Publications by year
In Press
Hjollund NHI, Valderas JM, Kyte D, Calvert MJ (In Press). Health Data Processes: a Framework for Analyzing and Discussing Efficient Use and Reuse of Health Data with a Focus on Patient-Reported Outcome Measures (Preprint).
Abstract:
Health Data Processes: a Framework for Analyzing and Discussing Efficient Use and Reuse of Health Data with a Focus on Patient-Reported Outcome Measures (Preprint)
. UNSTRUCTURED
. The collection and use of patient health data are central to any kind of activity in the health care system. These data may be produced during routine clinical processes or obtained directly from the patient using patient-reported outcome (PRO) measures. Although efficiency and other reasons justify data availability for a range of potentially relevant uses, these data are nearly always collected for a single specific purpose. The health care literature reflects this narrow scope, and there is limited literature on the joint use of health data for daily clinical use, clinical research, surveillance, and administrative purposes. The aim of this paper is to provide a framework for discussing the efficient use of health data with a specific focus on the role of PRO measures. PRO data may be used at an individual patient level to inform patient care or shared decision making and to tailor care to individual needs or group-level needs as a complement to health record data, such as that on mortality and readmission, in order to inform service delivery and measure the real-world effectiveness of treatment. PRO measures may be used either for their own sake, to provide valuable information from the patient perspective, or as a proxy for clinical data that would otherwise not be feasible to collect. We introduce a framework to analyze any health care activity that involves health data. The framework consists of four data processes (patient identification, data collection, data aggregation and data use), further structured into two dichotomous dimensions in each data process (level: group vs patient; timeframe: ad hoc vs systematic). This framework is used to analyze various health activities with respect to joint use of data, considering the technical, legal, organizational, and logistical challenges that characterize each data process. Finally, we propose a model for joint use of health data with data collected during follow-up as a base. Demands for health data will continue to increase, which will further add to the need for the concerted use and reuse of PRO data for parallel purposes. Repeated and uncoordinated PRO data collection for the same patient for different purposes results in misuse of resources for the patient and the health care system as well as reduced response rates owing to questionnaire fatigue. PRO data can be routinely collected both at the hospital (from inpatients as well as outpatients) and outside of hospital settings; in primary or social care settings; or in the patient’s home, provided the health informatics infrastructure is in place. In the future, clinical settings are likely to be a prominent source of PRO data; however, we are also likely to see increased remote collection of PRO data by patients in their own home (telePRO). Data collection for research and quality surveillance will have to adapt to this circumstance and adopt complementary data capture methods that take advantage of the utility of PRO data collected during daily clinical practice. The European Union’s regulation with respect to the protection of personal data—General Data Protection Regulation—imposes severe restrictions on the use of health data for parallel purposes, and steps should be taken to alleviate the consequences while still protecting personal data against misuse.
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Abstract.
Valderas Martinez JM, Hjollund NHI, Kyte D, Calvert MJ (In Press). Health data processes. A framework for analysing and discussing efficient use and reuse of health data with focus on Patient Reported Outcome (PRO) measures.
Journal of Medical Internet Research Full text.
Lloyd H, Wheat H, Horrell J, Sugavanam T, Fosh B, Valderas JM, Close J (In Press). Patient-Reported Measures for Person-Centered Coordinated Care: a Comparative Domain Map and Web-Based Compendium for Supporting Policy Development and Implementation.
Lloyd H, Wheat H, Horrell J, Sugavanam T, Fosh B, Valderas JM, Close J (In Press). Patient-Reported Measures for Person-Centered Coordinated Care: a Comparative Domain Map and Web-Based Compendium for Supporting Policy Development and Implementation (Preprint).
Abstract:
Patient-Reported Measures for Person-Centered Coordinated Care: a Comparative Domain Map and Web-Based Compendium for Supporting Policy Development and Implementation (Preprint)
. BACKGROUND
. Patient-reported measure (PRM) questionnaires were originally used in research to measure outcomes of intervention studies. They have now evolved into a diverse family of tools measuring a range of constructs including quality of life and experiences of care. Current health and social care policy increasingly advocates their use for embedding the patient voice into service redesign through new models of care such as person-centered coordinated care (P3C). If chosen carefully and used efficiently, these tools can help improve care delivery through a variety of novel ways, including system-level feedback for health care management and commissioning. Support and guidance on how to use these tools would be critical to achieve these goals.
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. OBJECTIVE
. The objective of this study was to develop evidence-based guidance and support for the use of P3C-PRMs in health and social care policy through identification of PRMs that can be used to enhance the development of P3C, mapping P3C-PRMs against an existing model of domains of P3C, and integration and organization of the information in a user-friendly Web-based database.
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. METHODS
. A pragmatic approach was used for the systematic identification of candidate P3C-PRMs, which aimed at balancing comprehensiveness and feasibility. This utilized a number of resources, including existing compendiums, peer-reviewed and gray literature (using a flexible search strategy), and stakeholder engagement (which included guidance for relevant clinical areas). A subset of those candidate measures (meeting prespecified eligibility criteria) was then mapped against a theoretical model of P3C, facilitating classification of the construct being measured and the subsequent generation of shortlists for generic P3C measures, specific aspects of P3C (eg, communication or decision making), and condition-specific measures (eg, diabetes, cancer) in priority areas, as highlighted by stakeholders.
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. RESULTS
. In total, 328 P3C-PRMs were identified, which were used to populate a freely available Web-based database. of these, 63 P3C-PRMs met the eligibility criteria for shortlisting and were classified according to their measurement constructs and mapped against the theoretical P3C model. We identified tools with the best coverage of P3C, thereby providing evidence of their content validity as outcome measures for new models of care. Transitions and medications were 2 areas currently poorly covered by existing measures. All the information is currently available at a user-friendly web-based portal (p3c.org.uk), which includes all relevant information on each measure, such as the constructs targeted and links to relevant literature, in addition to shortlists according to relevant constructs.
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. CONCLUSIONS
. A detailed compendium of P3C-PRMs has been developed using a pragmatic systematic approach supported by stakeholder engagement. Our user-friendly suite of tools is designed to act as a portal to the world of PRMs for P3C, and have utility for a broad audience, including (but not limited to) health care commissioners, managers, and researchers.
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Arias-de la Torre J, Puigdomenech E, GarcÃa X, Valderas JM, Eiroa-Orosa FJ, Fernández-Villa T, Molina AJ, MartÃn V, Serrano-Blanco A, Alonso J, et al (In Press). Relationship Between Depression and the Use of Mobile Technologies and Social Media Among Adolescents: Umbrella Review (Preprint).
Abstract:
Relationship Between Depression and the Use of Mobile Technologies and Social Media Among Adolescents: Umbrella Review (Preprint)
. BACKGROUND
. Despite the relevance of mobile technologies and social media (MTSM) for adolescents, their association with depressive disorders in this population remains unclear. While there are previous reviews that have identified the use of MTSM as a risk factor for developing depression, other reviews have indicated their possible preventive effect.
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. OBJECTIVE
. The aim of this review was to synthesize the current evidence on the association between MTSM use and the development or prevention of depressive disorders in adolescents.
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. METHODS
. An umbrella review was conducted using information published up to June 2019 from PubMed/MEDLINE, PsycINFO, Web of Science, and the Cochrane Library. Systematic reviews focusing on the adolescent population (up to 20 years old) and depression and its potential relationship with MTSM use were included. Screening of titles, abstracts, and full texts was performed. After selecting the reviews and given the heterogeneity of the outcome variables and exposures, a narrative synthesis of the results was carried out.
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. RESULTS
. The search retrieved 338 documents, from which 7 systematic reviews (3 meta-analyses) were selected for data extraction. There were 11-70 studies and 5582-46,015 participants included in the 7 reviews. All reviews included quantitative research, and 2 reviews also included qualitative studies. A statistically significant association between social media and developing depressive symptoms was reported in 2 reviews, while 5 reviews reported mixed results.
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. CONCLUSIONS
. Excessive social comparison and personal involvement when using MTSM could be associated with the development of depressive symptomatology. Nevertheless, MTSM might promote social support and even become a point of assistance for people with depression. Due to the mixed results, prospective research could be valuable for providing stronger evidence.
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Allan L, Corbett A, Valderas Martinez J (In Press). Social prescribing programmes to prevent or delay frailty in community-dwelling older adults.
Geriatrics Full text.
2021
Fellenor J, Britten N, Courtenay M, Payne RA, Valderas J, Denholm R, Duncan P, McCahon D, Tatnell L, Fitzgerald R, et al (2021). A multi-stakeholder approach to the co-production of the research agenda for medicines optimisation.
BMC Health Services Research,
21(1).
Abstract:
A multi-stakeholder approach to the co-production of the research agenda for medicines optimisation
Abstract
. Background
. Up to 50% of medicines are not used as intended, resulting in poor health and economic outcomes. Medicines optimisation is ‘a person-centred approach to safe and effective medicines use, to ensure people obtain the best possible outcomes from their medicines’. The purpose of this exercise was to co-produce a prioritised research agenda for medicines optimisation using a multi-stakeholder (patient, researcher, public and health professionals) approach.
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. Methods
. A three-stage, multiple method process was used including: generation of preliminary research questions (Stage 1) using a modified Nominal Group Technique; electronic consultation and ranking with a wider multi-stakeholder group (Stage 2); a face-to-face, one-day consensus meeting involving representatives from all stakeholder groups (Stage 3).
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. Results
. In total, 92 research questions were identified during Stages 1 and 2 and ranked in order of priority during stage 3. Questions were categorised into four areas: ‘Patient Concerns’ [e.g. is there a shared decision (with patients) about using each medicine?], ‘Polypharmacy’ [e.g. how to design health services to cope with the challenge of multiple medicines use?], ‘Non-Medical Prescribing’ [e.g. how can the contribution of non-medical prescribers be optimised in primary care?], and ‘Deprescribing’ [e.g. what support is needed by prescribers to deprescribe?]. A significant number of the 92 questions were generated by Patient and Public Involvement representatives, which demonstrates the importance of including this stakeholder group when identifying research priorities.
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. Conclusions
. A wide range of research questions was generated reflecting concerns which affect patients, practitioners, the health service, as well the ethical and philosophical aspects of the prescribing and deprescribing of medicines. These questions should be used to set future research agendas and funding commissions.
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Arias de la Torre J, Ronaldson A, Valderas JM, Vilagut G, Serrano-Blanco A, Hatch SL, Alonso J, Hotopf M, Dregan A (2021). Diagnostic promiscuity: the use of real-world data to study multimorbidity in mental health.
Br J Psychiatry, 1-3.
Abstract:
Diagnostic promiscuity: the use of real-world data to study multimorbidity in mental health.
Mental health-related multimorbidity can be considered as multimorbidity in the presence of a mental disorder. Some knowledge gaps on the study of mental health-related multimorbidity were identified. These knowledge gaps could be potentially addressed with real-world data.
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Ricci-Cabello I, Gangannagaripalli J, Mounce LTA, Valderas JM (2021). Identifying Factors Leading to Harm in English General Practices: a Mixed-Methods Study Based on Patient Experiences Integrating Structural Equation Modeling and Qualitative Content Analysis.
Journal of Patient Safety,
17(1), e20-e27.
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Arias de la Torre J, Vilagut G, Ronaldson A, Dregan A, Ricci-Cabello I, Hatch SL, Serrano-Blanco A, Valderas JM, Hotopf M, Alonso J, et al (2021). Prevalence and age patterns of depression in the United Kingdom. A population-based study.
Journal of Affective Disorders,
279, 164-172.
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Arias-de la Torre J, Eiroa-Orosa FJ, Molina AJ, Colell E, Dávila-Batista V, Moreno-Montero F, Robles N, Valderas JM, MartÃn V (2021). Relación del consumo problemático de cannabis en la población joven de España con el riesgo percibido, los factores ambientales y los factores sociodemográficos. Adicciones, 33(1), 63-63.
Arias-de la Torre J, Jose Eiroa-Orosa F, Molina AJ, Colell E, Davila-Batista V, Moreno-Montero F, Robles N, Valderas JM, Vicente-Martin (2021). Relationship of problematic cannabis use among youth in Spain with perceived risk, environmental factors and sociodemographic factors.
ADICCIONES,
33(1), 63-69.
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Masoli M, Lanario JW, Hyland ME, Menzies-Gow A, Mansur AH, Allen D, Dodd JW, Hayes G, Valderas JM, Lamb SE, et al (2021). The Severe Asthma Questionnaire: sensitivity to change and minimal clinically important difference (MCID). European Respiratory Journal, 2100300-2100300.
2020
la Torre JAD, Vilagut G, Serrano-Blanco A, MartÃn V, Molina AJ, Valderas JM, Alonso J (2020). Accuracy of self-reported items for the screening of depression in the general population.
International Journal of Environmental Research and Public Health,
17(21), 1-10.
Abstract:
Accuracy of self-reported items for the screening of depression in the general population
Introduction: Though self-reported items (SRD, self-reported depression) are commonly used in health surveys and cohort studies, their metric properties as a depression indicator remain unclear. The aims were to evaluate the measurement properties of SRD using the Patient Health Questionnaire-8 (PHQ-8) as reference and to identify factors related to the agreement between both indicators. Methods: Data from the European Health Interview Survey in Spain in 2014/2015 (n = 22,065) were analyzed. Two indicators of depression were considered: SRD based on two items yes/no (positive: both yes), and the PHQ-8 (positive ≥ 10). Socioeconomic factors and use of health services were considered as independent variables. The prevalence of depression, sensitivity, specificity, global agreement, and positive and negative predictive values (PPV and NPV) of SRDs were evaluated using the PHQ-8 as a reference. Logistic regression models were fitted to determine factors associated with the agreement between indicators. Results: the prevalence of depression was lower when assessed with PHQ-8 (5.9%) than with SRD (7.7%). SRD sensitivity and PPV were moderate–low (52.9% and 40.4%, respectively) whereas global agreement, specificity, and NPV were high (92.7%, 95.1%, and 97.0%, respectively). Positive agreement was associated with marital status, country of birth, employment status, and social class. Negative agreement was related to all independent variables except country of birth. Conclusions: SRD items tend to overestimate the current prevalence of depression. While its use in health surveys and cohorts may be appropriate as a quick assessment of possible depression, due to their low sensitivity, its use in clinical contexts is questionable.
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Arias-de la Torre J, Valderas JM, Benavides FG, Alonso J (2020). Cardboard floor: about the barriers for social progression and their impact on the representativeness of epidemiological studies.
Journal of Epidemiology and Community Health Full text.
Arias de la Torre J, Ronaldson A, Valderas JM, Alonso J, Prina M, Hatch S, Rayner L, Pickles A, Hotopf M, Dregan A, et al (2020). Depression and physical multimorbidity during the adulthood. Cross-sectional associations.
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Müller BS, Uhlmann L, Ihle P, Stock C, von Buedingen F, Beyer M, Gerlach FM, Perera R, Valderas JM, Glasziou P, et al (2020). Development and internal validation of prognostic models to predict negative health outcomes in older patients with multimorbidity and polypharmacy in general practice.
BMJ Open,
10(10), e039747-e039747.
Abstract:
Development and internal validation of prognostic models to predict negative health outcomes in older patients with multimorbidity and polypharmacy in general practice
BackgroundPolypharmacy interventions are resource-intensive and should be targeted to those at risk of negative health outcomes. Our aim was to develop and internally validate prognostic models to predict health-related quality of life (HRQoL) and the combined outcome of falls, hospitalisation, institutionalisation and nursing care needs, in older patients with multimorbidity and polypharmacy in general practices.MethodsDesign: two independent data sets, one comprising health insurance claims data (n=592 456), the other data from the PRIoritising MUltimedication in Multimorbidity (PRIMUM) cluster randomised controlled trial (n=502). Population: ≥60 years, ≥5 drugs, ≥3 chronic diseases, excluding dementia. Outcomes: combined outcome of falls, hospitalisation, institutionalisation and nursing care needs (after 6, 9 and 24 months) (claims data); and HRQoL (after 6 and 9 months) (trial data). Predictor variables in both data sets: age, sex, morbidity-related variables (disease count), medication-related variables (European Union-Potentially Inappropriate Medication list (EU-PIM list)) and health service utilisation. Predictor variables exclusively in trial data: additional socio-demographics, morbidity-related variables (Cumulative Illness Rating Scale, depression), Medication Appropriateness Index (MAI), lifestyle, functional status and HRQoL (EuroQol EQ-5D-3L). Analysis: mixed regression models, combined with stepwise variable selection, 10-fold cross validation and sensitivity analyses.ResultsMost important predictors of EQ-5D-3L at 6 months in best model (Nagelkerke’s R² 0.507) were depressive symptoms (−2.73 (95% CI: −3.56 to −1.91)), MAI (−0.39 (95% CI: −0.7 to −0.08)), baseline EQ-5D-3L (0.55 (95% CI: 0.47 to 0.64)). Models based on claims data and those predicting long-term outcomes based on both data sets produced low R² values. In claims data-based model with highest explanatory power (R²=0.16), previous falls/fall-related injuries, previous hospitalisations, age, number of involved physicians and disease count were most important predictor variables.ConclusionsBest trial data-based model predicted HRQoL after 6 months well and included parameters of well-being not found in claims. Performance of claims data-based models and models predicting long-term outcomes was relatively weak. For generalisability, future studies should refit models by considering parameters representing well-being and functional status.
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Arias-de la Torre J, Zioga EAM, Macorigh L, Muñoz L, Estrada O, Mias M, Estrada M-D, Puigdomenech E, Valderas JM, MartÃn V, et al (2020). Differences in Results and Related Factors Between Hospital-at-Home Modalities in Catalonia: a Cross-Sectional Study.
J Clin Med,
9(5).
Abstract:
Differences in Results and Related Factors Between Hospital-at-Home Modalities in Catalonia: a Cross-Sectional Study.
Hospital-at-home (HaH) is a healthcare modality that provides active treatment by healthcare staff in the patient's home for a condition that would otherwise require hospitalization. The aims were to describe the characteristics of different types of hospital-at-home (HaH), assess their results, and examine which factors could be related to these results. A cross-sectional study based on data from all 2014 HaH contacts from Catalonia was designed. The following HaH modalities were considered-admission avoidance (n = 7,214; 75.1%) and early assisted discharge (n = 2,387; 24.9%). The main outcome indicators were readmission, mortality, and length of stay (days). Multivariable models were fitted to assess the association between explanatory factors and outcomes. Hospital admission avoidance is a scheme in which, instead of being admitted to acute care hospitals, patients are directly treated in their own homes. Early assisted discharge is a scheme in which hospital in-care patients continue their treatment at home. In the hospital avoidance modality, there were 8.3% readmissions, 0.9% mortality, and a mean length of stay (SD) of 9.6 (10.6) days. In the early assisted discharge modality, these figures were 7.9%, 0.5%, and 9.8 (11.1), respectively. In both modalities, readmission and mean length of stay were related to comorbidity and type of hospital, and mortality with age. The results of HaH in Catalonia are similar to those observed in other contexts. The factors related to these results identified might help to improve the effectiveness and efficiency of the different HaH modalities.
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Violán C, Fernández-BertolÃn S, Guisado-Clavero M, Foguet-Boreu Q, Valderas JM, Vidal Manzano J, Roso-Llorach A, Cabrera-Bean M (2020). Five-year trajectories of multimorbidity patterns in an elderly Mediterranean population using Hidden Markov Models.
Scientific Reports,
10(1).
Abstract:
Five-year trajectories of multimorbidity patterns in an elderly Mediterranean population using Hidden Markov Models
Abstract
This study aimed to analyse the trajectories and mortality of multimorbidity patterns in patients aged 65 to 99 years in Catalonia (Spain). Five year (2012–2016) data of 916,619 participants from a primary care, population-based electronic health record database (Information System for Research in Primary Care, SIDIAP) were included in this retrospective cohort study. Individual longitudinal trajectories were modelled with a Hidden Markov Model across multimorbidity patterns. We computed the mortality hazard using Cox regression models to estimate survival in multimorbidity patterns. Ten multimorbidity patterns were originally identified and two more states (death and drop-outs) were subsequently added. At baseline, the most frequent cluster was the Non-Specific Pattern (42%), and the least frequent the Multisystem Pattern (1.6%). Most participants stayed in the same cluster over the 5 year follow-up period, from 92.1% in the Nervous, Musculoskeletal pattern to 59.2% in the Cardio-Circulatory and Renal pattern. The highest mortality rates were observed for patterns that included cardio-circulatory diseases: Cardio-Circulatory and Renal (37.1%); Nervous, Digestive and Circulatory (31.8%); and Cardio-Circulatory, Mental, Respiratory and Genitourinary (28.8%). This study demonstrates the feasibility of characterizing multimorbidity patterns along time. Multimorbidity trajectories were generally stable, although changes in specific multimorbidity patterns were observed. The Hidden Markov Model is useful for modelling transitions across multimorbidity patterns and mortality risk. Our findings suggest that health interventions targeting specific multimorbidity patterns may reduce mortality in patients with multimorbidity.
