随着世界各地的卫生系统越来越多地寻求衡量和提高他们为患者提供的护理价值,能够衡量对患者最重要的结果是至关重要的。为了支持房颤(AF)向基于价值的医疗保健的转变,国际健康结果测量联盟(ICHOM)组建了一个由30名志愿者组成的国际工作组(WG),包括卫生专业人员和患者代表,为临床环境中的基准护理提供制定标准化的最低结果集。
使用在线修改的Delphi流程,选择对患者和卫生专业人员重要的结局,并将其分类为(i)疾病结局的长期后果,(ii)治疗结果的并发症,和(iii)患者报告的结果。工作组确定了人口统计学和临床变量,用作病例混合风险调整器。这些包括基线人口统计,合并症,认知功能,诊断日期,疾病持续时间,规定的药物和AF程序,除了吸烟,体重指数(BMI),酒精摄入量,和身体活动。在适当的情况下,为了便于实施,使用ICD代码实现了结果和病例组合变量的标准化。标准集进行了一个开放的审查过程,其中超过80%的接受调查的患者同意标准集捕获的结果。
实施这些共识建议可以帮助机构监督,比较和改善慢性房颤护理的质量和交付。它们一致的定义和收集,在适用的情况下使用ICD代码,还可以扩大房颤中更多以患者为中心的临床结局研究的实施。
As health systems around the world increasingly look to measure and improve the value of care that they provide to patients, being able to measure the outcomes that matter most to patients is vital. To support the shift towards value-based health care in atrial fibrillation (AF), the International Consortium for Health Outcomes Measurement (ICHOM) assembled an international Working Group (WG) of 30 volunteers, including health professionals and patient representatives to develop a standardized minimum set of outcomes for benchmarking care delivery in clinical settings.
Using an online-modified Delphi process, outcomes important to patients and health professionals were selected and categorized into (i) long-term consequences of disease outcomes, (ii) complications of treatment outcomes, and (iii) patient-reported outcomes. The WG identified demographic and clinical variables for use as case-mix risk adjusters. These included baseline demographics, comorbidities, cognitive function, date of diagnosis, disease duration, medications prescribed and AF procedures, as well as smoking, body mass index (BMI), alcohol intake, and physical activity. Where appropriate, and for ease of implementation, standardization of outcomes and case-mix variables was achieved using ICD codes. The standard set underwent an open review process in which over 80% of patients surveyed agreed with the outcomes captured by the standard set.
Implementation of these consensus recommendations could help institutions to monitor, compare and improve the quality and delivery of chronic AF care. Their consistent definition and collection, using ICD codes where applicable, could also broaden the implementation of more patient-centric clinical outcomes research in AF.