José M Valderas

University of Exeter

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Jordi Alonso

Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública

Ignacio Ricci‐Cabello

Health Research Institute of the Balearic Islands

Jorge Arias de la Torre

King's College London

Joanne Greenhalgh

University of Leeds

Ian Porter

New York State College of Veterinary Medicine

Vicente Martín

Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública

Mireia Espallargues

Agència de Qualitat i Avaluació Sanitàries de Catalunya

Jaheeda Gangannagaripalli

University of Strathclyde

Gemma Vilagut

Instituto de Salud Carlos III

David Reeves

University of Manchester

Cooperative Institutions

Université Paris-Sud

191

Instituto de Salud Carlos III

123

University of Exeter

122

University of Oxford

111

National Institute for Health Research

King's College London

University College London

University of Manchester

Primary Health Care

National University of Singapore

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Stage 2 patient characteristics

Albert Prats‐Uribe Spyros Kolovos Klara Berencsi Andrew Carr Andrew Judge

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Identifying Primary Care Pathways from Quality of Care to Outcomes and Satisfaction Using Structural Equation Modeling

Health Services Research (2017)

Ignacio Ricci‐Cabello Sarah Stevens Andrew RH Dalton Robert I. Griffiths John Campbell

Objective To study the relationships between the different domains of quality of primary health care for the evaluation of health system performance and for informing policy decision making. Data Sources A total of 137 quality indicators collected from 7,607 English practices between 2011 and 2012. Study Design Cross‐sectional study at the practice level. Indicators were allocated to subdomains of processes of care (“quality assurance,” “education and training,” “medicine management,” “access,” “clinical management,” and “patient‐centered care”), health outcomes (“intermediate outcomes” and “patient‐reported health status”), and patient satisfaction. The relationships between the subdomains were hypothesized in a conceptual model and subsequently tested using structural equation modeling. Principal Findings The model supported two independent paths. In the first path, “access” was associated with “patient‐centered care” ( β = 0.63), which in turn was strongly associated with “patient satisfaction” ( β = 0.88). In the second path, “education and training” was associated with “clinical management” ( β = 0.32), which in turn was associated with “intermediate outcomes” ( β = 0.69). “Patient‐reported health status” was weakly associated with “patient‐centered care” ( β = −0.05) and “patient satisfaction” ( β = 0.09), and not associated with “clinical management” or “intermediate outcomes.” Conclusions This is the first empirical model to simultaneously provide evidence on the independence of intermediate health care outcomes, patient satisfaction, and health status. The explanatory paths via technical quality clinical management and patient centeredness offer specific opportunities for the development of quality improvement initiatives.

10.1111/1475-6773.12666

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Matttioli contra Lusitano. II. Las "censuras" y la interpretación de Dioscórides

DOAJ (DOAJ: Directory of Open Access Journals) (2003)

José M Valderas

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Routine care provided by specialists to children and adolescents in the United States (2002-2006)

BMC Health Services Research (2009)

José M Valderas Bárbara Starfield Christopher B. Forrest Luís Rajmil Martín Roland

Specialist physicians provide a large share of outpatient health care for children and adolescents in the United States, but little is known about the nature and content of these services in the ambulatory setting. Our objective was to quantify and characterize routine and co-managed pediatric healthcare as provided by specialists in community settings. Nationally representative data were obtained from the National Ambulatory Medical Care Survey for the years 2002-2006. We included office based physicians (excluding family physicians, general internists and general pediatricians), and a representative sample of their patients aged 18 or less. Visits were classified into mutually exclusive categories based on the major reason for the visit, previous knowledge of the health problem, and whether the visit was the result of a referral. Primary diagnoses were classified using Expanded Diagnostic Clusters. Physician report of sharing care for the patient with another physician and frequency of reappointments were also collected. Overall, 41.3% out of about 174 million visits were for routine follow up and preventive care of patients already known to the specialist. Psychiatry, immunology and allergy, and dermatology accounted for 54.5% of all routine and preventive care visits. Attention deficit disorder, allergic rhinitis and disorders of the sebaceous glands accounted for about a third of these visits. Overall, 73.2% of all visits resulted in a return appointment with the same physician, in half of all cases as a result of a routine or preventive care visit. Ambulatory office-based pediatric care provided by specialists includes a large share of non referred routine and preventive care for common problems for patients already known to the physician. It is likely that many of these services could be managed in primary care settings, lessening demand for specialists and improving coordination of care.