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Arias-de la Torre J, Alonso J, MartÃn V, Valderas JM (2020). Hospital-at-Home as an Alternative to Release the Overload of Healthcare Systems During the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Pandemic.
J Am Med Dir Assoc,
21(7), 990-991.
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Rijken M, Valderas JM, Heins M, Schellevis F, Korevaar J (2020). Identifying high-need patients with multimorbidity from their illness perceptions and personal resources to manage their health and care: a longitudinal study.
BMC Fam Pract,
21(1).
Abstract:
Identifying high-need patients with multimorbidity from their illness perceptions and personal resources to manage their health and care: a longitudinal study.
BACKGROUND: a proactive person-centred care process is advocated for people with multimorbidity. To that aim, general practitioners may benefit from support in the identification of high-need patients, i.e. patients who are high or suboptimal users of health services and/or have a poor quality of life. To develop such support, we examined whether knowledge about patients' illness perceptions and personal resources to manage their health and care is useful to identify high-need patients among multimorbid general practice populations. METHODS: Survey data, collected in 2016 and 2017, of 601 patients with two or more chronic diseases (e.g. COPD, diabetes, Parkinson's disease) registered with 40 general practices in the Netherlands were analysed by logistic regression analysis to predict frequent contact with the general practice, contact with general practice out-of-office services, unplanned hospitalisations and poor health related quality of life. Patients' illness perceptions and personal resources (education, health literacy, mastery, mental health status, financial resources, social support) were included as predictors. RESULTS: the four outcomes were only weakly associated among themselves (Phi. 07-.19). Patients' illness perceptions and personal resources were of limited value to predict potentially suboptimal health service use, but they were important predictors of health related quality of life. Patients with a poor health related quality of life could be identified by their previously reported illness perceptions (attributing many symptoms to their chronic conditions (B = 1.479, P
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Arias-de la Torre J, Smith K, Dregan A, Valderas JM, Evans JP, Prieto-Alhambra D, Lozano L, Molina AJ, MartÃn V, Domingo L, et al (2020). Impact of comorbidity on the short- and medium-term risk of revision in total hip and knee arthroplasty.
BMC Musculoskeletal Disorders,
21(1).
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Aith F, Castilla MartÃnez M, Cho M, Dussault G, Harris M, Padilla M, Tomblin Murphy G, Tomlin P, Valderas JM (2020). Is COVID-19 a turning point for the health workforce?.
Revista Panamericana de Salud Pública,
44, 1-1.
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Oemrawsingh A, Swami N, Valderas JM, Hazelzet JA, Pusic AL, Gliklich RE, Bergmark RW (2020). Patient-Reported Morbidity Instruments: a Systematic Review.
Value in Health,
23(6), 791-811.
Abstract:
Patient-Reported Morbidity Instruments: a Systematic Review
Objectives: Although comorbidities play an essential role in risk adjustment and outcomes measurement, there is little consensus regarding the best source of this data. The aim of this study was to identify general patient-reported morbidity instruments and their measurement properties. Methods: a systematic review was conducted using multiple electronic databases (Embase, Medline, Cochrane Central, and Web of Science) from inception to March 2018. Articles focusing primarily on the development or subsequent validation of a patient-reported morbidity instrument were included. After including relevant articles, the measurement properties of each morbidity instrument were extracted by 2 investigators for narrative synthesis. Results: a total of 1005 articles were screened, of which 34 eligible articles were ultimately included. The most widely assessed instruments were the Self-Reported Charlson Comorbidity Index (n = 7), the Self-Administered Comorbidity Questionnaire (n = 3), and the Disease Burden Morbidity Assessment (n = 3). The most commonly included conditions were diabetes, hypertension, and myocardial infarction. Studies demonstrated substantial variability in item-level reliability versus the gold standard medical record review (κ range 0.66-0.86), meaning that the accuracy of the self-reported comorbidity data is dependent on the selected morbidity. Conclusions: the Self-Reported Charlson Comorbidity Index and the Self-Administered Comorbidity Questionnaire were the most frequently cited instruments. Significant variability was observed in reliability per comorbid condition of patient-reported morbidity questionnaires. Further research is needed to determine whether patient-reported morbidity data should be used to bolster medical records data or serve as a stand-alone entity when risk adjusting observational outcomes data.
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van Oppen JD, Valderas JM, Mackintosh NJ, Conroy SP (2020). Patient-reported outcome and experience measures in geriatric emergency medicine.
Zeitschrift fuer Gerontologie und Geriatrie: Organ der Deutschen Gesellschaft fuer Gerontologie und Geriatrie Full text.
Salema N, Gangannagaripalli J, Mounce L, Valderas JM, Ricci-Cabello I, Avery A (2020). Patients' perceptions of safety in general practice captured using an online patient safety questionnaire for primary care (PREOS-PC).
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Klapproth CP, van Bebber J, Sidey-Gibbons CJ, Valderas JM, Leplege A, Rose M, Fischer F (2020). Predicting EQ-5D-5L crosswalk from the PROMIS-29 profile for the United Kingdom, France, and Germany.
Health and Quality of Life Outcomes,
18(1).
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Predicting EQ-5D-5L crosswalk from the PROMIS-29 profile for the United Kingdom, France, and Germany
Background: EQ-5D health state utilities (HSU) are commonly used in health economics to compute quality-adjusted life years (QALYs). The EQ-5D, which is country-specific, can be derived directly or by mapping from self-reported health-related quality of life (HRQoL) scales such as the PROMIS-29 profile. The PROMIS-29 from the Patient Reported Outcome Measures Information System is a comprehensive assessment of self-reported health with excellent psychometric properties. We sought to find optimal models predicting the EQ-5D-5L crosswalk from the PROMIS-29 in the United Kingdom, France, and Germany and compared the prediction performances with that of a US model. Methods: We collected EQ-5D-5L and PROMIS-29 profiles and three samples representative of the general populations in the UK (n = 1509), France (n = 1501), and Germany (n = 1502). We used stepwise regression with backward selection to find the best models to predict the EQ-5D-5L crosswalk from all seven PROMIS-29 domains. We investigated the agreement between the observed and predicted EQ-5D-5L crosswalk in all three countries using various indices for the prediction performance, including Bland–Altman plots to examine the performance along the HSU continuum. Results: the EQ-5D-5L crosswalk was best predicted in France (nRMSE. = 0.075, nMAE. = 0.052), followed by the UK (nRMSE. = 0.076, nMAE. = 0.053) and Germany (nRMSE. = 0.079, nMAE. = 0.051). The Bland–Altman plots show that the inclusion of higher-order effects reduced the overprediction of low HSU scores. Conclusions: Our models provide a valid method to predict the EQ-5D-5L crosswalk from the PROMIS-29 for the UK, France, and Germany. FRA FRA UK UK GER GER
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Bowman K, Jones L, Masoli J, Mujica-Mota R, Strain D, Butchart J, Valderas JM, Fortinsky RH, Melzer D, Delgado J, et al (2020). Predicting incident delirium diagnoses using data from primary-care electronic health records.
Age Ageing,
49(3), 374-381.
Abstract:
Predicting incident delirium diagnoses using data from primary-care electronic health records.
IMPORTANCE: risk factors for delirium in hospital inpatients are well established, but less is known about whether delirium occurring in the community or during an emergency admission to hospital care might be predicted from routine primary-care records. OBJECTIVES: identify risk factors in primary-care electronic health records (PC-EHR) predictive of delirium occurring in the community or recorded in the initial episode in emergency hospitalisation. Test predictive performance against the cumulative frailty index. DESIGN: Stage 1: case-control; Stages 2 and 3: retrospective cohort. SETTING: clinical practice research datalink: PC-EHR linked to hospital discharge data from England. SUBJECTS: Stage 1: 17,286 patients with delirium aged ≥60 years plus 85,607 controls. Stages 2 and 3: patients ≥ 60 years (n = 429,548 in 2015), split into calibration and validation groups. METHODS: Stage 1: logistic regression to identify associations of 110 candidate risk measures with delirium. Stage 2: calibrating risk factor weights. Stage 3: validation in independent sample using area under the curve (AUC) receiver operating characteristic. RESULTS: fifty-five risk factors were predictive, in domains including: cognitive impairment or mental illness, psychoactive drugs, frailty, infection, hyponatraemia and anticholinergic drugs. The derived model predicted 1-year incident delirium (AUC = 0.867, 0.852:0.881) and mortality (AUC = 0.846, 0.842:0.853), outperforming the frailty index (AUC = 0.761, 0.740:0.782). Individuals with the highest 10% of predicted delirium risk accounted for 55% of incident delirium over 1 year. CONCLUSIONS: a risk factor model for delirium using data in PC-EHR performed well, identifying individuals at risk of new onsets of delirium. This model has potential for supporting preventive interventions.
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Arias-de la Torre J, Puigdomenech E, GarcÃa X, Valderas JM, Eiroa-Orosa FJ, Fernández-Villa T, Molina AJ, MartÃn V, Serrano-Blanco A, Alonso J, et al (2020). Relationship Between Depression and the Use of Mobile Technologies and Social Media Among Adolescents: Umbrella Review.
Journal of Medical Internet Research,
22(8), e16388-e16388.
Abstract:
Relationship Between Depression and the Use of Mobile Technologies and Social Media Among Adolescents: Umbrella Review
. Background
. Despite the relevance of mobile technologies and social media (MTSM) for adolescents, their association with depressive disorders in this population remains unclear. While there are previous reviews that have identified the use of MTSM as a risk factor for developing depression, other reviews have indicated their possible preventive effect.
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.
. Objective
. The aim of this review was to synthesize the current evidence on the association between MTSM use and the development or prevention of depressive disorders in adolescents.
.
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. Methods
. An umbrella review was conducted using information published up to June 2019 from PubMed/MEDLINE, PsycINFO, Web of Science, and the Cochrane Library. Systematic reviews focusing on the adolescent population (up to 20 years old) and depression and its potential relationship with MTSM use were included. Screening of titles, abstracts, and full texts was performed. After selecting the reviews and given the heterogeneity of the outcome variables and exposures, a narrative synthesis of the results was carried out.
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.
. Results
. The search retrieved 338 documents, from which 7 systematic reviews (3 meta-analyses) were selected for data extraction. There were 11-70 studies and 5582-46,015 participants included in the 7 reviews. All reviews included quantitative research, and 2 reviews also included qualitative studies. A statistically significant association between social media and developing depressive symptoms was reported in 2 reviews, while 5 reviews reported mixed results.
.
.
. Conclusions
. Excessive social comparison and personal involvement when using MTSM could be associated with the development of depressive symptomatology. Nevertheless, MTSM might promote social support and even become a point of assistance for people with depression. Due to the mixed results, prospective research could be valuable for providing stronger evidence.
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Tomari S, Magin P, Lasserson D, Quain D, Valderas JM, Dewey HM, Barber PA, Spratt NJ, Cadilhac DA, Feigin VL, et al (2020). The Characteristics of Patients with Possible Transient Ischemic Attack and Minor Stroke in the Hunter and Manning Valley Regions, Australia (the INSIST Study).
Frontiers in Neurology,
11Abstract:
The Characteristics of Patients with Possible Transient Ischemic Attack and Minor Stroke in the Hunter and Manning Valley Regions, Australia (the INSIST Study)
Background: Transient ischemic attack (TIA) and minor stroke (TIAMS) are risk factors for stroke recurrence. Some TIAMS may be preventable by appropriate primary prevention. We aimed to recruit “possible-TIAMS” patients in the INternational comparison of Systems of care and patient outcomes in minor Stroke and TIA (INSIST) study. Methods: a prospective inception cohort study performed across 16 Hunter–Manning region, Australia, general practices in the catchment of one secondary-care acute neurovascular clinic. Possible-TIAMS patients were recruited from August 2012 to August 2016. We describe the baseline demographics, risk factors and pre-event medications of participating patients. Results: There were 613 participants (mean age; 69 ± 12 years, 335 women), and 604 (99%) were Caucasian. Hypertension was the most common risk factor (69%) followed by hyperlipidemia (52%), diabetes mellitus (17%), atrial fibrillation (AF) (17%), prior TIA (13%) or stroke (10%). Eighty-nine (36%) of the 249 participants taking antiplatelet therapy had no known history of cardiovascular morbidity. of 102 participants with known AF, 91 (89%) had a CHA2DS2-VASc score ≥ 2 but only 47 (46%) were taking anticoagulation therapy. Among 304 participants taking an antiplatelet or anticoagulant agent, 30 (10%) had stopped taking these in the month prior to the index event. Conclusion: This study provides the first contemporary data on TIAMS or TIAMS-mimics in Australia. Community and health provider education is required to address the under-use of anticoagulation therapy in patients with known AF, possibly inappropriate use of antiplatelet therapy and possibly inappropriate discontinuation of antiplatelet or anticoagulation therapy.
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Leiva-Fernández F, Prados-Torres JD, Prados-Torres A, del-Cura-González I, Castillo-Jimena M, López-RodrÃguez JA, Rogero-Blanco ME, Lozano-Hernández CM, López-Verde F, Bujalance-Zafra MJ, et al (2020). Training primary care professionals in multimorbidity management: Educational assessment of the eMULTIPAP course. Mechanisms of Ageing and Development, 192, 111354-111354.
2019
Evans JP, Porter I, Gangannagaripalli JB, Bramwell C, Davey A, Smith CD, Fine N, Goodwin VA, Valderas JM (2019). Assessing Patient-Centred Outcomes in Lateral Elbow Tendinopathy: a Systematic Review and Standardised Comparison of English Language Clinical Rating Systems.
Sports Medicine - Open,
5Abstract:
Assessing Patient-Centred Outcomes in Lateral Elbow Tendinopathy: a Systematic Review and Standardised Comparison of English Language Clinical Rating Systems
© 2019, the Author(s). Background: Lateral elbow tendinopathy (LET) is a common condition affecting adults. Although a lack of treatment consensus continues to prompt numerous effectiveness studies, there is a paucity of clear guidance on the choice of outcome measure. Our aim was to undertake a standardised evaluation of the available clinical rating systems that report patient-centred outcomes in LET. Methods: a systematic review of studies reporting the development, assessment of metric properties and/or use of instruments aiming to quantify LET-specific patient-centred outcome measures was conducted in MEDLINE, Embase and CINAHL (inception-2017) adhering to PRISMA guidance. The evidence for each instrument was independently assessed by two reviewers using the standardised evaluating measures of patient-reported outcomes (EMPRO) method evaluating overall and attribute-specific instrument performance (metric properties and usability). EMPRO scores > 50/100 were considered indicative of high performance. Results: Out of 7261 references, we identified 105 articles reporting on 15 instruments for EMPRO analysis. Median performance score was 41.6 (range 21.6–72.5), with four instruments meeting high-performance criteria: quick Disabilities of the Arm Shoulder and Hand score (qDASH) (72.5), DASH (66.9), Oxford Elbow Score (OES) (66.6) and Patient-Rated Tennis Elbow Evaluation (PRTEE) (57.0). One hundred seventy-nine articles reported instrument use internationally with DASH as the most frequent (29.7% articles) followed by PRTEE (25.6%), MEPS (15.1%) and qDASH (8.1%). The correlation between frequency of use and performance was r = 0.35 (95%CI − 0.11; 0.83). Conclusions: This is the first study to provide standardised guidance on the choice of measures for LET. A large number of clinical rating systems are both available and being used for patients with LETs. Robust evidence is available for four measures, the DASH, QDASH, PRTEE and OES. The use of instruments in the literature is only in part explained by instrument performance.
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Valderas Martinez JM, Catala-Lopez F, Forres-Martos J, Driver JA, Page MJ, Hutton B, Ridao M, Alonso-Arroyo A, Saint-Gerons DM, Genova-Maleras R, et al (2019). Association of anorexia nervosa with risk of cancer. A systematic review and meta-analysis.
JAMA Network Open,
2 Full text.
Arias-de la Torre J, Puigdomenech E, Valderas JM, Evans JP, MartÃn V, Molina AJ, RodrÃguez N, Espallargues M (2019). Availability of specific tools to assess patient reported outcomes in hip arthroplasty in Spain. Identifying the best candidates to incorporate in an arthroplasty register. A systematic review and standardized assessment.
PLoS One,
14(4).
Abstract:
Availability of specific tools to assess patient reported outcomes in hip arthroplasty in Spain. Identifying the best candidates to incorporate in an arthroplasty register. A systematic review and standardized assessment.
PURPOSE: 1) to systematically review the available scientific literature regarding specific instruments developed and/or tested in a Spanish population, to assess these PROMs in hip arthroplasty; 2) to carry out a standardized assessment of their measurement properties; and 3) to identify the best tools for use in Spain in an arthroplasty registry context. METHODS: a systematic review of PubMed/MEDLINE and EMBASE and CINHAL was done. Furthermore, a standardized assessment of the questionnaires identified using the Evaluating the Measurement of Patient-Reported Outcomes (EMPRO) tool was performed. All developments, validation and studies aiming to assess the measurement properties of PROMs in hip arthroplasty in the Spanish population were included. Data from the questionnaires on metric properties was taken into account to identify the best candidates for inclusion in a register. RESULTS: a total of 853 documents were found. After screening title and abstract, 13 full text documents were reviewed and 8 questionnaires adapted and validated to assess some of the aspects of hip arthroplasty in the Spanish population were identified. After the EMPRO assessment, 4 questionnaires showed suitable properties (WOMAC, OAKHQOL, mini-OAKHQOL and PFH). CONCLUSIONS: in Spain, there are a few suitable hip-specific questionnaires currently available to assess PROMs in hip arthroplasty surgery. Some of the more widely used questionnaires, like the OHS and HOOS, have not been validated in the Spanish population until now. Identified tools are suitable for use in a clinical context, however their use in an arthroplasty register is more questionable due to the lack of validation studies of the widely used tools in other registers.
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Arana MA, Valderas JM, Solomon J (2019). Being tested but not educated - a qualitative focus group study exploring patients' perceptions of diabetic dietary advice.
BMC Fam Pract,
20(1).
Abstract:
Being tested but not educated - a qualitative focus group study exploring patients' perceptions of diabetic dietary advice.
BACKGROUND: Diet is a key component of the management of diabetes. Several studies suggest that patients receive insufficient and inadequate information. As a first step for developing an intervention for improving dietary advice in primary care, we aimed to explore patients' experience of receiving dietary advice; their attitudes towards that advice; their perceived dietary advice needs, and any barriers faced in adopting a diet that supports the management of their diabetes. METHODS: a qualitative study with three focus groups (20 purposively sampled participants) was conducted with adult primary care patients with Type 2 diabetes in 2016. A semi-structured topic guide was developed from the literature. The focus groups were audio recorded and transcribed. The data were analysed by emergent themes analysis. Data saturation was achieved in the third focus group. RESULTS: the majority of participants were given dietary advice in the form of a generic healthy eating leaflet from a Practice Nurse. Participants had their Haemoglobin A1c (HbA1c) reviewed regularly, but the results seemed not to be linked with review of dietary habits. The test was perceived as being a "pass or fail", judgmental experience. Participants felt tested but not educated. CONCLUSION: Individuals with type 2 diabetes seem not to receive dietary advice according to their expectations. Information collected as part of the study can be used to inform the development of interventions aimed at improving dietary advice in this population.
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Serrano-Ripoll MJ, Ripoll J, Llobera J, Valderas JM, Pastor-Moreno G, Olry de Labry Lima A, Ricci-Cabello I (2019). Development and evaluation of an intervention based on the provision of patient feedback to improve patient safety in Spanish primary healthcare centres: study protocol.
BMJ Open,
9(12).
Abstract:
Development and evaluation of an intervention based on the provision of patient feedback to improve patient safety in Spanish primary healthcare centres: study protocol.
