital specialists would also be valuable.","Health Technol Assess, 8(50): 1-106, iii-iv","UK",2004,"Not Specified","Tele-communications","PEI","Children,Adults","Resource Use","Clinical Trial","UK","Children,Adults","Not Specified","Tele-communications","Resource Use","Clinical Trial","PEI","2000:2004"]

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{"sheet":"Setup","index":8,"n_rows":304,"n_cols":100,"rows_kept":304,"cut":false,"hidden":false,"merged":[[1,51,1,52],[42,1,42,3],[42,4,42,6],[43,1,43,3],[43,4,43,6],[33,1,33,3],[33,4,33,6],[34,1,34,3],[34,4,34,6],[35,1,35,3],[35,4,35,6],[30,1,30,3],[30,4,30,6],[31,1,31,3],[31,4,31,6],[32,1,32,3],[32,4,32,6],[27,1,27,3],[27,4,27,6],[28,1,28,3],[28,4,28,6],[29,1,29,3],[29,4,29,6],[44,1,44,3],[44,4,44,6],[39,1,39,3],[39,4,39,6],[40,1,40,3],[40,4,40,6],[41,1,41,3],[41,4,41,6],[36,1,36,3],[36,4,36,6],[37,1,37,3],[37,4,37,6],[38,1,38,3],[38,4,38,6],[24,1,24,3],[24,4,24,6],[25,1,25,3],[25,4,25,6],[26,1,26,3],[26,4,26,6],[21,1,21,3],[21,4,21,6],[22,1,22,3],[22,4,22,6],[23,1,23,3],[23,4,23,6],[18,1,18,3],[18,4,18,6],[19,1,19,3],[19,4,19,6],[20,1,20,3],[20,4,20,6],[15,1,15,3],[15,4,15,6],[16,1,16,3],[16,4,16,6],[17,1,17,3],[17,4,17,6],[12,1,12,3],[12,4,12,6],[13,1,13,3],[13,4,13,6],[14,1,14,3],[14,4,14,6],[10,1,10,3],[10,4,10,6],[11,1,11,3],[11,4,11,6],[9,1,9,3],[9,4,9,6],[6,1,6,3],[6,4,6,6],[7,1,7,3],[7,4,7,6],[8,1,8,3],[8,4,8,6],[5,1,5,3],[5,4,5,6],[1,1,1,6],[3,1,3,3],[3,4,3,6],[4,1,4,3],[4,4,4,6]]}
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"OFFSET($CI$1,0,domainChoice)","v":17},{"$f":"COUNTA(CJ3:CJ513)","v":17},{"$f":"COUNTA(CK3:CK513)","v":25},27,22,9,7,6,null,null,null,null,{"$f":"ADDRESS(2,1,1,1,domainSheet)","v":"locationCategories!$A$2"},{"$f":"INDIRECT(CU1)","v":"Unallocated"}]
[null,"Toggle age cut-offs",null,null,null,null,null,null,1,1,null,null,null,null,null,null,null,null,null,1,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"This year =",{"$f":"YEAR(NOW())","v":2018},null,"Years","Cut","Selected cut state","Start","End",{"$f":"COUNTA(CF3:CF58)","v":7},{"$f":"OFFSET($CI$2,0,domainChoice)","v":"Locations"},"Locations","Interventions","Diseases","PRO tools","subPopulations","Study types","Study methodologies",null,null,null,null,"selected categories"]
[null,null,56,null,null,null,null,null,"Unallocated","Canada",null,null,null,null,null,null,null,null,null,null,null,"New names","Existing names",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Low year =",{"$f":"MIN($CF$3:$CF$60)","v":1960},null,1960,false,true,1960,1989,{"$f":"IF(CF3<>\"\",_xlfn.CONCAT(CF3,\":\",CG3),\"\")","v":"1960:1989"},{"$f":"OFFSET($CJ$2,0,ROW()-3)","v":"Locations"},"Canada","Acupuncture","Asthma","AEP","Adolescent","Cost-effectiveness","Clinical Trial",null,null,null,null,{"$f":"OFFSET(INDIRECT($CU$1),ROW()-3,0)","v":"Unallocated"}]
[null,"From",null,null,"To",null,null,null,null,"Canada",null,null,null,null,null,null,null,null,null,null,null,"C1","C1","Locations",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"OFFSET($BY$5,domainChoice,0)","v":"locationCategories"},"High year =",{"$f":"MAX(CG3:$CG$60)","v":2018},null,1961,false,null,1990,1994,{"$f":"IF(CF4<>\"\",_xlfn.CONCAT(CF4,\":\",CG4),\"\")","v":"1990:1994"},{"$f":"OFFSET($CJ$2,0,ROW()-3)","v":"Interventions"},"China","Antidepressants","Cancer","BCQ","Adults","Costs","Cross-sectional",null,null,null,null,{"$f":"OFFSET(INDIRECT($CU$1),ROW()-3,0)","v":"Canada"}]
[null,{"$f":"IF(CF3=\"\",\"\",CF3)","v":1960},null,null,{"$f":"IF(CG3=\"\",\"\",CG3)","v":1989},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"C2","C2","Interventions",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1962,false,"Segment count",1995,1999,"1995:1999","Diseases","France","Appendectomy","Cardiovascular","CDIS","Children","Narrative Review","Longitudinal Observation",null,null,null,null,"China"]
[null,{"$f":"IF(CF4=\"\",\"\",CF4)","v":1990},null,null,{"$f":"IF(CG4=\"\",\"\",CG4)","v":1994},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"C3","C3","Diseases",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"locationCategories",null,null,null,1963,false,null,2000,2004,"2000:2004","PRO tools","Iran","Chemotherapy","Chronic conditions","CollaboRATE","Elderly","PRO study","RCT",null,null,null,null,"France"]
[null,1995,null,null,1999,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"C4","C4","Sub-populations",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"interventionCategories",null,null,null,1964,false,null,2005,2009,"2005:2009","subPopulations","Israel","Cognitive Therapy","Dementia","EC-17","Mental Health Carers","Resource Use","Review",null,null,null,null,"Iran"]
[null,2000,null,null,2004,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"C5","C5","PRO tools",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"diseaseCategories",null,null,null,1965,false,null,2010,2014,"2010:2014","Study types","Italy","Counselling","Depression","GCQ","Military","Systematic Review","Systematic Review",null,null,null,null,"Israel"]
