Challenges in measuring patient defined outcomes in diagnostic radiological investigations

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Challenges in measuring patient defined outcomes
in diagnostic radiological investigations

• S Mathers, G McKenzie, E Robertson,
• J Proctor, R Chesson
• NHS Grampian The Health Services Research
  Group
• Aberdeen, Scotland, UK.

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What aspects of health care can be evaluated?
Outcome Change due to intervention
Process Intervention e.g. surgery, procedure
Structure Resources, facilities organisational
settings
Donabedian, 1980
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Outcome measures

• have been defined
• ... as the results (effects) of processes. They
  are
• that part of the situation pertaining after a
  process
• which can be attributed to the process.
• UK Clearing House on Health Outcomes, 1993

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Why is outcome measurement important?
... to show that an intervention has been
appropriate and effective Austin and
Clark, 1993
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Aim

• To carry out a systematic review of literature to
  
• identify
• the prevalence,
• use of outcome measures in radiology.

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Search Strategy
?
Databases searched
?
Abstracts read according to defined criteria
?
Criteria redefined, abstracts to be re-read in light of this
?
Articles to be retrieved
?
Initial paper review
?
Data synthesis 1. Data extraction form 2. Quality checklist
?
Data analysis 1.SPSS 2. Summary tables 3. Meta-analysis
?
Write up and dissemination.
Modified from NHS Centre for Reviews and
Dissemination, (UK)
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• 46 key words used
• radiology/diagnostic imaging/x-ray
• outcomes patient satisfaction
• efficacy outcome measures
• utility adverse reaction
• waiting times quality of care
• Databases searched e.g. MEDLINE

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Results

• Citations 4893
• Publications retrieved 84
• Publication by references 25
• Patient focused outcome 22

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Final Scrutiny

• Exclude
• 8 for a number of reasons
• e.g. hypothetical studies
• Included
• 14 primary patient focused studies

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Patient focused outcome papers

• In total 8
• Mammography 2 x USA
• Low back pain 2 x UK
• Ankle radiography 1 Canada
• DCBE/US/Mammography 1 Norway
• MRI 1 UK
• Effects of radiation dose 1 Canada

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Conclusions

• Dearth of research into patient centred outcomes
  in radiology
• Lack of coherent body of work
• Demonstrates little patient involvement in
  radiology research

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Challenges

• Imaging procedure only part of investigations and
  patient final outcome remote from department
  Blackmore et al 1999
• Multi-disciplinary approach to research
  Revicki et al 1999
• Development of suitable outcome measurement tools
• Would benefit from a qualitative methodology

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Future agenda

• It is important that we develop a culture of
  outcome measurement in radiology
• Patient defined outcome is necessary to evaluate
  our procedures

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Acknowledgements

• The Royal College of Radiologists (UK)
• (Pump Priming Research Award)