INTRODUCTION: Despite the enormous potential for adverse events in primary healthcare (PHC), the knowledge about how to improve patient safety in this context is still sparse. We describe the methods for the development and evaluation of an intervention targeted at PHC professionals to improve patient safety in Spanish PHC centres. METHODS AND ANALYSIS: the intervention will consist in using the patient reported experiences and outcomes of safety in primary care (PREOS-PC) survey to gather patient-reported experiences and outcomes concerning the safety of the healthcare patients receive in their PHC centres, and feed that information back to the PHC professionals to help them identify opportunities for safer healthcare provision. The study will involve three stages. Stage 1 (developing the intervention) will involve: (i) qualitative study with 40 PHC providers to optimise the acceptability and perceived utility of the proposed intervention; (ii) Spanish translation, cross-cultural adaptation and validation of the PREOS-PC survey; (iii) developing the intervention components; and (iv) developing an online tool to electronically administrate PREOS-PC and automatically generate feedback reports to PHC centres. Stage 2 (piloting the intervention) will involve a 3-month feasibility (one group pre-post) study in 10 PHC centres (500 patients, 260 providers). Stage 3 (evaluating the intervention) will involve: (i) a 12-month, two-arm, two-level cluster randomised controlled trial (1248 PHC professionals within 48 PHC centres; with randomisation at the centre level in a 1:1 ratio) to evaluate the impact of the intervention on patient safety culture (primary outcome), patient-reported safety experiences and outcomes (using the PREOS-PC survey), and avoidable hospitalisations; (ii) qualitative study with 20 PHC providers to evaluate the acceptability and perceived utility of the intervention and identify implementation barriers. ETHICS AND DISSEMINATION: the study was approved by the Ethics Committee of the Balearic Islands (CEI IB: 3686/18) with the 1964 Helsinki Declaration and its later amendments. The results will be disseminated in peer-reviewed publications and national and international conferences. TRIAL REGISTRATION NUMBER: NCT03837912; pre-results.
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Arias-de la Torre J, Valderas JM, Evans JP, MartÃn V, Molina AJ, Muñoz L, Pons-Cabrafiga M, Espallargues M, Catalan Arthroplasty Register Steering Committee (RACat) (2019). Differences in Risk of Revision and Mortality Between Total and Unicompartmental Knee Arthroplasty. The Influence of Hospital Volume.
J Arthroplasty,
34(5), 865-871.
Abstract:
Differences in Risk of Revision and Mortality Between Total and Unicompartmental Knee Arthroplasty. The Influence of Hospital Volume.
BACKGROUND: the volume of arthroplasties performed in a hospital by year has an influence on the outcomes of total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA). The aims of this study are (1) to evaluate and compare the risk of revision and mortality of TKA and UKA and (2) to assess whether hospital volume is related to differences in revision risk and mortality. METHODS: all individuals recorded in the Catalan Arthroplasty Register between 1/1/2005 and 31/12/2016, diagnosed with osteoarthritis, undergoing cemented TKA and UKA were included. A propensity score matching method was used to obtain comparable cohorts, including 2374 matched prostheses overall. Hospital volume was considered as a dichotomous variable (lower/higher). Descriptive analyses were done before and after matching. Risks of revision and mortality at 30 days, 90 days, 1, 3, and 5 years were calculated and competing risks models and Cox models were fitted. RESULTS: for the population as a whole, higher risk of revision (sub-hazard ratio, 1.98; 95% confidence interval, 1.25-3.17) was found in UKA than in TKA but higher mortality was not. Considering the volume groups, significantly higher risk of revision in UKA than TKA was found in the lower-volume group only (sub-hazard ratio, 1.95; 95% confidence interval, 1.11-3.44). No differences in mortality between TKA and UKA were found in either group. CONCLUSION: Mortality and revision rates after TKA and UKA at higher-volume hospitals are similar. UKAs performed at lower-volume hospitals have higher revision rates. Volume-dependent specialization thus might help to reduce revision and mortality after surgery.
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Muth C, Blom JW, Smith SM, Johnell K, Gonzalez-Gonzalez AI, Nguyen TS, Brueckle M-S, Cesari M, Tinetti ME, Valderas JM, et al (2019). Evidence supporting the best clinical management of patients with multimorbidity and polypharmacy: a systematic guideline review and expert consensus.
J Intern Med,
285(3), 272-288.
Abstract:
Evidence supporting the best clinical management of patients with multimorbidity and polypharmacy: a systematic guideline review and expert consensus.
The complexity and heterogeneity of patients with multimorbidity and polypharmacy renders traditional disease-oriented guidelines often inadequate and complicates clinical decision making. To address this challenge, guidelines have been developed on multimorbidity or polypharmacy. To systematically analyse their recommendations, we conducted a systematic guideline review using the Ariadne principles for managing multimorbidity as analytical framework. The information synthesis included a multistep consensus process involving 18 multidisciplinary experts from seven countries. We included eight guidelines (four each on multimorbidity and polypharmacy) and extracted about 250 recommendations. The guideline addressed (i) the identification of the target population (risk factors); (ii) the assessment of interacting conditions and treatments: medical history, clinical and psychosocial assessment including physiological status and frailty, reviews of medication and encounters with healthcare providers highlighting informational continuity; (iii) the need to incorporate patient preferences and goal setting: eliciting preferences and expectations, the process of shared decision making in relation to treatment options and the level of involvement of patients and carers; (iv) individualized management: guiding principles on optimization of treatment benefits over possible harms, treatment communication and the information content of medication/care plans; (v) monitoring and follow-up: strategies in care planning, self-management and medication-related aspects, communication with patients including safety instructions and adherence, coordination of care regarding referral and discharge management, medication appropriateness and safety concerns. The spectrum of clinical and self-management issues varied from guiding principles to specific recommendations and tools providing actionable support. The limited availability of reliable risk prediction models, feasible interventions of proven effectiveness and decision aids, and limited consensus on appropriate outcomes of care highlight major research deficits. An integrated approach to both multimorbidity and polypharmacy should be considered in future guidelines.
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Klapproth C, Gibbons C, Valderas JM, Leplege A, Rose M, Fischer F (2019). HEALTH-RELATED QUALITY OF LIFE (HRQOL) MEASURED BY PROMIS PREFERENCE SCORE (PROPR) IN THE GENERAL POPULATION OF THE UNITED KINGDOM, FRANCE, AND GERMANY.
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Kluge H, Kelley E, Birtanov Y, Theodorakis PN, Barkley S, Aidossov S, Valderas JM (2019). Implementing the renewed vision for Primary Health Care in the Declaration of Astana: the time is now.
Prim Health Care Res Dev,
20 Author URL.
Arias-de la Torre J, Pons-Cabrafiga M, Valderas JM, Evans JP, MartÃn V, Molina AJ, Pallisó F, Smith K, Martinez O, Espallargues M, et al (2019). Influence of Hospital Volume of Procedures by Year on the Risk of Revision of Total Hip and Knee Arthroplasties: a Propensity Score-Matched Cohort Study.
J Clin Med,
8(5).
Abstract:
Influence of Hospital Volume of Procedures by Year on the Risk of Revision of Total Hip and Knee Arthroplasties: a Propensity Score-Matched Cohort Study.
The volume of total hip (THA) and knee arthroplasties (TKA) performed in a hospital per year could be an influential factor on the revision of these procedures. The aims of this study were: to obtain comparable cohorts in higher- and lower-volume hospitals; and to assess the association between the hospital volume and the incidence of revision. Data from patients undergoing THA and TKA caused by osteoarthritis and recorded in the Catalan Arthroplasty Register (RACat) between January 2005 and December 2016 were used. The main explanatory variable was hospital volume by year (higher/lower). The cut-off point was fixed, based on previous research, at 50 THA and 125 TKA procedures/year. To obtain comparable populations, a propensity-score matching method (1:1) was used. Patient characteristics prior to and after matching were compared. To assess differences by volume, subhazard ratios (SHRs) from competing risks models were obtained. After matching, 13,772 THA and 36,316 TKA patients remained in the study. Prior to matching, in both joints, significant differences in all confounders were observed between volume groups. After matching, none of them remained significant. Both in THA and TKA, a higher risk of revision in higher-volume hospitals was observed (THA SHR: 1.25, 95%CI: 1.02-1.53; and TKA SHR: 1.29, 95%CI: 1.16-1.44). Unlike other contexts, currently in Catalonia, higher-volume hospitals have a greater risk of revision than lower-volume hospitals. Further research could be valuable to define context-dependent measures to reduce the incidence of revision.
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Calvert M, Kyte D, Price G, Valderas JM, Hjollund NH (2019). Maximising the impact of patient reported outcome assessment for patients and society.
BMJ (Online),
364 Full text.
Evans J (2019). Optimising the Investigation of Interventional Treatments in Lateral Elbow Tendinopathy.
Abstract:
Optimising the Investigation of Interventional Treatments in Lateral Elbow Tendinopathy
Background and Aim Lateral Elbow Tendinopathy (LET) is a common, painful condition, predominantly affecting working age people. Although numerous studies have been conducted assessing a multitude of therapeutic interventions, fundamental information regarding outcome measure choice, treatment delivery techniques, and trial feasibility have not been explored. This thesis aims to optimise the investigation of interventional therapies in lateral elbow tendinopathy by furthering the foundational knowledge from which future researchers can inform their study design. Methods a portfolio of studies was undertaken to explore three main themes: the choice of patient-centred outcome measure, the rationale for injection therapy technique and the feasibility and acceptability of a randomised controlled study methodology in Platelet-Rich Plasma (PRP) injection therapy. Seven studies addressing these themes were undertaken: a three-phase systematic review and standardised evaluation of patient-centred clinical rating systems in elbow pathology, a validation study of outcome measures in a UK population of lateral elbow tendinopathy patients, a cadaveric assessment of elbow injection distribution, a Delphi consensus study of PRP injection use and a feasibility randomised controlled trial of PRP versus surgery for chronic LET. Results the systematic review identified 72 clinical rating systems used in elbow pathology, 15 of which had a history of validation in lateral elbow tendinopathy patients. Standardised comparative assessment found that only four reached the minimum threshold for recommendation (QDASH, DASH, OES and PRTEE). The correlation between the frequency of clinical rating systems use and their performance was r = 0.35. Cross-culturally specific validity of these rating systems in a UK population was limited to 20 patients embedded in mixed pathology cohorts. Evaluation of the psychometric properties of the highest performing clinical rating systems was performed in 50 tendinopathy patients recruited across general practice, physiotherapy and secondary care settings, with all instruments achieving adequate internal consistency (Cronbach’s alpha >0.87), reliability (intraclass correlation coefficient >0.85) and responsiveness (effect sizes >0.46). The cadaveric evaluation found no statistical difference between the intratendinous distribution of lateral elbow injections between 1ml and 3ml or between single shot or fenestrated injection techniques. The Delphi consensus study on the application of platelet-rich plasma injections found poor levels of agreement amongst experts on the technical preparation and application of this treatment. The feasibility randomised control trial found that a randomised controlled trial is technically feasible (86% recruitment rate, 8% drop-out and 8% cross-over). Qualitative interviews with these patients identified very high levels of procedural injection pain. Conclusion This research improves upon the knowledge base from which future evaluations of interventional treatment in lateral elbow tendinopathy can be constructed. It is the first one to identify the wide choice and disparate utility of patient-centred outcome measures in elbow pathology. It can recommend the QDASH, DASH, OES or PRTEE for use in the English language and provides evidence of the validity and reliability of these instruments in the UK. Injection methodology should be rationalised to low volume single-shot injections, and research priorities should be allied to areas identified as lacking expert consensus. Though feasible and acceptable, future parallel group studies should quantify and report procedural pain.
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Valderas JM (2019). Patient outcomes monitoring. In (Ed) Cambridge Handbook of Psychology, Health and Medicine: Third Edition, 214-217.
Strauss VY, Prats-Uribe A, Berencsi K, Carr A, Judge A, Silman A, Murray DW, Arden NK, Petersen I, Pinedo-Villanueva R, et al (2019). Propensity score stratification and inverse probability weighting compared to surgical randomized clinical trial results in device epidemiology.
Author URL.
Valderas Martinez JM, Gangannagaripalli J, Nolte E, Boyd C, Roland M, Sarria-Santamera A, Jones E, Rijken M (2019). Quality of care assessment for people with multimorbidity.
Journal of Internal Medicine,
285(3), 289-300.
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Sidey-Gibbons C, Porter I, Tsangaris E, Valderas J, Grp CPROMR (2019). Routine provision of information on patient-reported outcomes measures to healthcare providers and patients in clinical practice: a Cochrane systematic review.
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Arias-de la Torre J, Garcia X, Smith K, Romero-Tamarit A, Puigdomenech E, Muñoz-Ortiz L, Evans JP, MartÃn V, Molina AJ, Torrens C, et al (2019). Safety and Effectiveness of Shoulder Arthroplasties in Spain: a Systematic Review.
J Clin Med,
8(12).
Abstract:
Safety and Effectiveness of Shoulder Arthroplasties in Spain: a Systematic Review.
The effectiveness and safety of shoulder arthroplasties in the general context of a Spanish patient population remains unclear. The aim of this study was to ascertain both the effectiveness and safety of primary shoulder arthroplasties and the prosthesis types used in Spain. A systematic review of all the available literature evaluating the effectiveness and safety of primary shoulder arthroplasties in Spain was performed. A narrative synthesis was performed, and evidence tables were created in four dimensions: study design, arthroplasty characteristics, safety, and effectiveness. Orthopaedic Data Evaluation Panel (ODEP) scores were used to evaluate prosthesis types. Twenty-one studies were selected that included a total of 1293 arthroplasties. The most common indication was fractures, while the prosthesis most frequently used was the Delta Xtend (ODEP 10A). The most common complication was scapular notching. Prosthesis revision rate was approximately 6% for follow-ups between 12 and 79 months. In addition, significant improvements were observed in the Constant-Murley test score after the intervention. Currently in Spain, shoulder arthroplasty can be considered a safe and effective procedure with functional recovery and pain reduction for eligible patients with humeral fracture, rotator cuff arthropathy, fracture sequelae and malunion of the proximal humerus, and degenerative disease. Future longitudinal research and population-based studies could serve to confirm these results and identify points of improvement.
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Valderas Martinez JM, Violan C, Foguet-Boreu Q, Fernandez-Bertolin S, Guisado-Clavero M, Cabrera-Bean M, Formiga F, Roso-Llorach A (2019). Soft clustering using real-world data for the identification of multimorbidity patterns in an elderly population: cross-sectional study in a Mediterranean population.
BMJ Open,
9 Full text.
Levi CR, Lasserson D, Quain D, Valderas J, Dewey HM, Alan Barber P, Spratt N, Cadilhac DA, Feigin V, Zareie H, et al (2019). The International comparison of Systems of care and patient outcomes in minor Stroke and Tia (InSIST) study: a community-based cohort study.
International Journal of Stroke,
14(2), 186-190.
Abstract:
The International comparison of Systems of care and patient outcomes in minor Stroke and Tia (InSIST) study: a community-based cohort study
Rationale: Rapid response by health-care systems for transient ischemic attack and minor stroke (TIA/mS) is recommended to maximize the impact of secondary prevention strategies. The applicability of this evidence to Australian non-hospital-based TIA/mS management is uncertain. Aims: Within an Australian community setting we seek to document processes of care, establish determinants of access to care, establish attack rates and determinants of recurrent vascular events and other clinical outcomes, establish the performance of ABC2-risk stratification, and compare the processes of care and outcomes to those in the UK and New Zealand for TIA/mS. Sample size estimates: Recruiting practices containing approximately 51 full-time-equivalent general practitioners to recruit 100 TIA/mS per year over a four-year study period will provide sufficient power for each of our outcomes. Methods and design: an inception cohort study of patients with possible TIA/mS recruited from 16 general practices in the Newcastle-Hunter Valley-Manning Valley region of Australia. Potential TIA/mS will be ascertained by multiple overlapping methods at general practices, after-hours collaborative, and hospital in-patient and outpatient services. Participants’ index and subsequent clinical events will be adjudicated as TIA/mS or mimics by an expert panel. Study outcomes: Process outcomes—whether the patient was referred for secondary care; time from event to first patient presentation to a health professional; time from event to specialist acute-access clinic appointment; time from event to brain and vascular imaging and relevant prescriptions. Clinical outcomes—recurrent stroke and major vascular events; and health-related quality of life. Discussion: Community management of TIA/mS will be informed by this study.
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Prats-Uribe A, Berencsi K, Carr A, Judge A, Silman A, Murray DW, Arden NK, Petersen I, Pinedo-Villanueva R, Beard DJ, et al (2019). The performance of preference-based instrumental variables to emulate a randomized clinical trial of comparative medical device effectiveness.
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Davey A, Mewse A, Green C, Valderas J (2019). Time dependent variation of patient reported outcomes: a conceptual model.
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Davey A, Porter I, Coombes J, Green C, Valderas J (2019). Time-dependent variation of patient reported outcome (PRO) measurement in patients with chronic conditions: a scoping review.
Author URL.
Ferguson RJ, Prieto-Alhambra D, Walker C, Yu D, Valderas JM, Judge A, Griffiths J, Jordan KP, Peat G, Glyn-Jones S, et al (2019). Validation of hip osteoarthritis diagnosis recording in the UK Clinical Practice Research Datalink.
Pharmacoepidemiol Drug Saf,
28(2), 187-193.
Abstract:
Validation of hip osteoarthritis diagnosis recording in the UK Clinical Practice Research Datalink.
PURPOSE: the diagnosis of hip osteoarthritis is subject to several uncertainties, especially in primary care. The aims of this study were to determine (i) the diagnostic accuracy of coding of hip osteoarthritis by primary care physicians in the UK Clinical Practice Research Datalink (CPRD), (ii) the relative influence of radiographic and clinical parameters on diagnostic accuracy, and (iii) the accuracy of the diagnosis date. METHODS: an extract of all patients aged over 65 years, with a Read code for hip osteoarthritis listed between January 1995 and December 2014, was obtained from CPRD. A random sample was selected of 170 participants. A questionnaire concerning data in medical records on relevant clinical and radiographic criteria used to establish the diagnosis of hip osteoarthritis was distributed to primary care physicians of participants. Using diagnostic criteria, we formulated thresholds for diagnosis based on clinical, radiographic, and combined grounds. RESULTS: One hundred nineteen completed questionnaires were returned (70% response rate). The positive predictive value (PPV) of hip osteoarthritis codes, based on radiological criteria, was 79.8%. The PPV, based on clinical criteria, was 79.0%, with substantial but not complete overlap. Overall 12% of diagnoses were not confirmed. In 42% of cases, there was disparity between date of diagnosis in CPRD and the medical record. Median difference in date was ±425 days (interquartile range, 18-1448 days). CONCLUSIONS: Despite the difficulties in reaching a diagnosis of hip osteoarthritis in primary care, CPRD Read codes have a sufficiently high PPV for most research uses. However, the accuracy of diagnosis date may not be as reliable.
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2018
Campbell SM, Bell BG, Marsden K, Spencer R, Kadam U, Perryman K, Rodgers S, Litchfield I, Reeves D, Chuter A, et al (2018). A Patient Safety Toolkit for Family Practices.
Journal of Patient Safety,
16(3), e182-e186.
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Ferrer M, Garcia-Forero C, Garin O, Pardo Y, Vilagut G, Alayo I, Zamora V, Oriol C, Valderas JM, Alonso J, et al (2018). A new online system for the standardized appraisal of PRO instruments: the EMPRO platform.
Author URL.
Arias-de la Torre J, Espallargues M, Evans JP, Puigdomenech E, Rodriguez N, Valderas JM (2018). AVAILABILITY OF TOOLS TO ASSESS PROMS IN HIP ARTHROPLASTY IN SPAIN. A SYSTEMATIC REVIEW.
Author URL.
Germeni E, Frost J, Garside R, Rogers M, Valderas JM, Britten N (2018). Antibiotic prescribing for acute respiratory tract infections in primary care: an updated and expanded meta-ethnography.
British Journal of General Practice,
68(674), e633-e645.