[null,2005,null,null,2009,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Study types",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"protoolCategories",null,null,null,1966,false,null,2015,2018,"2015:2018","Study methodologies","Japan","Decision Aids","Diabetes","HAQ-II","Not Specified","Tool Validation",null,null,null,null,null,"Italy"]
[null,2010,null,null,2014,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Study methodologies",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"subpopulationCategories",null,null,null,1967,false,null,null,null,"",null,"Kuwait","Empowerment Program","Fecal incontinence","HCCQ","Pregnant",null,null,null,null,null,null,"Japan"]
[null,2015,null,null,2018,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Location categorised",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"studytypeCategories",null,null,null,1968,false,null,null,null,"",null,"Mexico","HCP Training","Gastrointestinal disorders","IEQ-EU","Women",null,null,null,null,null,null,"Kuwait"]
[null,{"$f":"IF(CF10=\"\",\"\",CF10)","v":""},null,null,{"$f":"IF(CG10=\"\",\"\",CG10)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Intervention categorised",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"studymethodCategories",null,null,null,1969,false,null,null,null,"",null,"Netherlands","Haemodialysis","General Poor Health","MBS",null,null,null,null,null,null,null,"Mexico"]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Disease categorised",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1970,false,null,null,null,"",null,"Portugal","Hormone replacement therapy","HIV","PDIS",null,null,null,null,null,null,null,"Netherlands"]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Sub-populations categorised",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1971,false,null,null,null,"",null,"South Africa","Hospitalisation","Heart Disease","PEI",null,null,null,null,null,null,null,"Portugal"]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PRO tool categorised",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1972,false,null,null,null,"",null,"Spain","Medication","Intracranial Aneurysm","PEPPI-5",null,null,null,null,null,null,null,"South Africa"]
[null,"",null,null,{"$f":"IF(CG14=\"\",\"\",CG14)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Study type categorised",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1973,false,null,null,null,"",null,"Switzerland","Neurology","MRSA","PICS",null,null,null,null,null,null,null,"Spain"]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Study methodology categorised",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1974,false,null,null,null,"",{"$f":"COLUMN()","v":87},"Turkey","Not Specified","Menopause","PPS",null,null,null,null,null,null,null,"Switzerland"]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1975,false,null,null,null,"",null,"UK","Nutrition","Menorrhagia","PRESS",null,null,null,null,null,null,null,"Turkey"]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1976,false,null,null,null,"",null,"USA","Preventative Services","Mental Health","PS-PVQ",null,null,null,null,null,null,null,"UK"]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1977,false,null,null,null,"",null,null,"Psychodynamic Therapy","Nosocomical infection","Patient career diary",null,null,null,null,null,null,null,"USA"]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1978,false,null,null,null,"",null,null,"Pulmonary Medicine","Not Specified","QPPI",null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1979,false,null,null,null,"",null,null,"Risk-assessment and Management","Oral Health","SCAF",null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1980,false,null,null,null,"",null,null,"Surgery","Osteoarthritis","SDM-Q-9",null,null,null,null,null,null,null,""]
[null,"",22,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1981,false,null,null,null,"",null,null,"Tele-communications","Otitis Media","SWD",null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1982,false,null,null,null,"",null,null,"Tooth extraction","Renal Disease",null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1983,false,null,null,null,"",null,null,"Tympanostomy tubes","Rheumatoid Arthritis",null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1984,false,null,null,null,"",null,null,"Wound cleaning","Schizophrenia",null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1985,false,null,null,null,"",null,null,null,"Surgical-wound infections",null,null,null,null,null,null,null,null,""]
[null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1986,false,null,null,null,"",null,null,null,"Various",null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1987,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1988,false,null,null,null,{"$f":"IF(CF31<>\"\",_xlfn.CONCAT(CF31,\":\",CG31),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,""]
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