背景:尽管有冠心病的负担,高成本和高利用率的条件,缺乏长期成果措施的实施。本研究的目的是试点实施国际健康结果测量联盟的冠心病标准在患者进行肺动脉瓣置换术,在患有多种CHD的大多数患者中进行的手术。
方法:对≥8岁接受基于导管插入术的肺动脉瓣置换术的患者进行各种方法,以了解患者报告的结果,术后3个月进行随访评估。实施策略分析是通过混合类型2设计进行的。
结果:在接受肺动脉瓣置换术的74例患者中,32个完成的初始患者报告结果,根据策略具有可变的反应率(电子邮件和亲自解释100%,电子邮件只有54%,电子邮件,其次是短信/电话64%)。年龄8-67岁(平均30岁)。在程序前,34%有症状性心律失常,这改善了后程序。对于那些在学校的人来说,43%的人每年错过≥6天,超过一半的人旷工。34%的人报告了财务问题。患者报告对生活(50%[n=16])和健康相关生活质量(90%[n=26])的满意度很高。抑郁症状报告在84%(n=27)和焦虑在62.5%(n=18),在程序后有改进的趋势。
结论:在肺动脉瓣置换术患者中实施国际健康结果测量协会制定的冠心病标准的试点实施揭示了以前未报告的重大疾病负担。实施的障碍包括可持续、用于患者报告结果收集和基础设施的自动化系统,以实时评估。这提供了在临床实践中实现心脏结果集的示例。
BACKGROUND: Despite the burden of CHD, a high cost and utilization condition, an implementation of long-term outcome measures is lacking. The objective of this study is to pilot the implementation of the International Consortium of Health Outcomes Measurement CHD standard set in patients undergoing pulmonary valve replacement, a procedure performed in mostly well patients with diverse CHD.
METHODS: Patients ≥ 8 years old undergoing catheterization-based pulmonary valve replacement were approached via various approaches for patient-reported outcomes, with a follow-up assessment at 3 months post-procedure. Implementation strategy analysis was performed via a hybrid type 2 design.
RESULTS: Of the 74 patients undergoing pulmonary valve replacement, 32 completed initial patient-reported outcomes with variable response rates by strategy (email and in-person explanation 100%, email only 54%, and email followed by text/call 64%). Ages ranged 8-67 years (mean 30). Pre-procedurally, 34% had symptomatic arrhythmias, which improved post-procedure. For those in school, 43% missed ≥ 6 days per year, and over half had work absenteeism. Financial concerns were reported in 34%. Patients reported high satisfaction with life (50% [n = 16]) and health-related quality of life (90% [n = 26]). Depression symptoms were reported in 84% (n = 27) and anxiety in 62.5% (n = 18), with tendency towards improvement post-procedurally.
CONCLUSIONS: Pilot implementation of the International Consortium of Health Outcomes Measurement CHD standard set in pulmonary valve replacement patients reveals a significant burden of disease not previously reported. Barriers to the implementation include a sustainable, automated system for patient-reported outcome collection and infrastructure to assess in real time. This provides an example of implementing cardiac outcomes set in clinical practice.