Abstract:
Antibiotic prescribing for acute respiratory tract infections in primary care: an updated and expanded meta-ethnography
BackgroundReducing unnecessary prescribing remains a key priority for tackling the global rise of antibiotic-resistant infections.AimThe authors sought to update a 2011 qualitative synthesis of GPs’ experiences of antibiotic prescribing for acute respiratory tract infections (ARTIs), including their views of interventions aimed at more prudent prescribing. They expanded the original scope to encompass all primary care professionals (PCPs) who can prescribe or dispense antibiotics for ARTIs (for example, nurses and pharmacists).Design and settingSystematic review and meta-ethnography of qualitative studies.MethodA systematic search was conducted on MEDLINE, EMBASE, PsycINFO, CINAHL, ASSIA, and Web of Science. No date or language restrictions were used. Identified studies were grouped according to their thematic focus (usual care versus intervention), and two separate syntheses were performed.ResultsIn all, 53 articles reporting the experiences of >1200 PCPs were included. Analysis of usual-care studies showed that PCPs tend to assume multiple roles in the context of ARTI consultations (the expert self, the benevolent self, the practical self), depending on the range of intrapersonal, interpersonal, and contextual situations in which they find themselves. Analysis of intervention studies identified four possible ways in which PCPs may experience quality improvement interventions (compromise, ‘supportive aids’, source of distress, and unnecessary).ConclusionContrary to the original review, these results suggest that the use of the same intervention is experienced in a totally different way by different PCPs, and that the same elements that are perceived as benefits by some could be viewed as drawbacks by others. Acceptability of interventions is likely to increase if these are context sensitive and take into account PCPs’ varying roles and changing priorities.
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Wheat HC, Horrell J, Valderas J, Close J, Fosh B, Lloyd H (2018). Can Practitioners use Patient Reported Measures to Enhance Person Centred Coordinated Care in Practice? a qualitative study.
Health and Quality of Life Outcomes Full text.
Evans JP, Smith CD, Fine NF, Porter I, Gangannagaripalli J, Goodwin VA, Valderas JM (2018). Clinical rating systems in elbow research—a systematic review exploring trends and distributions of use.
Journal of Shoulder and Elbow Surgery,
27, e98-e106.
Abstract:
Clinical rating systems in elbow research—a systematic review exploring trends and distributions of use
© 2018 Journal of Shoulder and Elbow Surgery Board of Trustees Background: Clinical rating systems are used as outcome measures in clinical trials and attempt to gauge the patient’s view of his or her own health. The choice of clinical rating system should be supported by its performance against established quality standards. Methods: a search strategy was developed to identify all studies that reported the use of clinical rating systems in the elbow literature. The strategy was run from inception in Medline Embase and CINHAL. Data extraction identified the date of publication, country of data collection, pathology assessed, and the outcome measure used. Results: We identified 980 studies that reported clinical rating system use. Seventy-two separate rating systems were identified. Forty-one percent of studies used ≥2 separate measures. Overall, 54% of studies used the Mayo Elbow Performance Score (MEPS). For arthroplasty, 82% used MEPS, 17% used Disabilities of Arm, Shoulder and Hand (DASH), and 7% used QuickDASH. For trauma, 66.7% used MEPS, 32% used DASH, and 23% used the Morrey Score. For tendinopathy, 31% used DASH, 23% used Patient-Rated Tennis Elbow Evaluation (PRTEE), and 13% used MEPS. Over time, there was an increased proportional use of the MEPS, DASH, QuickDASH, PRTEE, and the Oxford Elbow Score. Conclusions: This study identified a wide choice and usage of clinical rating systems in the elbow literature. Numerous studies reported measures without a history of either a specific pathology or cross-cultural validation. Interpretability and comparison of outcomes is dependent on the unification of outcome measure choice. This was not demonstrated currently.
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Roso-Llorach A, Violán C, Foguet-Boreu Q, Rodriguez-Blanco T, Pons-Vigués M, Pujol-Ribera E, Valderas JM (2018). Comparative analysis of methods for identifying multimorbidity patterns: a study of 'real-world' data.
BMJ Open,
8(3).
Abstract:
Comparative analysis of methods for identifying multimorbidity patterns: a study of 'real-world' data.
OBJECTIVE: the aim was to compare multimorbidity patterns identified with the two most commonly used methods: hierarchical cluster analysis (HCA) and exploratory factor analysis (EFA) in a large primary care database. Specific objectives were: (1) to determine whether choice of method affects the composition of these patterns and (2) to consider the potential application of each method in the clinical setting. DESIGN: Cross-sectional study. Diagnoses were based on the 263 corresponding blocks of the International Classification of Diseases version 10. Multimorbidity patterns were identified using HCA and EFA. Analysis was stratified by sex, and results compared for each method. SETTING AND PARTICIPANTS: Electronic health records for 408 994 patients with multimorbidity aged 45-64 years in 274 primary health care teams from 2010 in Catalonia, Spain. RESULTS: HCA identified 53 clusters for women, with just 12 clusters including at least 2 diagnoses, and 15 clusters for men, all of them including at least two diagnoses. EFA showed 9 factors for women and 10 factors for men. We observed differences by sex and method of analysis, although some patterns were consistent. Three combinations of diseases were observed consistently across sex groups and across both methods: hypertension and obesity, spondylopathies and deforming dorsopathies, and dermatitis eczema and mycosis. CONCLUSIONS: This study showed that multimorbidity patterns vary depending on the method of analysis used (HCA vs EFA) and provided new evidence about the known limitations of attempts to compare multimorbidity patterns in real-world data studies. We found that EFA was useful in describing comorbidity relationships and HCA could be useful for in-depth study of multimorbidity. Our results suggest possible applications for each of these methods in clinical and research settings, and add information about some aspects that must be considered in standardisation of future studies: spectrum of diseases, data usage and methods of analysis.
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Davey A, Porter I, Green C, Valderas JM (2018). EXPLORING TIME-DEPENDENT VARIATION OF PATIENT-REPORTED OUTCOME SCORES ACROSS DIFFERENT TIME-POINTS FOR PATIENTS WITH MULTIPLE CONDITIONS: a MIXED METHODS LONGITUDINAL STUDY.
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Muth C, Uhlmann L, Haefeli WE, Rochon J, van den Akker M, Perera R, Güthlin C, Beyer M, Oswald F, Valderas JM, et al (2018). Effectiveness of a complex intervention on Prioritising Multimedication in Multimorbidity (PRIMUM) in primary care: results of a pragmatic cluster randomised controlled trial.
BMJ Open,
8(2).
Abstract:
Effectiveness of a complex intervention on Prioritising Multimedication in Multimorbidity (PRIMUM) in primary care: results of a pragmatic cluster randomised controlled trial.
OBJECTIVES: Investigate the effectiveness of a complex intervention aimed at improving the appropriateness of medication in older patients with multimorbidity in general practice. DESIGN: Pragmatic, cluster randomised controlled trial with general practice as unit of randomisation. SETTING: 72 general practices in Hesse, Germany. PARTICIPANTS: 505 randomly sampled, cognitively intact patients (≥60 years, ≥3 chronic conditions under pharmacological treatment, ≥5 long-term drug prescriptions with systemic effects); 465 patients and 71 practices completed the study. INTERVENTIONS: Intervention group (IG): the healthcare assistant conducted a checklist-based interview with patients on medication-related problems and reconciled their medications. Assisted by a computerised decision support system, the general practitioner optimised medication, discussed it with patients and adjusted it accordingly. The control group (CG) continued with usual care. OUTCOME MEASURES: the primary outcome was a modified Medication Appropriateness Index (MAI, excluding item 10 on cost-effectiveness), assessed in blinded medication reviews and calculated as the difference between baseline and after 6 months; secondary outcomes after 6 and 9 months' follow-up: quality of life, functioning, medication adherence, and so on. RESULTS: at baseline, a high proportion of patients had appropriate to mildly inappropriate prescriptions (MAI 0-5 points: n=350 patients). Randomisation revealed balanced groups (IG: 36 practices/252 patients; CG: 36/253). Intervention had no significant effect on primary outcome: mean MAI sum scores decreased by 0.3 points in IG and 0.8 points in CG, resulting in a non-significant adjusted mean difference of 0.7 (95% CI -0.2 to 1.6) points in favour of CG. Secondary outcomes showed non-significant changes (quality of life slightly improved in IG but continued to decline in CG) or remained stable (functioning, medication adherence). CONCLUSIONS: the intervention had no significant effects. Many patients already received appropriate prescriptions and enjoyed good quality of life and functional status. We can therefore conclude that in our study, there was not enough scope for improvement. TRIAL REGISTRATION NUMBER: ISRCTN99526053. NCT01171339; Results.
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Kluge H, Kelley E, Theodorakis PN, Barkley S, Valderas JM (2018). Forty years on from Alma Ata: present and future of Primary Health Care research.
Prim Health Care Res Dev,
19(5), 421-423.
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Sheaff R, Brand SL, Lloyd H, Wanner A, Fornasiero M, Briscoe S, Valderas JM, Byng R, Pearson M (2018). From programme theory to logic models for multispecialty community providers: a realist evidence synthesis.
Health Services and Delivery Research,
6(24), 1-210.
Abstract:
From programme theory to logic models for multispecialty community providers: a realist evidence synthesis
. Background
. The NHS policy of constructing multispecialty community providers (MCPs) rests on a complex set of assumptions about how health systems can replace hospital use with enhanced primary care for people with complex, chronic or multiple health problems, while contributing savings to health-care budgets.
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. Objectives
. To use policy-makers’ assumptions to elicit an initial programme theory (IPT) of how MCPs can achieve their outcomes and to compare this with published secondary evidence and revise the programme theory accordingly.
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. Design
. Realist synthesis with a three-stage method: (1) for policy documents, elicit the IPT underlying the MCP policy, (2) review and synthesise secondary evidence relevant to those assumptions and (3) compare the programme theory with the secondary evidence and, when necessary, reformulate the programme theory in a more evidence-based way.
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. Data sources
. Systematic searches and data extraction using (1) the Health Management Information Consortium (HMIC) database for policy statements and (2) topically appropriate databases, including MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Applied Social Sciences Index and Abstracts (ASSIA). A total of 1319 titles and abstracts were reviewed in two rounds and 116 were selected for full-text data extraction. We extracted data using a formal data extraction tool and synthesised them using a framework reflecting the main policy assumptions.
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. Results
. The IPT of MCPs contained 28 interconnected context–mechanism–outcome relationships. Few policy statements specified what contexts the policy mechanisms required. We found strong evidence supporting the IPT assumptions concerning organisational culture, interorganisational network management, multidisciplinary teams (MDTs), the uses and effects of health information technology (HIT) in MCP-like settings, planned referral networks, care planning for individual patients and the diversion of patients from inpatient to primary care. The evidence was weaker, or mixed (supporting some of the constituent assumptions but not others), concerning voluntary sector involvement, the effects of preventative care on hospital admissions and patient experience, planned referral networks and demand management systems. The evidence about the effects of referral reductions on costs was equivocal. We found no studies confirming that the development of preventative care would reduce demands on inpatient services. The IPT had overlooked certain mechanisms relevant to MCPs, mostly concerning MDTs and the uses of HITs.
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. Limitations
. The studies reviewed were limited to Organisation for Economic Co-operation and Development countries and, because of the large amount of published material, the period 2014–16, assuming that later studies, especially systematic reviews, already include important earlier findings. No empirical studies of MCPs yet existed.
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. Conclusions
. Multidisciplinary teams are a central mechanism by which MCPs (and equivalent networks and organisations) work, provided that the teams include the relevant professions (hence, organisations) and, for care planning, individual patients. Further primary research would be required to test elements of the revised logic model, in particular about (1) how MDTs and enhanced general practice compare and interact, or can be combined, in managing referral networks and (2) under what circumstances diverting patients from in-patient to primary care reduces NHS costs and improves the quality of patient experience.
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. Study registration
. This study is registered as PROSPERO CRD42016038900.
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. Funding
. The National Institute for Health Research (NIHR) Health Services and Delivery Research programme and supported by the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula.
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Greenhalgh J, Dalkin S, Gibbons E, Wright J, Valderas JM, Meads D, Black N (2018). How do aggregated patient-reported outcome measures data stimulate health care improvement? a realist synthesis.
J Health Serv Res Policy,
23(1), 57-65.
Abstract:
How do aggregated patient-reported outcome measures data stimulate health care improvement? a realist synthesis.
Objectives Internationally, there has been considerable debate about the role of data in supporting quality improvement in health care. Our objective was to understand how, why and in what circumstances the feedback of aggregated patient-reported outcome measures data improved patient care. Methods We conducted a realist synthesis. We identified three main programme theories underlying the use of patient-reported outcome measures as a quality improvement strategy and expressed them as nine 'if then' propositions. We identified international evidence to test these propositions through searches of electronic databases and citation tracking, and supplemented our synthesis with evidence from similar forms of performance data. We synthesized this evidence through comparing the mechanisms and impact of patient-reported outcome measures and other performance data on quality improvement in different contexts. Results Three programme theories were identified: supporting patient choice, improving accountability and enabling providers to compare their performance with others. Relevant contextual factors were extent of public disclosure, use of financial incentives, perceived credibility of the data and the practicality of the results. Available evidence suggests that patients or their agents rarely use any published performance data when selecting a provider. The perceived motivation behind public reporting is an important determinant of how providers respond. When clinicians perceived that performance indicators were not credible but were incentivized to collect them, gaming or manipulation of data occurred. Outcome data do not provide information on the cause of poor care: providers needed to integrate and interpret patient-reported outcome measures and other outcome data in the context of other data. Lack of timeliness of performance data constrains their impact. Conclusions Although there is only limited research evidence to support some widely held theories of how aggregated patient-reported outcome measures data stimulate quality improvement, several lessons emerge from interventions sharing the same programme theories to help guide the increasing use of these measures.
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Greenhalgh J, Gooding K, Gibbons E, Dalkin S, Wright J, Valderas J, Black N (2018). How do patient reported outcome measures (PROMs) support clinician-patient communication and patient care? a realist synthesis.
J Patient Rep Outcomes,
2Abstract:
How do patient reported outcome measures (PROMs) support clinician-patient communication and patient care? a realist synthesis.
Background: in this paper, we report the findings of a realist synthesis that aimed to understand how and in what circumstances patient reported outcome measures (PROMs) support patient-clinician communication and subsequent care processes and outcomes in clinical care. We tested two overarching programme theories: (1) PROMs completion prompts a process of self-reflection and supports patients to raise issues with clinicians and (2) PROMs scores raise clinicians' awareness of patients' problems and prompts discussion and action. We examined how the structure of the PROM and care context shaped the ways in which PROMs support clinician-patient communication and subsequent care processes. Results: PROMs completion prompts patients to reflect on their health and gives them permission to raise issues with clinicians. However, clinicians found standardised PROMs completion during patient assessments sometimes constrained rather than supported communication. In response, clinicians adapted their use of PROMs to render them compatible with the ongoing management of patient relationships. Individualised PROMs supported dialogue by enabling the patient to tell their story. In oncology, PROMs completion outside of the consultation enabled clinicians to identify problematic symptoms when the PROM acted as a substitute rather than addition to the clinical encounter and when the PROM focused on symptoms and side effects, rather than health related quality of life (HRQoL). Patients did not always feel it was appropriate to discuss emotional, functional or HRQoL issues with doctors and doctors did not perceive this was within their remit. Conclusions: This paper makes two important contributions to the literature. First, our findings show that PROMs completion is not a neutral act of information retrieval but can change how patients think about their condition. Second, our findings reveal that the ways in which clinicians use PROMs is shaped by their relationships with patients and professional roles and boundaries. Future research should examine how PROMs completion and feedback shapes and is influenced by the process of building relationships with patients, rather than just their impact on information exchange and decision making.
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Kluge H, Kelley E, Barkley S, Theodorakis PN, Yamamoto N, Tsoy A, Aiypkhanova A, Ganesh V, Hipgrave DB, Peterson SS, et al (2018). How primary health care can make universal health coverage a reality, ensure healthy lives, and promote wellbeing for all.
LANCET,
392(10156), 1372-1374.
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Ricci-Cabello I, Stevens S, Dalton ARH, Griffiths RI, Campbell JL, Valderas JM (2018). Identifying Primary Care Pathways from Quality of Care to Outcomes and Satisfaction Using Structural Equation Modeling.
Health Services Research,
53(1), 430-449.
Abstract:
Identifying Primary Care Pathways from Quality of Care to Outcomes and Satisfaction Using Structural Equation Modeling
Objective: to study the relationships between the different domains of quality of primary health care for the evaluation of health system performance and for informing policy decision making. Data Sources: a total of 137 quality indicators collected from 7,607 English practices between 2011 and 2012. Study Design: Cross-sectional study at the practice level. Indicators were allocated to subdomains of processes of care (“quality assurance,” “education and training,” “medicine management,” “access,” “clinical management,” and “patient-centered care”), health outcomes (“intermediate outcomes” and “patient-reported health status”), and patient satisfaction. The relationships between the subdomains were hypothesized in a conceptual model and subsequently tested using structural equation modeling. Principal Findings: the model supported two independent paths. In the first path, “access” was associated with “patient-centered care” (β = 0.63), which in turn was strongly associated with “patient satisfaction” (β = 0.88). In the second path, “education and training” was associated with “clinical management” (β = 0.32), which in turn was associated with “intermediate outcomes” (β = 0.69). “Patient-reported health status” was weakly associated with “patient-centered care” (β = −0.05) and “patient satisfaction” (β = 0.09), and not associated with “clinical management” or “intermediate outcomes.”. Conclusions: This is the first empirical model to simultaneously provide evidence on the independence of intermediate health care outcomes, patient satisfaction, and health status. The explanatory paths via technical quality clinical management and patient centeredness offer specific opportunities for the development of quality improvement initiatives.
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Wanner A, Sheaff R, Brand S, Lloyd H, Fornasiero M, Briscoe S, Valderas J, Byng R, Pearson M (2018). Information technology in multispecialty community providers: results from a realist evidence synthesis.
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Fischer F, Gibbons C, Coste J, Valderas JM, Rose M, Leplège A (2018). Measurement invariance and general population reference values of the PROMIS Profile 29 in the UK, France, and Germany.
Qual Life Res,
27(4), 999-1014.
Abstract:
Measurement invariance and general population reference values of the PROMIS Profile 29 in the UK, France, and Germany.
PURPOSE: Comparability of patient-reported outcome measures over different languages is essential to allow cross-national research. We investigate the comparability of the PROMIS Profile 29, a generic health-related quality of life measure, in general population samples in the UK, France, and Germany and present general population reference values. METHODS: a web-based survey was simultaneously conducted in the UK (n = 1509), France (1501), and Germany (1502). Along with the PROMIS Profile 29, we collected sociodemographic information as well as the EQ-5D. We tested measurement invariance by means of multigroup confirmatory factor analysis (CFA). Differences in the health-related quality of life between countries were modeled by linear regression analysis. We present general population reference data for the included PROMIS domains utilizing plausible value imputation and quantile regression. RESULTS: Multigroup CFA of the PROMIS Profile 29 showed that factor means are insensitive to potential measurement bias except in one item. We observed significant differences in patient-reported health between countries, which could be partially explained by the differences in overall ratings of health. The physical function and pain interference scales showed considerable floor effects in the normal population in all countries. CONCLUSIONS: Scores derived from the PROMIS Profile 29 are largely comparable across the UK, France, and Germany. Due to the use of plausible value imputation, the presented general population reference values can be compared to data collected with other PROMIS short forms or computer-adaptive tests.
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Sepulveda M, Alamo M, Preiss Y, Valderas JP (2018). Metabolic Surgery Comparing Sleeve Gastrectomy with Jejunal Bypass and Roux-en-Y Gastric Bypass in Type 2 Diabetic Patients After 3 Years.
OBESITY SURGERY,
28(11), 3466-3473.
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Palmer K, Marengoni A, Forjaz MJ, Jureviciene E, Laatikainen T, Mammarella F, Muth C, Navickas R, Prados-Torres A, Rijken M, et al (2018). Multimorbidity care model: Recommendations from the consensus meeting of the Joint Action on Chronic Diseases and Promoting Healthy Ageing across the Life Cycle (JA-CHRODIS).
Abstract:
Multimorbidity care model: Recommendations from the consensus meeting of the Joint Action on Chronic Diseases and Promoting Healthy Ageing across the Life Cycle (JA-CHRODIS)
Abstract.
Violán C, Roso-Llorach A, Foguet-Boreu Q, Guisado-Clavero M, Pons-Vigués M, Pujol-Ribera E, Valderas JM (2018). Multimorbidity patterns with K-means nonhierarchical cluster analysis.
BMC Fam Pract,
19(1).
Abstract:
Multimorbidity patterns with K-means nonhierarchical cluster analysis.