Health administration

Health Services Research

10.1186/1472-6963-9-221

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Framework and guidance for implementing patient-reported outcomes in clinical practice: evidence, challenges and opportunities

Journal of Comparative Effectiveness Research (2016)

Ian Porter Daniela C. Gonçalves Ignacio Ricci‐Cabello Chris Sidey‐Gibbons Jaheeda Gangannagaripalli

Patient-reported outcomes (PROs) are reports of the status of a patient's health condition that come directly from the patient. While PRO measures are a well-developed technology with robust standards in research, their use for informing healthcare decisions is still poorly understood. We review relevant examples of their application in the provision of healthcare and examine the challenges associated with implementing PROs in clinical settings. We evaluate evidence for their use and examine barriers to their uptake, and present an evidence-based framework for the successful implementation of PROs in clinical practice. We discuss current and future developments for the use of PROs in clinical practice, such as individualized measurement and computer-adaptive testing.

Clinical Practice

Evidence-Based Practice

Evidence-Based Medicine

10.2217/cer-2015-0014

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Predicting EQ-5D-3L index value from the PROMIS-29 profile for the United Kingdom, France, and Germany

Research Square (Research Square) (2020)

Christoph Paul Klapproth Jan van Bebber Christopher J. Sidey-Gibbons José M Valderas Alain Leplège

Abstract Background: EQ-5D health state utilities (HSU) are commonly used in health economics to compute quality-adjusted life years (QALYs). The EQ-5D, which is country-specific, can be derived directly or by mapping from self-reported health-related quality of life (HRQoL) scales such as the PROMIS-29 profile. The PROMIS-29 from the Patient Reported Outcome Measures Information System is a comprehensive assessment of self-reported health with excellent psychometric properties. We sought to find optimal models predicting the EQ-5D from the PROMIS-29 in the United Kingdom, France, and Germany and compared the prediction performances with that of a US model. Methods: We collected EQ-5D-5L and PROMIS-29 profiles and three samples representative of the general populations in the UK (n=1,509), France (n=1,501), and Germany (n=1,502). We used stepwise regression with backward selection to find the best models to predict the EQ-5D from all seven PROMIS-29 domains. We investigated the agreement between the observed and predicted EQ-5D in all three countries using various indices for the prediction performance, including Bland-Altman plots to examine the performance along the HSU continuum. Results: The EQ-5D was best predicted in France (nRMSE FRA = 0.075, nMAE FRA = 0.052), followed by the UK (nRMSE UK = 0.076, nMAE UK = 0.053) and Germany (nRMSE GER = 0.079, nMAE GER = 0.051). The Bland-Altman plots show that the inclusion of higher-order effects reduced the overprediction of low HSU scores. Conclusions: Our models provide a valid method to predict the EQ-5D from the PROMIS-29 for the UK, France, and Germany.

EQ-5D

10.21203/rs.3.rs-34792/v2

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PRM217 - THE ONLINE VERSION OF EMPRO: A NEW PLATFORM SYSTEM FOR THE STANDARDIZED APPRAISAL OF PRO INSTRUMENTS.

