Utilizing a learning health system to capture real‐world patient data: Application of the reliable change index to evaluate and improve the outcome of a pain rehabilitation program.
Background and Objectives: The learning healthcare system (LHS) has been developed to integrate patients' clinical data into clinical decisions and improve treatment outcomes. Having little guidance on this integration process, we aim to explain (a) an applicable analytic tool for clinicians to eval...
| Publicado en: | Pain Practice Vol. 24; no. 6; pp. 856 - 866 |
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| Autores principales: | , , , |
| Formato: | equations & formulas research tables/charts Journal Article |
| Publicado: |
Wiley-Blackwell
Jul2024
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=178395249&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 178395249 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 15307085 HYN jtl: Pain Practice issn: 15307085 maglogo: Y pubinfo: dt: Jul2024 vid: 24 iid: 6 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 178395249 175947102 178395249 178395249 10.1111/papr.13364 178395249 ppf: 856 ppct: 10 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Utilizing a learning health system to capture real‐world patient data: Application of the reliable change index to evaluate and improve the outcome of a pain rehabilitation program. aug: au: You, Dokyoung S. Chong, Jeanette L. Mackey, Sean C. Poupore‐King, Heather affil: Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto California, , USA sug: subj: Learning Health System Chronic Pain Rehabilitation Pain Management Quality Improvement Treatment Outcomes Psychometrics Decision Support Techniques Human Funding Source Questionnaires Scales Measurement Error Reliability Descriptive Statistics ab: Background and Objectives: The learning healthcare system (LHS) has been developed to integrate patients' clinical data into clinical decisions and improve treatment outcomes. Having little guidance on this integration process, we aim to explain (a) an applicable analytic tool for clinicians to evaluate the clinical outcomes at a group and an individual level and (b) our quality improvement (QI) project, analyzing the outcomes of a new outpatient pain rehabilitation program ("Back‐in‐Action": BIA) and applying the analysis results to modify our clinical practice. Methods: Through our LHS (CHOIR; https://choir.stanford.edu), we administered the Pain Catastrophizing Scale (PCS), Chronic Pain Acceptance Questionnaire (CPAQ), and Patient‐Reported Outcomes Measures (PROMIS)® before and after BIA. After searching for appropriate analytic tools, we decided to use the Reliable Change Index (RCI) to determine if an observed change in the direction of better (improvement) or worse (deterioration) would be beyond or within the measurement error (no change). Results: Our RCI calculations revealed that at least a 9‐point decrease in the PCS scores and 10‐point increase in the CPAQ scores would indicate reliable improvement. RCIs for the PROMIS measures ranged from 5 to 8 T‐score points (i.e., 0.5–0.8 SD). When evaluating change scores of the PCS, CPAQ, and PROMIS measures, we found that 94% of patients showed improvement in at least one domain after BIA and 6% showed no reliable improvement. Conclusions: Our QI project revealed RCI as a useful tool to evaluate treatment outcomes at a group and an individual level, and RCI could be incorporated into the LHS to generate a progress report automatically for clinicians. We further explained how clinicians could use RCI results to modify a clinical practice, to improve the outcomes of a pain program, and to develop individualized care plans. Lastly, we suggested future research areas to improve the LHS application in pain practice. pubtype: Academic Journal doctype: equations & formulas research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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