BACKGROUND: the purpose of this study was to ascertain multimorbidity patterns using a non-hierarchical cluster analysis in adult primary patients with multimorbidity attended in primary care centers in Catalonia. METHODS: Cross-sectional study using electronic health records from 523,656 patients, aged 45-64 years in 274 primary health care teams in 2010 in Catalonia, Spain. Data were provided by the Information System for the Development of Research in Primary Care (SIDIAP), a population database. Diagnoses were extracted using 241 blocks of diseases (International Classification of Diseases, version 10). Multimorbidity patterns were identified using two steps: 1) multiple correspondence analysis and 2) k-means clustering. Analysis was stratified by sex. RESULTS: the 408,994 patients who met multimorbidity criteria were included in the analysis (mean age, 54.2 years [Standard deviation, SD: 5.8], 53.3% women). Six multimorbidity patterns were obtained for each sex; the three most prevalent included 68% of the women and 66% of the men, respectively. The top cluster included coincident diseases in both men and women: Metabolic disorders, Hypertensive diseases, Mental and behavioural disorders due to psychoactive substance use, Other dorsopathies, and Other soft tissue disorders. CONCLUSION: Non-hierarchical cluster analysis identified multimorbidity patterns consistent with clinical practice, identifying phenotypic subgroups of patients.
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Lloyd HM, Sheaff R, Brand S, Wanner A, Byng R, Valderas J, Pearson M (2018). Patient Experiences of Care from Multi-Speciality Community Providers: Findings from a Realist Synthesis of International Evidence.
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Goodwin V, Evans J, Smith C, Gangannagaripalli J, Porter I, Valderas J (2018). Patient-Centred Outcomes in Lateral Elbow Tendinopathy: a systematic review of available evidence in UK populations.
Shoulder and Elbow Full text.
Lloyd H, Wheat H, Horrell J, Sugavanam T, Fosh B, Valderas JM, Close J (2018). Patient-Reported Measures for Person-Centered Coordinated Care: a Comparative Domain Map and Web-Based Compendium for Supporting Policy Development and Implementation.
J Med Internet Res,
20(2).
Abstract:
Patient-Reported Measures for Person-Centered Coordinated Care: a Comparative Domain Map and Web-Based Compendium for Supporting Policy Development and Implementation.
BACKGROUND: Patient-reported measure (PRM) questionnaires were originally used in research to measure outcomes of intervention studies. They have now evolved into a diverse family of tools measuring a range of constructs including quality of life and experiences of care. Current health and social care policy increasingly advocates their use for embedding the patient voice into service redesign through new models of care such as person-centered coordinated care (P3C). If chosen carefully and used efficiently, these tools can help improve care delivery through a variety of novel ways, including system-level feedback for health care management and commissioning. Support and guidance on how to use these tools would be critical to achieve these goals. OBJECTIVE: the objective of this study was to develop evidence-based guidance and support for the use of P3C-PRMs in health and social care policy through identification of PRMs that can be used to enhance the development of P3C, mapping P3C-PRMs against an existing model of domains of P3C, and integration and organization of the information in a user-friendly Web-based database. METHODS: a pragmatic approach was used for the systematic identification of candidate P3C-PRMs, which aimed at balancing comprehensiveness and feasibility. This utilized a number of resources, including existing compendiums, peer-reviewed and gray literature (using a flexible search strategy), and stakeholder engagement (which included guidance for relevant clinical areas). A subset of those candidate measures (meeting prespecified eligibility criteria) was then mapped against a theoretical model of P3C, facilitating classification of the construct being measured and the subsequent generation of shortlists for generic P3C measures, specific aspects of P3C (eg, communication or decision making), and condition-specific measures (eg, diabetes, cancer) in priority areas, as highlighted by stakeholders. RESULTS: in total, 328 P3C-PRMs were identified, which were used to populate a freely available Web-based database. of these, 63 P3C-PRMs met the eligibility criteria for shortlisting and were classified according to their measurement constructs and mapped against the theoretical P3C model. We identified tools with the best coverage of P3C, thereby providing evidence of their content validity as outcome measures for new models of care. Transitions and medications were 2 areas currently poorly covered by existing measures. All the information is currently available at a user-friendly web-based portal (p3c.org.uk), which includes all relevant information on each measure, such as the constructs targeted and links to relevant literature, in addition to shortlists according to relevant constructs. CONCLUSIONS: a detailed compendium of P3C-PRMs has been developed using a pragmatic systematic approach supported by stakeholder engagement. Our user-friendly suite of tools is designed to act as a portal to the world of PRMs for P3C, and have utility for a broad audience, including (but not limited to) health care commissioners, managers, and researchers.
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Mounce LTA, Campbell JL, Henley WE, Tejerina Arreal MC, Porter I, Valderas JM (2018). Predicting Incident Multimorbidity.
Ann Fam Med,
16(4), 322-329.
Abstract:
Predicting Incident Multimorbidity.
PURPOSE: Multimorbidity is associated with adverse outcomes, yet research on the determinants of its incidence is lacking. We investigated which sociodemographic, health, and individual lifestyle (eg, physical activity, smoking behavior, body mass index) characteristics predict new cases of multimorbidity. METHODS: We used data from 4,564 participants aged 50 years and older in the English Longitudinal Study of Aging that included a 10-year follow-up period. Discrete time-to-event (complementary log-log) models were constructed for exploring the associations of baseline characteristics with outcomes between 2002-2003 and 2012-2013 separately for participants with no initial conditions (n = 1,377) developing multimorbidity, any increase in conditions within 10 years regardless of initial conditions, and the impact of individual conditions on incident multimorbidity. RESULTS: the risks of developing multimorbidity were positively associated with age, and they were greater for the least wealthy, for participants who were obese, and for those who reported the lowest levels of physical activity or an external locus of control (believing that life events are outside of one's control) for all groups regardless of baseline conditions (all linear trends
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Close J, Byng R, Valderas JM, Britten N, Lloyd H (2018). Quality after the QOF? Before dismantling it, we need a redefined measure of 'quality'.
Br J Gen Pract,
68(672), 314-315.
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Griffiths RI, McFadden EC, Stevens RJ, Valderas JM, Lavery BA, Khan NF, Keating NL, Bankhead CR (2018). Quality of diabetes care in breast, colorectal, and prostate cancer.
J Cancer Surviv,
12(6), 803-812.
Abstract:
Quality of diabetes care in breast, colorectal, and prostate cancer.
PURPOSE: Overlooking other medical conditions during cancer treatment and follow-up could result in excess morbidity and mortality, thereby undermining gains associated with early detection and improved treatment of cancer. We compared the quality of care for diabetes patients subsequently diagnosed with breast, colorectal, or prostate cancer to matched, diabetic non-cancer controls. METHODS: Longitudinal cohort study using primary care records from the Clinical Practice Research Datalink, United Kingdom. Patients with pre-existing diabetes were followed for up to 5 years after cancer diagnosis, or after an assigned index date (non-cancer controls). Quality of diabetes care was estimated based on Quality and Outcomes Framework indicators. Mixed effects logistic regression analyses were used to compare the unadjusted and adjusted odds of meeting quality measures between cancer patients and controls, overall and stratified by type of cancer. RESULTS: 3382 cancer patients and 11,135 controls contributed 44,507 person-years of follow-up. In adjusted analyses, cancer patients were less likely to meet five of 14 quality measures, including: total cholesterol ≤ 5 mmol/L (odds ratio [OR] = 0.82; 95% confidence interval [CI], 0.75-0.90); glycosylated hemoglobin ≤ 59 mmol/mol (adjusted OR = 0.77; 95% CI, 0.70-0.85); and albumin creatinine ratio testing (adjusted OR = 0.83; 95% CI, 0.75-0.91). However, cancer patients were as likely as their matched controls to meet quality measures for other diabetes services, including retinal screening, foot examination, and dietary review. CONCLUSIONS: Although in the short-term, cancer patients were less likely to achieve target thresholds for cholesterol and HbA1c, they continued to receive high-quality diabetes primary care throughout 5 years post diagnosis. IMPLICATIONS FOR CANCER SURVIVORS: These findings are important for cancer survivors with pre-existing diabetes because they indicate that high-quality diabetes care is maintained throughout the continuum of cancer diagnosis, treatment, and follow-up.
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Garin O, Garcia-Forero C, Vilagut G, Pardo Y, Alayo I, Oriol Zerbe C, Valderas JM, Alonso J, Ferrer Fores M, Empro G, et al (2018). THE ONLINE VERSION OF EMPRO: a NEW PLATFORM SYSTEM FOR THE STANDARDIZED APPRAISAL OF PRO INSTRUMENTS.
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Davey A, Green C, Porter I, Valderas JM (2018). TIME-DEPENDENT VARIATION OF PRO SCORES IN CHRONIC CONDITIONS: a SCOPING REVIEW.
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Coste J, Rouquette A, Valderas JM, Rose M, Leplège A (2018). The French PROMIS-29. Psychometric validation and population reference values.
Revue d'Epidemiologie et de Sante Publique,
66(5), 317-324.
Abstract:
The French PROMIS-29. Psychometric validation and population reference values
Background: PROMIS-29 is a new generic standardized questionnaire measuring self-reported health status. It was developed as part of the Patient Reported Outcome Measurement Information System (PROMIS) in the United States. The objective of this study was to carry out the psychometric validation of a French-language version of PROMIS-29 and to establish general population reference values for France. Methods: Quota sampling was conducted by an independent polling company (Ipsos) to obtain a general population sample (n = 1,501) representative with regards to: gender, age, occupation, region, and population density of the place of residence. Data collected included the results of the questionnaires PROMIS-29 and Short Form Health Survey (SF-36), the presence of selected chronic diseases, and socio-demographic information. Results: the French PROMIS-29 demonstrated excellent factorial validity, confirming the 7-factor model of the original PROMIS-29. The use of modern measurement methods indicated that the PROMIS-29 scales satisfy the important characteristics of unidimensionality and, for five of the seven composite scales, invariance across age, educational level and gender. Gender and age specific (10-year intervals) reference values were generated for PROMIS-29 use in France. Conclusion: the French version of PROMIS-29 is a valid and reliable measure of self-reported health status in the French population. The instrument's sensitivity to change needs to be evaluated before its use in longitudinal studies can be recommended.
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Evans JP, Smith A, Gibbons C, Alonso J, Valderas JM (2018). The National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS): a view from the UK.
Patient Relat Outcome Meas,
9, 345-352.
Abstract:
The National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS): a view from the UK.
The interest in patient-reported outcome measures (PROMs) continues to increase as recognition of their potential utility rises in an effort to make health systems more patient-centered. The US National Institutes of Health (NIH) Patient-Reported Outcomes Measurement Information System® (PROMIS®) has used state of the art psychometric and statistical techniques to create a universal PROMs language, with potential application across the whole spectrum of health conditions, languages, and geographic locations. PROMIS offers a versatile platform where specific health domains are assessed using both standardized short forms and computerized adaptive tests, which are automatically tailored to individual patients. The scores of each health domain or a standardized profile of multiple domains are all scored on a common metric scale. PROMIS is increasingly recognized as the international gold standard for patient-centered assessment, although the use of these tools in the UK is limited. In this review, the developmental methodology of the PROMIS is described with discussion of its relevant strengths and limitations for use in the UK. We provide a case study of the largest application of the PROMIS tools in the UK as an example of straightforward integration into health-care research. Barriers to the uptake of PROMIS in the UK include the technology requirement, measurement tradition, and lack of a clear understanding of its benefits, and although potential stakeholders should cautiously consider its use, its impressive potential and increasing international utilization should be recognized.
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2017
Close J, Valderas JM, Byng R, Britten N, Lloyd H (2017). Adapting QOF to focus on wellbeing and health.
BMJ-BRITISH MEDICAL JOURNAL,
359 Full text.
Catalá-López F, Hutton B, Driver JA, Ridao M, Valderas JM, Gènova-Maleras R, Forés-Martos J, Alonso-Arroyo A, Saint-Gerons DM, Vieta E, et al (2017). Anorexia nervosa and cancer: a protocol for a systematic review and meta-analysis of observational studies.
Syst Rev,
6(1).
Abstract:
Anorexia nervosa and cancer: a protocol for a systematic review and meta-analysis of observational studies.
BACKGROUND: Anorexia nervosa is characterized by a severe restriction of caloric intake, low body weight, fear of gaining weight or of becoming fat, and disturbance of body image. Pathogenesis of the disorder may include genetic predisposition, hormonal changes and a combination of environmental, psychosocial, and cultural factors. Cancer is the second leading cause of death worldwide. At present, no systematic reviews and meta-analyses have evaluated the risk of cancer in people with anorexia nervosa. The objective of this study will be to evaluate the association between anorexia nervosa and the risk of developing or dying from cancer. METHODS/DESIGN: This study protocol is part of a systematic collection and assessment of multiple systematic reviews and meta-analyses (umbrella review) evaluating the association of cancer and multiple central nervous system disorders. We designed a specific protocol for a new systematic review and meta-analysis of observational studies of anorexia nervosa with risk of developing or dying from any cancer. Data sources will be PubMed, Embase, Scopus, Web of Science, and manual screening of references. Observational studies (case-control and cohort) in humans that examined the association between anorexia nervosa and risk of developing or dying from cancer will be sought. The primary outcomes will be cancer incidence and cancer mortality in association with anorexia nervosa. Secondary outcomes will be site-specific cancer incidence and mortality, respectively. Screening of abstracts and full texts, and data abstraction will be performed by two team members independently. Conflicts at all levels of screening and abstraction will be resolved through discussion. The quality of studies will be assessed by using the Ottawa-Newcastle scale by two team members independently. Random effects models will be conducted where appropriate. Subgroup and additional analyses will be conducted to explore the potential sources of heterogeneity. The World Cancer Research Fund (WCRF)/American Institute for Cancer Research (AICR) criteria and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach will be used for determining the quality of evidence for cancer outcomes. DISCUSSION: Findings from this systematic review will inform an ongoing umbrella review on cancer and central nervous system disorders. Our systematic review and meta-analysis of observational studies will establish the extent of the epidemiological evidence underlying the association between anorexia nervosa and cancer. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42017067462.
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Evans JP, Smith CM, Porter I, Gangannagaripalli J, Bramwell C, Davey AF, Goodwin V, Valderas JM (2017). Assessing condition-specific health-related quality of life in lateral epicondylar tendinopathy: a systematic and standardised comparison of available instruments.
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Chalk D, Manzi S, Britten N, Kluettgens B, Magura R, Valderas J (2017). Can agent-based simulation be used as a tool to support polypharmacy prescribing practice?.
BMJ Simulation and Technology Enhanced Learning,
3(3), 94-98.
Abstract:
Can agent-based simulation be used as a tool to support polypharmacy prescribing practice?
ObjectiveWe sought to develop a simulation modelling method to help better understand the complex interplay of factors that lead to people with type 2 diabetes and asthma not taking all of their medication as prescribed when faced with multiple medications (polypharmacy).Research design and methodsIn collaboration with polypharmacy patients, general practitioners, pharmacists and polypharmacy researchers, we developed a map of factors that directly and indirectly affect somebody’s decision to take their medication as prescribed when faced with multiple type 2 diabetes and asthma medications. We then translated these behavioural influences into logical rules using data from the literature and developed a proof-of-concept agent-based simulation model that captures the medicine-taking behaviours of those with type 2 diabetes and asthma taking multiple medications and which predicts both the clinical effectiveness and rates of adherence for different combinations of medications.ConclusionsThe model we have developed could be used as a prescription support tool or a way of estimating medicine-taking behaviour in cost-effectiveness analyses.
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Catalá-López F, Hutton B, Driver JA, Page MJ, Ridao M, Valderas JM, Alonso-Arroyo A, Forés-Martos J, MartÃnez S, Gènova-Maleras R, et al (2017). Cancer and central nervous system disorders: protocol for an umbrella review of systematic reviews and updated meta-analyses of observational studies.
Syst Rev,
6(1).
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Cancer and central nervous system disorders: protocol for an umbrella review of systematic reviews and updated meta-analyses of observational studies.
BACKGROUND: the objective of this study will be to synthesize the epidemiological evidence and evaluate the validity of the associations between central nervous system disorders and the risk of developing or dying from cancer. METHODS/DESIGN: We will perform an umbrella review of systematic reviews and conduct updated meta-analyses of observational studies (cohort and case-control) investigating the association between central nervous system disorders and the risk of developing or dying from any cancer or specific types of cancer. Searches involving PubMed/MEDLINE, EMBASE, SCOPUS and Web of Science will be used to identify systematic reviews and meta-analyses of observational studies. In addition, online databases will be checked for observational studies published outside the time frames of previous reviews. Eligible central nervous system disorders will be Alzheimer's disease, anorexia nervosa, amyotrophic lateral sclerosis, autism spectrum disorders, bipolar disorder, depression, Down's syndrome, epilepsy, Huntington's disease, multiple sclerosis, Parkinson's disease and schizophrenia. The primary outcomes will be cancer incidence and cancer mortality in association with a central nervous system disorder. Secondary outcome measures will be site-specific cancer incidence and mortality, respectively. Two reviewers will independently screen references identified by the literature search, as well as potentially relevant full-text articles. Data will be abstracted, and study quality/risk of bias will be appraised by two reviewers independently. Conflicts at all levels of screening and abstraction will be resolved through discussion. Random-effects meta-analyses of primary observational studies will be conducted where appropriate. Parameters for exploring statistical heterogeneity are pre-specified. The World Cancer Research Fund (WCRF)/American Institute for Cancer Research (AICR) criteria and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach will be used for determining the quality of evidence for cancer outcomes. DISCUSSION: Our study will establish the extent of the epidemiological evidence underlying the associations between central nervous system disorders and cancer and will provide a rigorous and updated synthesis of a range of important site-specific cancer outcomes. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016052762.
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Lloyd HM, Pearson M, Sheaff R, Asthana S, Wheat H, Sugavanam TP, Britten N, Valderas J, Bainbridge M, Witts L, et al (2017). Collaborative action for person-centred coordinated care (P3C): an approach to support the development of a comprehensive system-wide solution to fragmented care.
Health Res Policy Syst,
15(1).
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Collaborative action for person-centred coordinated care (P3C): an approach to support the development of a comprehensive system-wide solution to fragmented care.
BACKGROUND: Fragmented care results in poor outcomes for individuals with complexity of need. Person-centred coordinated care (P3C) is perceived to be a potential solution, but an absence of accessible evidence and the lack of a scalable 'blue print' mean that services are 'experimenting' with new models of care with little guidance and support. This paper presents an approach to the implementation of P3C using collaborative action, providing examples of early developments across this programme of work, the core aim of which is to accelerate the spread and adoption of P3C in United Kingdom primary care settings. METHODS: Two centrally funded United Kingdom organisations (South West Collaboration for Leadership in Applied Health Research and Care and South West Academic Health Science Network) are leading this initiative to narrow the gap between research and practice in this urgent area of improvement through a programme of service change, evaluation and research. Multi-stakeholder engagement and co-design are core to the approach. A whole system measurement framework combines outcomes of importance to patients, practitioners and health organisations. Iterative and multi-level feedback helps to shape service change while collecting practice-based data to generate implementation knowledge for the delivery of P3C. The role of the research team is proving vital to support informed change and challenge organisational practice. The bidirectional flow of knowledge and evidence relies on the transitional positioning of researchers and research organisations. RESULTS: Extensive engagement and embedded researchers have led to strong collaborations across the region. Practice is beginning to show signs of change and data flow and exchange is taking place. However, working in this way is not without its challenges; progress has been slow in the development of a linked data set to allow us to assess impact innovations from a cost perspective. Trust is vital, takes time to establish and is dependent on the exchange of services and interactions. If collaborative action can foster P3C it will require sustained commitment from both research and practice. This approach is a radical departure from how policy, research and practice traditionally work, but one that we argue is now necessary to deal with the most complex health and social problems.
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Mounce LTA, Price S, Valderas JM, Hamilton W (2017). Comorbid conditions delay diagnosis of colorectal cancer: a cohort study using electronic primary care records.
Br J Cancer,
116(12), 1536-1543.
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Comorbid conditions delay diagnosis of colorectal cancer: a cohort study using electronic primary care records.