Value in Health (2018)

Olatz Garín C. García-Forero Gemma Vilagut Yolanda Pardo Itxaso Alayo

10.1016/j.jval.2018.09.2335

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Patient Outcomes Monitoring

José M Valderas

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Impact of comorbidity on the short- and medium-term risk of revision in total hip and knee arthroplasty

BMC Musculoskeletal Disorders (2020)

Jorge Arias de la Torre Kayla Smith Alex Dregan José M Valderas Jonathan Evans

Abstract Background The impact of comorbidity on the risk of revision in patients undergoing Total Knee arthroplasty (TKA) and Total Hip Arthroplasty (THA) is not currently well known. The aim of this study was to analyze the impact of comorbidity on the risk of revision in TKA and THA. Methods Patients recorded in the Catalan Arthroplasty Register (RACat) between 01/01/2005 and 31/12/2016 undergoing TKA ( n = 49,701) and THA ( n = 17,923) caused by osteoarthritis were included. As main explanatory factors, comorbidity burden was assessed by the Elixhauser index, categorized, and specific comorbidities from the index were taken into account. Descriptive analyses for comorbidity burden and specific conditions were done. Additionally, incidence at 1 and 5 years’ follow-up was calculated, and adjusted Competing Risks models were fitted. Results A higher incidence of revision was observed when the number of comorbidities was high, both at 1 and 5 years for THA, but only at 1 year for TKA. Of the specific conditions, only obesity was related to the incidence of revision at 1 year in both joints, and at 5 years in TKA. The risk of revision was related to deficiency anemia and liver diseases in TKA, while in THA, it was related to peripheral vascular disorders, metastatic cancer and psychoses. Conclusions Different conditions, depending on the joint, might be related to higher revision rates. This information could be relevant for clinical decision-making, patient-specific information and improving the results of both TKA and THA.

10.1186/s12891-020-03455-3

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Cross-Cultural Adaptation of The Spanish MINICHAL Instrument Into English For Use In The United Kingdom

Research Square (Research Square) (2021)

Andrew N. Jordan Christine Anning Lindsay Wilkes Claire Ball Nicola Pamphilon

Abstract Background: Hypertension is a highly prevalent condition, with optimal treatment to BP targets conferring significant gains in terms of cardiovascular outcomes. Understanding why some patients do not achieve BP targets would be enhanced through greater understanding of their health-related quality of life (HRQoL). However, the only English language disease-specific instruments for measurement of HRQoL in hypertension have not been validated in accordance with accepted standards. It is proposed that the Spanish MINICHAL instrument for the assessment of HRQoL in hypertension could be translated, adapted and validated for use in the United Kingdom. The aim of the study was therefore to complete this process, using a cohort of patients enrolled in an 18-week programme for the treatment of grade II-III hypertension. Methods: The MINICHAL authors were contacted and the original instrument obtained. This was then translated into English by two independent English-speakers, with these versions then reconciled, before back-translation and subsequent production of a 2 nd reconciled version. Thereafter, a final version was produced after cognitive debriefing, for administration and psychometric analysis in the target population. Results: The final version of the instrument was administered to 30 individuals with grade II/III hypertension before and after 18 weeks’ intensive treatment. Psychometric analysis demonstrated a floor effect, though no ceiling effect. Internal consistency for both state of mind (StM) and somatic manifestations (SM) dimensions of the instrument were acceptable (Cronbach’s alpha = 0.81 and 0.75), as was test-retest reliability (ICC=0.717 and 0.961) and construct validity, which was measured through co-administration with the EQ5d5L and Bulpitt-Fletcher instruments. No significant associations were found between scores and patient characteristics known to affect HRQoL. The EQ5D5L instrument found an improvement in HRQoL following treatment, with the StM and SM dimensions of the English language MINICHAL trending to support this (d=0.32 and 0.02 respectively). Conclusions: The present study details the successful English translation and validation of the MINICHAL instrument for use in individuals with hypertension. The data reported also supports an improvement in HRQoL with rapid treatment of grade II/III hypertension, a strategy which has been recommended by contemporaneous European guidelines. Trial registration: ISRCTN registry number: 57475376 (assigned 25/06/2015).

Debriefing

Ceiling effect

10.21203/rs.3.rs-824132/v1

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