Abstract：
OBJECTIVE: Value-based healthcare (VBHC) involves the use of standardised outcome measures, including patient-reported outcome measures (PROMs). This study aimed to assess to what extent discussion of PROMs is associated with patient- and person-centredness.
METHODS: This study used a separate sample pre-/post-test design and multiple methods (observations, questionnaires, and interviews) in a VBHC care pathway for patients with a vestibular schwannoma, to assess to what extent the implementation of PROMs is associated with a difference in patient- and person-centredness.
RESULTS: A total of 139 patients with a vestibular schwannoma and their four treating physicians were included in the study. No significant differences were found in observed patient-centredness (Mpre=6.71 ± 2.42 vs. Mpost=6.93 ± 2.01; P = 0.60) or patient-reported patient-centredness (Mpre=1.73 vs. Mpost=1.68; P = 0.63) and person-centredness after PROM implementation (Mpre=11.81 vs. Mpost=13.42; P = 0.34). We observed more discussion of patient-reported outcomes. However, a majority of patients did not expect PRO discussion in consultations.
CONCLUSIONS: The implementation of standardised PROMs in a VBHC care pathway was associated with more discussion on patient-reported outcomes in clinical consultations. Overall, the implementation of PROMs was not observed or perceived as leading to more patient-centred consultations.
CONCLUSIONS: Physicians should assess whether the discussion of PROMs add value collaboratively with patients.
METHODS: This study used a separate sample pre-/post-test design and multiple methods (observations, questionnaires, and interviews) in a VBHC care pathway for patients with a vestibular schwannoma, to assess to what extent the implementation of PROMs is associated with a difference in patient- and person-centredness.
RESULTS: A total of 139 patients with a vestibular schwannoma and their four treating physicians were included in the study. No significant differences were found in observed patient-centredness (Mpre=6.71 ± 2.42 vs. Mpost=6.93 ± 2.01; P = 0.60) or patient-reported patient-centredness (Mpre=1.73 vs. Mpost=1.68; P = 0.63) and person-centredness after PROM implementation (Mpre=11.81 vs. Mpost=13.42; P = 0.34). We observed more discussion of patient-reported outcomes. However, a majority of patients did not expect PRO discussion in consultations.
CONCLUSIONS: The implementation of standardised PROMs in a VBHC care pathway was associated with more discussion on patient-reported outcomes in clinical consultations. Overall, the implementation of PROMs was not observed or perceived as leading to more patient-centred consultations.
CONCLUSIONS: Physicians should assess whether the discussion of PROMs add value collaboratively with patients.
摘要：
目标：基于价值的医疗保健（VBHC）涉及使用标准化的结果指标，包括患者报告的结果测量（PROMs）。这项研究旨在评估PROM的讨论与患者和以人为本相关的程度。
方法：本研究使用单独的样本前/后测设计和多种方法（观察，问卷，和访谈）在前庭神经鞘瘤患者的VBHC护理途径中，评估PROM的实施在多大程度上与患者和以人为本的差异相关。
结果：共139例前庭神经鞘瘤患者和他们的四位主治医生被纳入研究。观察到的患者中心度没有发现显着差异（Mpre=6.71±2.42vs.Mpost=6.93±2.01；P=0.60）或患者报告的患者中心（Mpre=1.73vs.Mpost=1.68；P=0.63）和PROM实施后的以人为本（Mpre=11.81vs.Mpost=13.42；P=0.34）。我们观察到更多关于患者报告结果的讨论。然而,大多数患者不希望在会诊中进行PRO讨论.
结论：在VBHC护理路径中实施标准化PROM与临床咨询中关于患者报告结果的更多讨论相关。总的来说,没有观察到或认为PROM的实施导致更多以患者为中心的咨询。
结论：医师应评估PROM的讨论是否与患者合作增加价值。
方法：本研究使用单独的样本前/后测设计和多种方法（观察，问卷，和访谈）在前庭神经鞘瘤患者的VBHC护理途径中，评估PROM的实施在多大程度上与患者和以人为本的差异相关。
结果：共139例前庭神经鞘瘤患者和他们的四位主治医生被纳入研究。观察到的患者中心度没有发现显着差异（Mpre=6.71±2.42vs.Mpost=6.93±2.01；P=0.60）或患者报告的患者中心（Mpre=1.73vs.Mpost=1.68；P=0.63）和PROM实施后的以人为本（Mpre=11.81vs.Mpost=13.42；P=0.34）。我们观察到更多关于患者报告结果的讨论。然而,大多数患者不希望在会诊中进行PRO讨论.
结论：在VBHC护理路径中实施标准化PROM与临床咨询中关于患者报告结果的更多讨论相关。总的来说,没有观察到或认为PROM的实施导致更多以患者为中心的咨询。
结论：医师应评估PROM的讨论是否与患者合作增加价值。