BACKGROUND: Pre-existing non-cancer conditions may complicate and delay colorectal cancer diagnosis. METHOD: Incident cases (aged ⩾40 years, 2007-2009) with colorectal cancer were identified in the Clinical Practice Research Datalink, UK. Diagnostic interval was defined as time from first symptomatic presentation of colorectal cancer to diagnosis. Comorbid conditions were classified as 'competing demands' (unrelated to colorectal cancer) or 'alternative explanations' (sharing symptoms with colorectal cancer). The association between diagnostic interval (log-transformed) and age, gender, consultation rate and number of comorbid conditions was investigated using linear regressions, reported using geometric means. RESULTS: Out of the 4512 patients included, 72.9% had ⩾1 competing demand and 31.3% had ⩾1 alternative explanation. In the regression model, the numbers of both types of comorbid conditions were independently associated with longer diagnostic interval: a single competing demand delayed diagnosis by 10 days, and four or more by 32 days; and a single alternative explanation by 9 days. For individual conditions, the longest delay was observed for inflammatory bowel disease (26 days; 95% CI 14-39). CONCLUSIONS: the burden and nature of comorbidity is associated with delayed diagnosis in colorectal cancer, particularly in patients aged ⩾80 years. Effective clinical strategies are needed for shortening diagnostic interval in patients with comorbidity.
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Mounce L, Gangannagaripalli J, Ricci-Cabello I, Avery AJ, Valderas JM (2017). Development of two short versions of the Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) questionnaire: PREOS-PC Compact and PREOS-PC-6.
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Prados-Torres A, Del Cura-González I, Prados-Torres D, López-RodrÃguez JA, Leiva-Fernández F, Calderón-Larrañaga A, López-Verde F, Gimeno-Feliu LA, Escortell-Mayor E, Pico-Soler V, et al (2017). Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy: study protocol of a cluster randomized clinical trial (Multi-PAP project).
Implement Sci,
12(1).
Abstract:
Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy: study protocol of a cluster randomized clinical trial (Multi-PAP project).
BACKGROUND: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12 months, as compared with usual care. METHODS/DESIGN: Design: pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. SCOPE: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). POPULATION: patients aged 65-74 years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3 months). SAMPLE SIZE: n = 400 (200 per study arm). INTERVENTION: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. OUTCOMES: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. STATISTICAL ANALYSIS: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. DISCUSSION: it is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. TRIAL REGISTRATION: Clinicaltrials.gov, NCT02866799.
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Greenhalgh J, Dalkin SM, Gibbons E, Wright J, Black N, Valderas JM, Meads D (2017). How does PROMs feedback work as a quality improvement strategy? Lessons from the feedback of other forms of performance data.
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Ricci-Cabello I, Reeves D, Bell BG, Valderas JM (2017). Identifying patient and practice characteristics associated with patient-reported experiences of safety problems and harm: a cross-sectional study using a multilevel modelling approach.
BMJ Qual Saf,
26(11), 899-907.
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Identifying patient and practice characteristics associated with patient-reported experiences of safety problems and harm: a cross-sectional study using a multilevel modelling approach.
OBJECTIVE: to identify patient and family practice characteristics associated with patient-reported experiences of safety problems and harm. DESIGN: Cross-sectional study combining data from the individual postal administration of the validated Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) questionnaire to a random sample of patients in family practices (response rate=18.4%) and practice-level data for those practices obtained from NHS Digital. We built linear multilevel multivariate regression models to model the association between patient-level (clinical and sociodemographic) and practice-level (size and case-mix, human resources, indicators of quality and safety of care, and practice safety activation) characteristics, and outcome measures. SETTING: Practices distributed across five regions in the North, Centre and South of England. PARTICIPANTS: 1190 patients registered in 45 practices purposefully sampled (maximal variation in practice size and levels of deprivation). MAIN OUTCOME MEASURES: Self-reported safety problems, harm and overall perception of safety. RESULTS: Higher self-reported levels of safety problems were associated with younger age of patients (beta coefficient 0.15) and lower levels of practice safety activation (0.44). Higher self-reported levels of harm were associated with younger age (0.13) and worse self-reported health status (0.23). Lower self-reported healthcare safety was associated with lower levels of practice safety activation (0.40). The fully adjusted models explained 4.5% of the variance in experiences of safety problems, 8.6% of the variance in harm and 4.4% of the variance in perceptions of patient safety. CONCLUSIONS: Practices' safety activation levels and patients' age and health status are associated with patient-reported safety outcomes in English family practices. The development of interventions aimed at improving patient safety outcomes would benefit from focusing on the identified groups.
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Ricci-Cabello I, Saletti-Cuesta L, Slight SP, Valderas JM (2017). Identifying patient-centred recommendations for improving patient safety in General Practices in England: a qualitative content analysis of free-text responses using the Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) questionnaire.
Health Expect,
20(5), 961-972.
Abstract:
Identifying patient-centred recommendations for improving patient safety in General Practices in England: a qualitative content analysis of free-text responses using the Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) questionnaire.
BACKGROUND: There is a growing interest in identifying strategies to achieve safer primary health-care provision. However, most of the research conducted so far in this area relies on information supplied by health-care providers, and limited attention has been paid to patients' perspectives. OBJECTIVE: to explore patients' experiences and perceptions of patient safety in English general practices with the aim of eliciting patient-centred recommendations for improving patient safety. METHODS: the Patient Reported Experiences and Outcomes of Safety in Primary Care questionnaire was sent to a random sample of 6736 primary care users registered in 45 English practices. We conducted a qualitative content analysis of responses to seven open-ended items addressing patients' experiences of safety problems, lessons learnt as a result of such experiences and recommendations for safer health care. RESULTS: a total of 1244 (18.4%) participants returned completed questionnaires. of those, 678 (54.5%) responded to at least one open-ended question. Two main themes emerged as follows: (i) experiences of safety problems and (ii) good practices and recommendations to improve patient safety in primary care. Most frequent experiences of safety problems were related to appointments, coordination between providers, tests, medication and diagnosis. Patients' responses to these problems included increased patient activation (eg speaking up about concerns with their health care) and avoidance of unnecessary health care. Recommendations for safer health care included improvements in patient-centred communication, continuity of care, timely appointments, technical quality of care, active monitoring, teamwork, health records and practice environment. CONCLUSION: This study identified a number of patient-centred recommendations for improving patient safety in English general practices.
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Gangannagaripalli J, Porter I, Bradley DG, Ricci-Cabello I, Valderas JM (2017). Individualised patient-reported outcome measures: a systematic review.
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Griffiths RI, Valderas JM, McFadden EC, Bankhead CR, Lavery BA, Khan NF, Stevens RJ, Keating NL (2017). Outcomes of preexisting diabetes mellitus in breast, colorectal, and prostate cancer.
Journal of Cancer Survivorship,
11(5), 604-613.
Abstract:
Outcomes of preexisting diabetes mellitus in breast, colorectal, and prostate cancer
Purpose: Preexisting diabetes is associated with increased morbidity and mortality in cancer. We examined the impact of incident cancer on the long-term outcomes of diabetes. Methods: Using the United Kingdom Clinical Practice Research Datalink, we identified three cohorts of diabetes patients subsequently diagnosed with breast, colorectal, or prostate cancer, each matched to diabetic noncancer controls. Patients were required to have survived at least 1 year after cancer diagnosis (cases) or a matched index date (controls), and were followed up to 10 years for incident microvascular and macrovascular complications and mortality. Multivariate competing risks regression analyses were used to compare outcomes between cancer patients and controls. Results: Overall, there were 3382 cancer patients and 11,135 controls with 59,431 person-years of follow-up. In adjusted analyses, there were no statistically significant (p ≤ 0.05) differences in diabetes complication rates between cancer patients and their controls in any of the three cancer cohorts. Combined, cancer patients were less likely (adjusted hazard ratio [HR] 0.88; 95% CI = 0.79–0.98) to develop retinopathy. Cancer patients were more likely to die of any cause (including cancer), but prostate cancer patients were less likely to die of causes associated with diabetes (HR 0.61; 95% CI = 0.43–0.88). Conclusions and implications: There is no evidence that incident cancer had an adverse impact on the long-term outcomes of preexisting diabetes. Implications for Cancer Survivors: These findings are important for cancer survivors with preexisting diabetes because they suggest that substantial improvements in the relative survival of several of the most common types of cancer are not undermined by excess diabetes morbidity and mortality.
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Klapproth CM, Leplege A, Gibbons C, Coste J, Valderas JM, Rose M, Fischer F (2017). PREDICTING EQ-5D INDEX SCORES FROM PROMIS PROFILE 29 IN THE UNITED KINGDOM, FRANCE, AND GERMANY.
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Ricci-Cabello I, Marsden KS, Avery AJ, Bell BG, Kadam UT, Reeves D, Slight SP, Perryman K, Barnett J, Litchfield I, et al (2017). Patients' evaluations of patient safety in English general practices: a cross-sectional study.
Br J Gen Pract,
67(660), e474-e482.
Abstract:
Patients' evaluations of patient safety in English general practices: a cross-sectional study.
BACKGROUND: Description of safety problems and harm in general practices has previously relied on information from health professionals, with scarce attention paid to experiences of patients. AIM: to examine patient-reported experiences and outcomes of patient safety in primary care. DESIGN AND SETTING: Cross-sectional study in 45 general practices across five regions in the north, centre, and south of England. METHOD: a version of the Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) questionnaire was sent to a random sample of 6736 patients. Main outcome measures included 'practice activation' (what a practice does to create a safe environment); 'patient activation' (how proactive are patients in ensuring safe healthcare delivery); 'experiences of safety events' (safety errors); 'outcomes of safety' (harm); and 'overall perception of safety' (how safe patients rate their practice). RESULTS: Questionnaires were returned by 1244 patients (18.4%). Scores were high for 'practice activation' (mean [standard error] = 80.4 out of 100 [2.0]) and low for 'patient activation' (26.3 out of 100 [2.6]). of the patients, 45% reported experiencing at least one safety problem in the previous 12 months, mostly related to appointments (33%), diagnosis (17%), patient provider communication (15%), and coordination between providers (14%). Twenty-three per cent of the responders reported some degree of harm in the previous 12 months. The overall assessment of level of safety of practices was generally high (86.0 out of 100 [16.8]). CONCLUSION: Priority areas for patient safety improvement in general practices in England include appointments, diagnosis, communication, coordination, and patient activation.
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Foguet-Boreu Q, Violán C, López Jiménez T, Pons-Vigués M, RodrÃguez-Blanco T, Valderas JM, Guisado Clavero M, Pujol-Ribera E (2017). Pharmacological control of diabetes and hypertension comorbidity in the elderly: a study of "real world" data.
Prim Care Diabetes,
11(4), 348-359.
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Pharmacological control of diabetes and hypertension comorbidity in the elderly: a study of "real world" data.
AIMS: the study aimed to determine which drug combinations achieve better control in comorbid diabetes and hypertension in a pragmatic sample of primary health care patients. METHODS: Cross-sectional study. SETTING: 251 primary health care centres in Catalonia, Spain. PARTICIPANTS: individuals ≥65 years old with a dual diagnosis of hypertension and diabetes. MAIN OUTCOME MEASURES: good control criteria were established as glycated haemoglobin ≤7% and blood pressure
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Klapproth CP, Leplege A, Gibbons C, Coste J, Valderas JM, Rose M, Fischer F (2017). Predicting EQ-5D index scores from PROMIS Profile 29 in the United Kingdom, France, and Germany.
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Gibbons C, Richards S, Valderas JM, Campbell J (2017). Supervised Machine Learning Algorithms can Classify Open-Text Feedback of Doctor Performance with Human-Level Accuracy.
Journal of Medical Internet Research,
19(3), e65-e65.
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Davey AF, Porter I, Green C, Coombes J, Gibbons C, Valderas JM (2017). Time-dependent variation of PRO measurements in patients with chronic health conditions: a systematic scoping review.
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2016
Gibbons C, Valderas JM, Skevington SM (2016). Adaptive tests for long term conditions (ATLanTiC): supporting patient centred care for patients with long term conditions.
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Stevens S, Valderas JM, Doran T, Perera R, Kontopantelis E (2016). Analysing indicators of performance, satisfaction, or safety using empirical logit transformation.
BMJ,
352 Author URL.
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Kontopantelis E, Springate DA, Ashcroft DM, Valderas JM, van der Veer SN, Reeves D, Guthrie B, Doran T (2016). Associations between exemption and survival outcomes in the UK's primary care pay-for-performance programme: a retrospective cohort study.
BMJ Qual Saf,
25(9), 657-670.
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Associations between exemption and survival outcomes in the UK's primary care pay-for-performance programme: a retrospective cohort study.
OBJECTIVES: the UK's Quality and Outcomes Framework permits practices to exempt patients from financially-incentivised performance targets. To better understand the determinants and consequences of being exempted from the framework, we investigated the associations between exception reporting, patient characteristics and mortality. We also quantified the proportion of exempted patients that met quality targets for a tracer condition (diabetes). DESIGN: Retrospective longitudinal study, using individual patient data from the Clinical Practice Research Datalink. SETTING: 644 general practices, 2006/7 to 2011/12. PARTICIPANTS: Patients registered with study practices for at least one year over the study period, with at least one condition of interest (2 460 341 in total). MAIN OUTCOME MEASURES: Exception reporting rates by reason (clinical contraindication, patient dissent); all-cause mortality in year following exemption. Analyses with logistic and Cox proportional-hazards regressions, respectively. RESULTS: the odds of being exempted increased with age, deprivation and multimorbidity. Men were more likely to be exempted but this was largely attributable to higher prevalence of conditions with high exemption rates. Modest associations remained, with women more likely to be exempted due to clinical contraindication (OR 0.90, 99% CI 0.88 to 0.92) and men more likely to be exempted due to informed dissent (OR 1.08, 99% CI 1.06 to 1.10). More deprived areas (both for practice location and patient residence) were non-linearly associated with higher exception rates, after controlling for comorbidities and other covariates, with stronger associations for clinical contraindication. Compared with patients with a single condition, odds ratios for patients with two, three, or four or more conditions were respectively 4.28 (99% CI 4.18 to 4.38), 16.32 (99% CI 15.82 to 16.83) and 68.69 (99% CI 66.12 to 71.37) for contraindication, and 2.68 (99% CI 2.63 to 2.74), 4.02 (99% CI 3.91 to 4.13) and 5.17 (99% CI 5.00 to 5.35) for informed dissent. Exempted patients had a higher adjusted risk of death in the following year than non-exempted patients, regardless of whether this exemption was for contraindication (hazard ratio 1.37, 99% CI 1.33 to 1.40) or for informed dissent (1.20, 99% CI 1.17 to 1.24). On average, quality standards were met for 48% of exempted patients in the diabetes domain, but there was wide variation across indicators (ranging from 8 to 80%). CONCLUSIONS: Older, multimorbid and more deprived patients are more likely to be exempted from the scheme. Exception reported patients are more likely to die in the following year, whether they are exempted by the practice for a contraindication or by themselves through informed dissent. Further research is needed to understand the relationship between exception reporting and patient outcomes.
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Gibbons C, Bower P, Lovell K, Valderas J, Skevington S (2016). Electronic Quality of Life Assessment Using Computer-Adaptive Testing.
Journal of Medical Internet Research,
18(9), e240-e240.
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Gangannagaripalli J, Porter I, Bramwell C, Evans J, Lopez JRG, Valderas JM (2016). Estimating minimum important difference (MID) for chronic disease-specific patient reported outcome measures (PROMs): a systematic review.
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Porter I, Gonçalves-Bradley D, Ricci-Cabello I, Gibbons C, Gangannagaripalli J, Fitzpatrick R, Black N, Greenhalgh J, Valderas JM (2016). Framework and guidance for implementing patient-reported outcomes in clinical practice: evidence, challenges and opportunities.
J Comp Eff Res,
5(5), 507-519.
Abstract:
Framework and guidance for implementing patient-reported outcomes in clinical practice: evidence, challenges and opportunities.
Patient-reported outcomes (PROs) are reports of the status of a patient's health condition that come directly from the patient. While PRO measures are a well-developed technology with robust standards in research, their use for informing healthcare decisions is still poorly understood. We review relevant examples of their application in the provision of healthcare and examine the challenges associated with implementing PROs in clinical settings. We evaluate evidence for their use and examine barriers to their uptake, and present an evidence-based framework for the successful implementation of PROs in clinical practice. We discuss current and future developments for the use of PROs in clinical practice, such as individualized measurement and computer-adaptive testing.
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Porter I, Gangannagaripalli J, Bramwell C, Valderas JM (2016). Integrating Patient Reported Outcome Measures (PROMs) into routine primary care for patients with multimorbidity: a feasibility study.
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Ricci-Cabello I, Avery AJ, Reeves D, Kadam UT, Valderas JM (2016). Measuring Patient Safety in Primary Care: the Development and Validation of the "Patient Reported Experiences and Outcomes of Safety in Primary Care" (PREOS-PC).
Ann Fam Med,
14(3), 253-261.
Abstract:
Measuring Patient Safety in Primary Care: the Development and Validation of the "Patient Reported Experiences and Outcomes of Safety in Primary Care" (PREOS-PC).
PURPOSE: We set out to develop and validate a patient-reported instrument for measuring experiences and outcomes related to patient safety in primary care. METHOD: the instrument was developed in a multistage process supported by an international expert panel and informed by a systematic review of instruments, a meta-synthesis of qualitative studies, 4 patient focus groups, 18 cognitive interviews, and a pilot study. The trial version of Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) covered 5 domains and 11 scales: practice activation (1 scale); patient activation (1 scale); experiences of patient safety events (1 scale); harm (6 scales); and general perceptions of patient safety (2 scales). The questionnaire was posted to 6,736 patients in 45 practices across England. We used "gold standard" psychometric methods to evaluate its acceptability, reliability, structural and construct validity, and ability to discriminate among practices. RESULTS: 1,244 completed questionnaires (18.5%) were returned. Median item-specific response rate was 91.3% (interquartile range 28.0%). No major ceiling or floor effects were observed. All 6 multi-item scales showed high internal consistency (Cronbach's α 0.75-0.96). Factor analysis, correlation between scales, and known group analyses generally supported structural and construct validity. The scales demonstrated a heterogeneous ability to discriminate between practices. The final version of PREOS-PC consisted of 5 domains, 8 scales, and 58 items. CONCLUSIONS: PREOS-PC is a new multi-dimensional patient safety instrument for primary care developed with experts and patients. Initial testing shows its potential for use in primary care, and future developments will further address its use in actual clinical practice.
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Valderas Martinez JM, Ricci-Cabello N, Prasopa-Plazier N, Wensing M, Santana MJ, Kaitiritimba R, Vazquez Curiel E, Murphy M (2016).
Patient Engagement: WHO Technical Series on Safer Primary Care. World Health Organisation, Geneva, World Health Organisation. 25 pages.
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Porter I, Valderas JM (2016). Patient reported outcomes (PROMs) based recommendation in clinical guidance for the management of chronic conditions in the United Kingdom.
Author URL.
Black N, Burke L, Forrest CB, Sieberer UHR, Ahmed S, Valderas JM, Bartlett SJ, Alonso J (2016). Patient-reported outcomes: pathways to better health, better services, and better societies.
Qual Life Res,
25(5), 1103-1112.
Abstract:
Patient-reported outcomes: pathways to better health, better services, and better societies.
While the use of PROs in research is well established, many challenges lie ahead as their use is extended to other applications. There is consensus that health outcome evaluations that include PROs along with clinician-reported outcomes and administrative data are necessary to inform clinical and policy decisions. The initiatives presented in this paper underline evolving recognition that PROs play a unique role in adding the patient perspective alongside clinical (e.g. blood pressure) and organizational (e.g. admission rates) indicators for evaluating the effects of new products, selecting treatments, evaluating quality of care, and monitoring the health of the population. In this paper, we first explore the use of PRO measures to support drug approval and labeling claims. We critically evaluate the evidence and challenges associated with using PRO measures to improve healthcare delivery at individual and population levels. We further discuss the challenges associated with selecting from the abundance of measures available, opportunities afforded by agreeing on common metrics for constructs of interest, and the importance of establishing an evidence base that supports integrating PRO measures across the healthcare system to improve outcomes. We conclude that the integration of PROs as a key end point within individual patient care, healthcare organization and program performance evaluations, and population surveillance will be essential for evaluating whether increased healthcare expenditure is translating into better health outcomes.
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Ricci-Cabello I, Pons-Vigués M, Berenguera A, Pujol-Ribera E, Slight SP, Valderas JM (2016). Patients' perceptions and experiences of patient safety in primary care in England.
Fam Pract,
33(5), 535-542.
Abstract:
Patients' perceptions and experiences of patient safety in primary care in England.
BACKGROUND: One of the most remarkable features of patient safety research in primary care is the sparse attention paid to patients' own experiences. OBJECTIVE: to explore patient's perceptions and experiences of patient safety in primary care in England. METHODS: We conducted a qualitative study in the South of England with an opportunistic sample of 27 primary care users. Information was obtained from four patient focus groups. A thematic content analysis was conducted by three analysts and consensus reached within the research team on the key themes that emerged. RESULTS: Participants' conceptualizations of patient safety referred to high standards of health care delivery within a relationship of trust. Participants identified four main factors that they believed could potentially affect patient safety. These included factors related to (i) the patient (attitudes, behaviours and health literacy); (ii) the health professional (attitudes, behaviours and accuracy of diagnoses); (iii) the relationship between patients and health professionals (communication and trust); and (iv) the health care system (workload, resources, care coordination, accessibility, interdisciplinary teamwork and accuracy of health care records). Confidentiality, continuity of care and treatment-related safety emerged as cross-cutting major threats to patient safety. CONCLUSIONS: the exploration of participants' perceptions and experiences allowed the identification of a wide variety of themes that were perceived to impact on patient safety in primary care. The findings of this study could be used to enrich current frameworks that are exclusively based on professional or health care system perspectives.
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Muth C, Harder S, Uhlmann L, Rochon J, Fullerton B, Güthlin C, Erler A, Beyer M, van den Akker M, Perera R, et al (2016). Pilot study to test the feasibility of a trial design and complex intervention on PRIoritising MUltimedication in Multimorbidity in general practices (PRIMUMpilot).
BMJ Open,
6(7).
Abstract:
Pilot study to test the feasibility of a trial design and complex intervention on PRIoritising MUltimedication in Multimorbidity in general practices (PRIMUMpilot).
OBJECTIVE: to improve medication appropriateness and adherence in elderly patients with multimorbidity, we developed a complex intervention involving general practitioners (GPs) and their healthcare assistants (HCA). In accordance with the Medical Research Council guidance on developing and evaluating complex interventions, we prepared for the main study by testing the feasibility of the intervention and study design in a cluster randomised pilot study. SETTING: 20 general practices in Hesse, Germany. PARTICIPANTS: 100 cognitively intact patients ≥65â€
years with ≥3 chronic conditions, ≥5 chronic prescriptions and capable of participating in telephone interviews; 94 patients completed the study. INTERVENTION: the HCA conducted a checklist-based interview with patients on medication-related problems and reconciled their medications. Assisted by a computerised decision-support system (CDSS), the GPs discussed medication intake with patients and adjusted their medication regimens. The control group continued with usual care. OUTCOME MEASURES: Feasibility of the intervention and required time were assessed for GPs, HCAs and patients using mixed methods (questionnaires, interviews and case vignettes after completion of the study). The feasibility of the study was assessed concerning success of achieving recruitment targets, balancing cluster sizes and minimising drop-out rates. Exploratory outcomes included the medication appropriateness index (MAI), quality of life, functional status and adherence-related measures. MAI was evaluated blinded to group assignment, and intra-rater/inter-rater reliability was assessed for a subsample of prescriptions. RESULTS: 10 practices were randomised and analysed per group. GPs/HCAs were satisfied with the interventions despite the time required (35/45â€
min/patient). In case vignettes, GPs/HCAs needed help using the CDSS. The study made no patients feel uneasy. Intra-rater/inter-rater reliability for MAI was excellent. Inclusion criteria were challenging and potentially inadequate, and should therefore be adjusted. Outcome measures on pain, functionality and self-reported adherence were unfeasible due to frequent missing values, an incorrect manual or potentially invalid results. CONCLUSIONS: Intervention and trial design were feasible. The pilot study revealed important limitations that influenced the design and conduct of the main study, thus highlighting the value of piloting complex interventions. TRIAL REGISTRATION NUMBER: ISRCTN99691973; Results.
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Porter I, Evans P, Valderas JM (2016). Routine individualized PRO feedback for the management of patients with multimorbidity in primary care: a pilot study in General Practice in England.
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Violán C, Foguet-Boreu Q, Roso-Llorach A, Rodriguez-Blanco T, Pons-Vigués M, Pujol-Ribera E, Valderas JM (2016). [Multimorbidity patterns in young adults in Catalonia: an analysis of clusters].
Aten Primaria,
48(7), 479-492.
Abstract:
[Multimorbidity patterns in young adults in Catalonia: an analysis of clusters].
OBJECTIVE: the aim of this study was to identify multimorbidity patterns in patients from 19 to 44 years attended in primary care in Catalonia in 2010. DESIGN: Cross-sectional study. SETTING: 251 primary care centres. PARTICIPANTS: 530,798 people with multimorbidity, aged 19 to 44 years. MAIN OUTCOME MEASURES: Multimorbidity was defined as the coexistence of ≥2 more International Classification system (ICD-10) registered in the electronic health record. Multimorbidity patterns were identified using hierarchical cluster analysis and by sex and age group (19-24 and 25-44). RESULTS: of the 882,708 people from initial population, 530,798 (60.1%) accomplished multimorbidity criterion. Mean age was 33.0 years (SD: 7.0) and 53.3% were women. Multimorbidity was higher in the 25-to 44-years-old group with respect the younger group (60.5 vs. 58.1%, p
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2015
Verstappen W, Gaal S, Bowie P, Parker D, Lainer M, Valderas JM, Wensing M, Esmail A (2015). A research agenda on patient safety in primary care. Recommendations by the LINNEAUS collaboration on patient safety in primary care.
EUROPEAN JOURNAL OF GENERAL PRACTICE,
21, 72-77.
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Ble A, Masoli JAH, Barry HE, Winder RE, Tavakoly B, Henley WE, Kuchel GA, Valderas JM, Melzer D, Richards SH, et al (2015). Any versus long-term prescribing of high risk medications in older people using 2012 Beers Criteria: results from three cross-sectional samples of primary care records for 2003/4, 2007/8 and 2011/12.
BMC Geriatr,
15Abstract:
Any versus long-term prescribing of high risk medications in older people using 2012 Beers Criteria: results from three cross-sectional samples of primary care records for 2003/4, 2007/8 and 2011/12.
BACKGROUND: High risk medications are commonly prescribed to older US patients. Currently, less is known about high risk medication prescribing in other Western Countries, including the UK. We measured trends and correlates of high risk medication prescribing in a subset of the older UK population (community/institutionalized) to inform harm minimization efforts. METHODS: Three cross-sectional samples from primary care electronic clinical records (UK Clinical Practice Research Datalink, CPRD) in fiscal years 2003/04, 2007/08 and 2011/12 were taken. This yielded a sample of 13,900 people aged 65 years or over from 504 UK general practices. High risk medications were defined by 2012 Beers Criteria adapted for the UK. Using descriptive statistical methods and regression modelling, prevalence of 'any' (drugs prescribed at least once per year) and 'long-term' (drugs prescribed all quarters of year) high risk medication prescribing and correlates were determined. RESULTS: While polypharmacy rates have risen sharply, high risk medication prevalence has remained stable across a decade. A third of older (65+) people are exposed to high risk medications, but only half of the total prevalence was long-term (any = 38.4 % [95 % CI: 36.3, 40.5]; long-term = 17.4 % [15.9, 19.9] in 2011/12). Long-term but not any high risk medication exposure was associated with older ages (85 years or over). Women and people with higher polypharmacy burden were at greater risk of exposure; lower socio-economic status was not associated. Ten drugs/drug classes accounted for most of high risk medication prescribing in 2011/12. CONCLUSIONS: High risk medication prescribing has not increased over time against a background of increasing polypharmacy in the UK. Half of patients receiving high risk medications do so for less than a year. Reducing or optimising the use of a limited number of drugs could dramatically reduce high risk medications in older people. Further research is needed to investigate why the oldest old and women are at greater risk. Interventions to reduce high risk medications may need to target shorter and long-term use separately.
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Klemp K, Dovey S, Valderas JM, Rohe J, Godycki-Cwirko M, Elliott P, Beyer M, Ferdin MG, Hoffmann B (2015). Developing a patient safety incident classification system for primary care. A literature review and Delphi-survey by the LINNEAUS collaboration on patient safety in primary care.
EUROPEAN JOURNAL OF GENERAL PRACTICE,
21, 35-38.
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Esmail A, Valderas JM, Verstappen W, Godycki-Cwirko M, Wensing M (2015). Developing a research agenda for patient safety in primary care. Background, aims and output of the LINNEAUS collaboration on patient safety in primary care.
Eur J Gen Pract,
21 Suppl, 3-7.
Abstract:
Developing a research agenda for patient safety in primary care. Background, aims and output of the LINNEAUS collaboration on patient safety in primary care.
This paper is an introduction to a supplement to the European Journal of General Practice, bringing together a body of research focusing on the issue of patient safety in relation to primary care. The supplement represents the outputs of the LINNEAUS collaboration on patient safety in primary care, which was a four-year (2009-2013) coordination and support action funded under the Framework 7 programme by the European Union. Being a coordination and support action, its aim was not to undertake new research, but to build capacity through engaging primary care researchers and practitioners in identifying some of the key challenges in this area and developing consensus statements, which will be an essential part in developing a future research agenda. This introductory article describes the aims of the LINNEAUS collaboration, provides a brief summary of the reasons to focus on patient safety in primary care, the epidemiological and policy considerations, and an introduction to the papers included in the supplement.
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Porter I, Valderas JM (2015). Development of a feedback form for routine clinical use of PROs in primary care for patients with multimorbidity.
QUALITY OF LIFE RESEARCH,
24, 181-182.
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Greenhalgh J, Dalkin S, Gibbons E, Black N, Valderas JM, Wright J, Meads D, Lingard L, Wood L, Jackson J, et al (2015). How do health care providers respond to PROMs data to improve patient care? a realist synthesis.
QUALITY OF LIFE RESEARCH,
24, 117-117.
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Ricci-Cabello I, Violán C, Foguet-Boreu Q, Mounce LTA, Valderas JM (2015). Impact of multi-morbidity on quality of healthcare and its implications for health policy, research and clinical practice. A scoping review.
Eur J Gen Pract,
21(3), 192-202.
Abstract:
Impact of multi-morbidity on quality of healthcare and its implications for health policy, research and clinical practice. A scoping review.
The simultaneous presence of multiple conditions in one patient (multi-morbidity) is a key challenge facing healthcare systems globally. It potentially threatens the coordination, continuity and safety of care. In this paper, we report the results of a scoping review examining the impact of multi-morbidity on the quality of healthcare. We used its results as a basis for a discussion of the challenges that research in this area is currently facing. In addition, we discuss its implications for health policy and clinical practice. The review identified 37 studies focussing on multi-morbidity but using conceptually different approaches. Studies focusing on 'comorbidity' (i.e. the 'index disease' approach) suggested that quality may be enhanced in the presence of synergistic conditions, and impaired by antagonistic or neutral conditions. Studies on 'multi-morbidity' (i.e. multiplicity of problems) and 'morbidity burden' (i.e. the total severity of conditions) suggested that increasing number of conditions and severity may be associated with better quality of healthcare when measured by process or intermediate outcome indicators, but with worse quality when patient-centred measures are used. However, issues related to the conceptualization and measurement of multi-morbidity (inconsistent across studies) and of healthcare quality (restricted to evaluations for each separate condition without incorporating considerations about multi-morbidity itself and its implications for management) compromised the generalizability of these observations. Until these issues are addressed and robust evidence becomes available, clinicians should apply minimally invasive and patient-centred medicine when delivering care for clinically complex patients. Health systems should focus on enhancing primary care centred coordination and continuity of care.
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Ricci-Cabello I, Stevens S, Kontopantelis E, Dalton ARH, Griffiths RI, Campbell JL, Doran T, Valderas JM (2015). Impact of the Prevalence of Concordant and Discordant Conditions on the Quality of Diabetes Care in Family Practices in England.
Ann Fam Med,
13(6), 514-522.
Abstract:
Impact of the Prevalence of Concordant and Discordant Conditions on the Quality of Diabetes Care in Family Practices in England.
PURPOSE: the purpose of this study was to examine the association between the prevalence of both diabetes-concordant and diabetes-discordant conditions and the quality of diabetes care at the family practice level in England. We hypothesized that the prevalence of concordant (or discordant) conditions would be associated with better (or worse) quality of diabetes care. METHODS: We conducted a cross-sectional study using practice-level data (7,884 practices). We estimated the practice-level prevalence of diabetes and 15 other chronic conditions, which were classified as diabetes concordant (ie, with the same pathophysiologic risk profile and therefore more likely to be part of the same management plan) or diabetes discordant (ie, not directly related in either their pathogenesis or management). We measured quality of diabetes care with diabetes-specific indicators (8 processes and 3 intermediate outcomes of care). We used linear regression models to quantify the effect of the prevalence of the conditions on aggregate achievement rate for quality of diabetes care. RESULTS: Consistent with the proposed model, the prevalence rates of 4 of 7 concordant conditions (obesity, chronic kidney disease, atrial fibrillation, heart failure) were positively associated with quality of diabetes care. Similarly, negative associations were observed as predicted for 2 of the 8 discordant conditions (epilepsy, mental health). Observations for other concordant and discordant conditions did not match predictions in the hypothesized model. CONCLUSIONS: the quality of diabetes care provided in English family practices is associated with the prevalence of other major chronic conditions at the practice level. The nature and direction of the observed associations cannot be fully explained by the concordant-discordant model.
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Trier H, Valderas JM, Wensing M, Martin HM, Egebart J (2015). Involving patients in patient safety programmes: a scoping review and consensus procedure by the LINNEAUS collaboration on patient safety in primary care.
EUROPEAN JOURNAL OF GENERAL PRACTICE,
21, 56-61.
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Parker D, Wensing M, Esmail A, Valderas JM (2015). Measurement tools and process indicators of patient safety culture in primary care. A mixed methods study by the LINNEAUS collaboration on patient safety in primary care.
Eur J Gen Pract,
21 Suppl, 26-30.
Abstract:
Measurement tools and process indicators of patient safety culture in primary care. A mixed methods study by the LINNEAUS collaboration on patient safety in primary care.
BACKGROUND: There is little guidance available to healthcare practitioners about what tools they might use to assess the patient safety culture. OBJECTIVE: to identify useful tools for assessing patient safety culture in primary care organizations in Europe; to identify those aspects of performance that should be assessed when investigating the relationship between safety culture and performance in primary care. METHODS: Two consensus-based studies were carried out, in which subject matter experts and primary healthcare professionals from several EU states rated (a) the applicability to their healthcare system of several existing safety culture assessment tools and (b) the appropriateness and usefulness of a range of potential indicators of a positive patient safety culture to primary care settings. The safety culture tools were field-tested in four countries to ascertain any challenges and issues arising when used in primary care. RESULTS: the two existing tools that received the most favourable ratings were the Manchester patient safety framework (MaPsAF primary care version) and the Agency for healthcare research and quality survey (medical office version). Several potential safety culture process indicators were identified. The one that emerged as offering the best combination of appropriateness and usefulness related to the collection of data on adverse patient events. CONCLUSION: Two tools, one quantitative and one qualitative, were identified as applicable and useful in assessing patient safety culture in primary care settings in Europe. Safety culture indicators in primary care should focus on the processes rather than the outcomes of care.
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Ricci-Cabello I, Gonçalves DC, Rojas-GarcÃa A, Valderas JM (2015). Measuring experiences and outcomes of patient safety in primary care: a systematic review of available instruments.
Fam Pract,
32(1), 106-119.
Abstract:
Measuring experiences and outcomes of patient safety in primary care: a systematic review of available instruments.
BACKGROUND: Despite the enormous potential for adverse events in primary care, the knowledge base about patient safety in this context is still sparse. The lack of appropriate measurement methods is a key factor limiting the development of research in this field. OBJECTIVE: to identify and characterize available patient reported instruments to measure patient safety in primary care. METHODS: We conducted a systematic literature review. We searched in bibliographic sources for empirical studies describing the development, evaluation or use of patient reported instruments assessing patient safety in primary care. Study selection and data extraction were independently conducted by two researchers. RESULTS: We identified 28 studies reporting on 23 different instruments. Fifteen instruments were designed for paper-based self-administration, six for phone interview and two consisted in electronic reporting systems. Most instruments focused on specific aspects of patient safety, most commonly on experiences of adverse drug reactions. Face validity was assessed for 10 instruments (43%), three reported construct validity (13%) and three described reliability (13%). Responsiveness was not ascertained. CONCLUSIONS: Although there is evidence of good psychometric properties for a reduced number of patient reported instruments, currently available instruments do not offer a comprehensive set of resources to measure the effects of interventions to improve patient safety in primary care from a patient perspective. Future research in the field should prioritize (i) the evaluation of the performance of already available instruments and (ii) the development of new instruments that enable an comprehensive assessment of patient safety at general practices.
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Foguet-Boreu Q, Violán C, Rodriguez-Blanco T, Roso-Llorach A, Pons-Vigués M, Pujol-Ribera E, Cossio Gil Y, Valderas JM (2015). Multimorbidity Patterns in Elderly Primary Health Care Patients in a South Mediterranean European Region: a Cluster Analysis.
PLoS One,
10(11).
Abstract:
Multimorbidity Patterns in Elderly Primary Health Care Patients in a South Mediterranean European Region: a Cluster Analysis.
OBJECTIVE: the purpose of this study was to identify clusters of diagnoses in elderly patients with multimorbidity, attended in primary care. DESIGN: Cross-sectional study. SETTING: 251 primary care centres in Catalonia, Spain. PARTICIPANTS: Individuals older than 64 years registered with participating practices. MAIN OUTCOME MEASURES: Multimorbidity, defined as the coexistence of 2 or more ICD-10 disease categories in the electronic health record. Using hierarchical cluster analysis, multimorbidity clusters were identified by sex and age group (65-79 and ≥80 years). RESULTS: 322,328 patients with multimorbidity were included in the analysis (mean age, 75.4 years [Standard deviation, SD: 7.4], 57.4% women; mean of 7.9 diagnoses [SD: 3.9]). For both men and women, the first cluster in both age groups included the same two diagnoses: Hypertensive diseases and Metabolic disorders. The second cluster contained three diagnoses of the musculoskeletal system in the 65- to 79-year-old group, and five diseases coincided in the ≥80 age group: varicose veins of the lower limbs, senile cataract, dorsalgia, functional intestinal disorders and shoulder lesions. The greatest overlap (54.5%) between the three most common diagnoses was observed in women aged 65-79 years. CONCLUSION: This cluster analysis of elderly primary care patients with multimorbidity, revealed a single cluster of circulatory-metabolic diseases that were the most prevalent in both age groups and sex, and a cluster of second-most prevalent diagnoses that included musculoskeletal diseases. Clusters unknown to date have been identified. The clusters identified should be considered when developing clinical guidance for this population.
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Valderas JM (2015). Multimorbidity, not a health condition or complexity by another name.
Eur J Gen Pract,
21(4), 213-214.
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Magin P, Dunbabin J, Goode S, Valderas JM, Levi C, D'Souza M, Marshall M, Barker D, Lasserson D (2015). Patients' responses to transient ischaemic attack symptoms: a cross-sectional questionnaire study in Australian general practices.
Br J Gen Pract,
65(630), e24-e31.
Abstract:
Patients' responses to transient ischaemic attack symptoms: a cross-sectional questionnaire study in Australian general practices.
BACKGROUND: Consensus guidelines for transient ischaemic attack (TIA) recommend urgent investigation and management, but delays in management occur and are attributable to patient and health system factors. AIM: to establish general practice patients' anticipated responses to TIA symptoms, and associations of appropriate responses. DESIGN AND SETTING: a cross-sectional questionnaire-based study in Australian general practices. METHOD: Consecutive patients attending general practices completed questionnaires that contained the Stroke Action Test (STAT) adapted for TIA about demographic, health system use, and stroke risk factors. STAT elicits appropriate or inappropriate anticipated responses to 28 symptom complexes. Anticipated actions in-hours and out-of-hours were elicited. Associations of independent variables with adapted-STAT scores were tested with multiple linear regression. RESULTS: There were 854 participants (response rate 76.9%). Urgent healthcare-seeking responses to transient neurological symptoms ranged from 96.8% for right-sided weakness with dysphasia to 59.1% for sudden dizziness. Associations of higher adapted-STAT scores were older age, Indigenous status, previous after-hours services use, self-perception of health as poor, and familiarity with a stroke public awareness campaign. A personal or family history of stroke, smoking status, and time of event (in-hours/out-of-hours) were not significantly associated with adapted-STAT scores. CONCLUSION: Most general practice attendees expressed intentions to seek health care urgently for most symptoms suggestive of TIA, with highest levels of urgency observed in high stroke-risk scenarios. Intentions were not associated with a number of major risk factors for TIA and might be improved by further educational interventions, either targeted or at population level.
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Gonçalves Bradley DC, Gibbons C, Ricci-Cabello I, Bobrovitz NJ, Gibbons EJ, Kotzeva A, Alonso J, Fitzpatrick R, Bower P, van der Wees PJ, et al (2015). Routine provision of information on patient-reported outcome measures to healthcare providers and patients in clinical practice.
Cochrane Database of Systematic Reviews,
2015(4).
Abstract:
Routine provision of information on patient-reported outcome measures to healthcare providers and patients in clinical practice
This is the protocol for a review and there is no abstract. The objectives are as follows: to assess the impact of the routine use of patient-reported outcomes (PROs) in clinical practice on the process of care (including patient-physician communication, professionals awareness of patients' quality of life, diagnosis and recognition rates, treatment rates, health services and resource use, as well as patient behaviour); patients' and professionals' experiences of care; and health outcomes (both generic and disease-specific, using both routinely-used clinical measures and PROs).
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Islam MM, McRae IS, Yen L, Jowsey T, Valderas JM (2015). Time spent on health-related activities by senior Australians with chronic diseases: what is the role of multimorbidity and comorbidity?.
Aust N Z J Public Health,
39(3), 277-283.
Abstract:
Time spent on health-related activities by senior Australians with chronic diseases: what is the role of multimorbidity and comorbidity?
OBJECTIVE: to examine the effect of various morbidity clusters of chronic diseases on health-related time use and to explore factors associated with heavy time burden (more than 30 hours/month) of health-related activities. METHODS: Using a national survey, data were collected from 2,540 senior Australians. Natural clusters were identified using cluster analysis and clinical clusters using clinical expert opinion. We undertook a set of linear regressions to model people's time use, and logistic regressions to model heavy time burden. RESULTS: Time use increases with the number of chronic diseases. Six of the 12 diseases are significantly associated with higher time use, with the highest effect for diabetes followed by depression; 18% reported a heavy time burden, with diabetes again being the most significant disease. Clusters and dominant comorbid groupings do not contribute to predicting time use or time burden. CONCLUSIONS: Total number of diseases and specific diseases are useful determinants of time use and heavy time burden. Dominant groupings and disease clusters do not predict time use. IMPLICATIONS: in considering time demands on patients and the need for care co-ordination, care providers need to be aware of how many and what specific diseases the patient faces.
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Porter I, Valderas JM (2015). Use of PROs in clinical guidance for the management of chronic conditions in primary care in the United Kingdom.
QUALITY OF LIFE RESEARCH,
24, 75-76.
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Le Reste JY, Nabbe P, Lingner H, Kasuba Lazic D, Assenova R, Munoz M, Sowinska A, Lygidakis C, Doerr C, Czachowski S, et al (2015). What research agenda could be generated from the European General Practice Research Network concept of Multimorbidity in Family Practice?.
BMC Family Practice,
16(1).
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2014
Catala-Lopez F, Crespo-Facorro B, Vieta E, Valderas JM, Valencia A, Tabares-Seisdedos R (2014). Alzheimer's Disease and Cancer: Current Epidemiological Evidence for a Mutual Protection.
NEUROEPIDEMIOLOGY,
42(2), 121-122.
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O′Neill B, Gonçalves D, Ricci-Cabello I, Ziebland S, Valderas J (2014). An Overview of Self-Administered Health Literacy Instruments.
PLoS ONE,
9(12), e109110-e109110.
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Garin O, Herdman M, Vilagut G, Ferrer M, Ribera A, Rajmil L, Valderas JM, Guillemin F, Revicki D, Alonso J, et al (2014). Assessing health-related quality of life in patients with heart failure: a systematic, standardized comparison of available measures.
HEART FAILURE REVIEWS,
19(3), 359-367.
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Schmidt S, Garin O, Pardo Y, Valderas JM, Alonso J, Rebollo P, Rajmil L, Garcia-Forero C, Ferrer M, Grp EMPRO, et al (2014). Assessing quality of life in patients with prostate cancer: a systematic and standardized comparison of available instruments.
QUALITY OF LIFE RESEARCH,
23(8), 2169-2181.
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Mavaddat N, Valderas JM, van der Linde R, Khaw KT, Kinmonth AL (2014). Association of self-rated health with multimorbidity, chronic disease and psychosocial factors in a large middle-aged and older cohort from general practice: a cross-sectional study.
BMC FAMILY PRACTICE,
15 Author URL.
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Violan C, Foguet-Boreu Q, Roso-Llorach A, Rodriguez-Blanco T, Pons-Vigues M, Pujol-Ribera E, Angel Munoz-Perez M, Valderas JM (2014). Burden of multimorbidity, socioeconomic status and use of health services across stages of life in urban areas: a cross-sectional study.
BMC PUBLIC HEALTH,
14 Author URL.
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Valderas JM, Avery A, Ricci-Cabello I (2014). Development of a measure of Patient-reported Experiences and Outcomes of Patient Safety in Primary Care: the PREOS-PC instrument.
QUALITY OF LIFE RESEARCH,
23, 38-38.
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Schmidt S, Ferrer M, González M, González N, Valderas JM, Alonso J, Escobar A, Vrotsou K, EMPRO Group (2014). Evaluation of shoulder-specific patient-reported outcome measures: a systematic and standardized comparison of available evidence.
J Shoulder Elbow Surg,
23(3), 434-444.
Abstract:
Evaluation of shoulder-specific patient-reported outcome measures: a systematic and standardized comparison of available evidence.
BACKGROUND: the aim of this study was to perform a standardized and systematic evaluation of the available evidence on multi-item shoulder-specific patient-reported outcome measures that are applicable to a wide spectrum of disorders. MATERIALS AND METHODS: a systematic review was conducted in PubMed to identify articles with information regarding the development process, metric properties, and administration issues of shoulder-specific patient-reported outcome measures. Two experts independently reviewed all the articles identified for one instrument and applied the EMPRO (Evaluating Measures of Patient Reported Outcomes) tool, which was designed to assess the quality of attributes in a standardized way. An overall EMPRO score and 6 attribute-specific scores were calculated (range, 0-100) to describe the quality of instrument performance. RESULTS: We identified 11 instruments and 112 articles (2-30 articles per instrument). The American Shoulder and Elbow Surgeons (ASES) shoulder assessment, Simple Shoulder Test (SST), and Oxford Shoulder Score (OSS) were the best rated, with overall scores of 77.4 points, 72.6 points, and 69.7 points, respectively. They have been shown to be valid, reliable, and responsive, with a low administration burden. Acceptable results were also found for the Flexilevel Scale of Shoulder Function, Shoulder Pain and Disability Index, and Dutch Shoulder Disability Questionnaire, but some of their attributes need further evaluation. CONCLUSIONS: Current evidence supports the use of the ASES, SST, or OSS. We recommend the SST for longitudinal studies or clinical trials, the Dutch Shoulder Disability Questionnaire for clinical practice to minimize administration burden, and the ASES or OSS to discriminate among patients' or groups' evaluations at one point of time.
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Greenhalgh J, Dalkin S, Wright J, Black N, Valderas JM, Gibbons EJ, Meads D, Wood L, Mills C, Pawson R, et al (2014). Functionality and feedback: a protocol for a realist synthesis of the collation, interpretation and utilisation of PRO data to improve patient care.
Author URL.
Greenhalgh J, Pawson R, Wright J, Black N, Valderas JM, Meads D, Gibbons E, Wood L, Wood C, Mills C, et al (2014). Functionality and feedback: a protocol for a realist synthesis of the collation, interpretation and utilisation of PROMs data to improve patient care.
BMJ Open,
4(7).
Abstract:
Functionality and feedback: a protocol for a realist synthesis of the collation, interpretation and utilisation of PROMs data to improve patient care.
INTRODUCTION: the feedback and public reporting of PROMs data aims to improve the quality of care provided to patients. Existing systematic reviews have found it difficult to draw overall conclusions about the effectiveness of PROMs feedback. We aim to execute a realist synthesis of the evidence to understand by what means and in what circumstances the feedback of PROMs data leads to the intended service improvements. METHODS AND ANALYSIS: Realist synthesis involves (stage 1) identifying the ideas, assumptions or 'programme theories' which explain how PROMs feedback is supposed to work and in what circumstances and then (stage 2) reviewing the evidence to determine the extent to which these expectations are met in practice. For stage 1, six provisional 'functions' of PROMs feedback have been identified to structure our review (screening, monitoring, patient involvement, demand management, quality improvement and patient choice). For each function, we will identify the different programme theories that underlie these different goals and develop a logical map of the respective implementation processes. In stage 2, we will identify studies that will provide empirical tests of each component of the programme theories to evaluate the circumstances in which the potential obstacles can be overcome and whether and how the unintended consequences of PROMs feedback arise. We will synthesise this evidence to (1) identify the implementation processes which support or constrain the successful collation, interpretation and utilisation of PROMs data; (2) identify the implementation processes through which the unintended consequences of PROMs data arise and those where they can be avoided. ETHICS AND DISSEMINATION: the study will not require NHS ethics approval. We have secured ethical approval for the study from the University of Leeds (LTSSP-019). We will disseminate the findings of the review through a briefing paper and dissemination event for National Health Service stakeholders, conferences and peer reviewed publications.
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Foguet-Boreu Q, Violan C, Roso-Llorach A, Rodriguez-Blanco T, Pons-Vigues M, Munoz-Perez MA, Pujol-Ribera E, Valderas JM (2014). Impact of multimorbidity: acute morbidity, area of residency and use of health services across the life span in a region of south Europe.
BMC FAMILY PRACTICE,
15 Author URL.
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Griffiths RI, Gleeson ML, Valderas JM, Danese MD (2014). Impact of undetected comorbidity on treatment and outcomes of breast cancer.
Int J Breast Cancer,
2014Abstract:
Impact of undetected comorbidity on treatment and outcomes of breast cancer.
Preexisting comorbidity adversely impacts breast cancer treatment and outcomes. We examined the incremental impact of comorbidity undetected until cancer. We followed breast cancer patients in SEER-Medicare from 12 months before to 84 months after diagnosis. Two comorbidity indices were constructed: the National Cancer Institute index, using 12 months of claims before cancer, and a second index for previously undetected conditions, using three months after cancer. Conditions present in the first were excluded from the second. Overall, 6,184 (10.1%) had ≥1 undetected comorbidity. Chronic obstructive pulmonary disease (38%) was the most common undetected condition. In multivariable analyses that adjusted for comorbidity detected before cancer, older age, later stage, higher grade, and poor performance status all were associated with higher odds of ≥1 undetected comorbidity. In stage I-III cancer, undetected comorbidity was associated with lower adjusted odds of receiving adjuvant chemotherapy (Odds Ratio (OR) = 0.81, 95% Confidence Interval (CI) 0.73-0.90, P < 0.0001; OR = 0.38, 95% CI 0.30-0.49, P < 0.0001; index score 1 or ≥2, respectively), and with increased mortality (Hazard Ratio (HR) = 1.45, 95% CI 1.38-1.53, P < 0.0001; HR = 2.38, 95% CI 2.18-2.60, P < 0.0001; index score 1 or ≥2). Undetected comorbidity is associated with less aggressive treatment and higher mortality in breast cancer.
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Catala-Lopez F, Suarez-Pinilla M, Suarez-Pinilla P, Valderas JM, Gomez-Beneyto M, Martinez S, Balanza-Martinez V, Climent J, Valencia A, McGrath J, et al (2014). Inverse and Direct Cancer Comorbidity in People with Central Nervous System Disorders: a Meta-Analysis of Cancer Incidence in 577,013 Participants of 50 Observational Studies.
PSYCHOTHERAPY AND PSYCHOSOMATICS,
83(2), 89-105.
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Islam MM, Valderas JM, Yen L, Dawda P, Jowsey T, McRae IS (2014). Multimorbidity and comorbidity of chronic diseases among the senior Australians: prevalence and patterns.
PLoS One,
9(1).
Abstract:
Multimorbidity and comorbidity of chronic diseases among the senior Australians: prevalence and patterns.
Understanding patterns and identifying common clusters of chronic diseases may help policymakers, researchers, and clinicians to understand the needs of the care process better and potentially save both provider and patient time and cost. However, only limited research has been conducted in this area, and ambiguity remains as those limited previous studies used different approaches to identify common clusters and findings may vary with approaches. This study estimates the prevalence of common chronic diseases and examines co-occurrence of diseases using four approaches: (i) identification of the most occurring pairs and triplets of comorbid diseases; performing (ii) cluster analysis of diseases, (iii) principal component analysis, and (iv) latent class analysis. Data were collected using a questionnaire mailed to a cross-sectional sample of senior Australians, with 4574 responses. Eighty-two percent of respondents reported having at least one chronic disease and over 52% reported having at least two chronic diseases. Respondents suffering from any chronic diseases had an average of 2.4 comorbid diseases. Three defined groups of chronic diseases were identified: (i) asthma, bronchitis, arthritis, osteoporosis and depression; (ii) high blood pressure and diabetes; and (iii) cancer, with heart disease and stroke either making a separate group or "attaching" themselves to different groups in different analyses. The groups were largely consistent across the approaches. Stability and sensitivity analyses also supported the consistency of the groups. The consistency of the findings suggests there is co-occurrence of diseases beyond chance, and patterns of co-occurrence are important for clinicians, patients, policymakers and researchers. Further studies are needed to provide a strong evidence base to identify comorbid groups which would benefit from appropriate guidelines for the care and management of patients with particular disease clusters.
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Muth C, Beyer M, Fortin M, Rochon J, Oswald F, Valderas JM, Harder S, Glynn LG, Perera R, Freitag M, et al (2014). Multimorbidity's research challenges and priorities from a clinical perspective: the case of 'Mr Curran'.
EUROPEAN JOURNAL OF GENERAL PRACTICE,
20(2), 139-147.
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Islam MM, Yen L, Valderas JM, McRae IS (2014). Out-of-pocket expenditure by Australian seniors with chronic disease: the effect of specific diseases and morbidity clusters.
BMC PUBLIC HEALTH,
14 Author URL.
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Violan C, Foguet-Boreu Q, Flores-Mateo G, Salisbury C, Blom J, Freitag M, Glynn L, Muth C, Valderas JM (2014). Prevalence, determinants and patterns of multimorbidity in primary care: a systematic review of observational studies.
PLoS One,
9(7).
Abstract:
Prevalence, determinants and patterns of multimorbidity in primary care: a systematic review of observational studies.
INTRODUCTION: Multimorbidity is a major concern in primary care. Nevertheless, evidence of prevalence and patterns of multimorbidity, and their determinants, are scarce. The aim of this study is to systematically review studies of the prevalence, patterns and determinants of multimorbidity in primary care. METHODS: Systematic review of literature published between 1961 and 2013 and indexed in Ovid (CINAHL, PsychINFO, Medline and Embase) and Web of Knowledge. Studies were selected according to eligibility criteria of addressing prevalence, determinants, and patterns of multimorbidity and using a pretested proforma in primary care. The quality and risk of bias were assessed using STROBE criteria. Two researchers assessed the eligibility of studies for inclusion (Kappa= 0.86). RESULTS: We identified 39 eligible publications describing studies that included a total of 70,057,611 patients in 12 countries. The number of health conditions analysed per study ranged from 5 to 335, with multimorbidity prevalence ranging from 12.9% to 95.1%. All studies observed a significant positive association between multimorbidity and age (odds ratio [OR], 1.26 to 227.46), and lower socioeconomic status (OR, 1.20 to 1.91). Positive associations with female gender and mental disorders were also observed. The most frequent patterns of multimorbidity included osteoarthritis together with cardiovascular and/or metabolic conditions. CONCLUSIONS: Well-established determinants of multimorbidity include age, lower socioeconomic status and gender. The most prevalent conditions shape the patterns of multimorbidity. However, the limitations of the current evidence base means that further and better designed studies are needed to inform policy, research and clinical practice, with the goal of improving health-related quality of life for patients with multimorbidity. Standardization of the definition and assessment of multimorbidity is essential in order to better understand this phenomenon, and is a necessary immediate step.
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Griffiths RI, Lindquist KJ, O'Malley CD, Gleeson ML, Duryea JL, Valderas JM, Danese MD (2014). Undiagnosed diabetes in breast, colorectal, lung, and prostate cancer: incidence and risk factors.
ISRN Oncol,
2014Abstract:
Undiagnosed diabetes in breast, colorectal, lung, and prostate cancer: incidence and risk factors.
Our study describes the incidence and risk factors for undiagnosed diabetes in elderly cancer patients. Using Surveillance, Epidemiology, and end Results-Medicare data, we followed patients with breast, colorectal, lung, or prostate cancer from 24 months before to 3 months after cancer diagnosis. Medicare claims were used to exclude patients with diabetes 24 to 4 months before cancer (look-back period), identify those with diabetes undiagnosed until cancer, and construct indicators of preventive services, physician contact, and comorbidity during the look-back period. Logistic regression analyses were performed to identify factors associated with undiagnosed diabetes. Overall, 2,678 patients had diabetes undiagnosed until cancer. Rates were the highest in patients with both advanced-stage cancer and low prior primary care/medical specialist contact (breast 8.2%, colorectal 5.9%, lung 4.4%). Nonwhite race/ethnicity, living in a census tract with a higher percent of the population in poverty and a lower percent college educated, lower prior preventive services use, and lack of primary care and/or medical specialist care prior to cancer all were associated with higher (P ≤ 0.05) adjusted odds of undiagnosed diabetes. Undiagnosed diabetes is relatively common in selected subgroups of cancer patients, including those already at high risk of poor outcomes due to advanced cancer stage.
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O'Neill B, Ziebland S, Valderas J, Lupiáñez-Villanueva F (2014). User-Generated Online Health Content: a Survey of Internet Users in the United Kingdom.
Journal of Medical Internet Research,
16(4), e118-e118.
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Kontopantelis E, Springate D, Reeves D, Ashcroft DM, Valderas JM, Doran T (2014). Withdrawing performance indicators: retrospective analysis of general practice performance under UK Quality and Outcomes Framework.
BMJ,
348Abstract:
Withdrawing performance indicators: retrospective analysis of general practice performance under UK Quality and Outcomes Framework.
OBJECTIVES: to investigate the effect of withdrawing incentives on recorded quality of care, in the context of the UK Quality and Outcomes Framework pay for performance scheme. DESIGN: Retrospective longitudinal study. SETTING: Data for 644 general practices, from 2004/05 to 2011/12, extracted from the Clinical Practice Research Datalink. PARTICIPANTS: all patients registered with any of the practices over the study period-13,772,992 in total. INTERVENTION: Removal of financial incentives for aspects of care for patients with asthma, coronary heart disease, diabetes, stroke, and psychosis. MAIN OUTCOME MEASURES: Performance on eight clinical quality indicators withdrawn from a national incentive scheme: influenza immunisation (asthma) and lithium treatment monitoring (psychosis), removed in April 2006; blood pressure monitoring (coronary heart disease, diabetes, stroke), cholesterol concentration monitoring (coronary heart disease, diabetes), and blood glucose monitoring (diabetes), removed in April 2011. Multilevel mixed effects multiple linear regression models were used to quantify the effect of incentive withdrawal. RESULTS: Mean levels of performance were generally stable after the removal of the incentives, in both the short and long term. For the two indicators removed in April 2006, levels in 2011/12 were very close to 2005/06 levels, although a small but statistically significant drop was estimated for influenza immunisation. For five of the six indicators withdrawn from April 2011, no significant effect on performance was seen following removal and differences between predicted and observed scores were small. Performance on related outcome indicators retained in the scheme (such as blood pressure control) was generally unaffected. CONCLUSIONS: Following the removal of incentives, levels of performance across a range of clinical activities generally remained stable. This indicates that health benefits from incentive schemes can potentially be increased by periodically replacing existing indicators with new indicators relating to alternative aspects of care. However, all aspects of care investigated remained indirectly or partly incentivised in other indicators, and further work is needed to assess the generalisability of the findings when incentives are fully withdrawn.
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2013
Violan C, Foguet-Boreu Q, Hermosilla-Perez E, Valderas JM, Bolibar B, Fabregas-Escurriola M, Brugulat-Guiteras P, Angel Munoz-Perez M (2013). Comparison of the information provided by electronic health records data and a population health survey to estimate prevalence of selected health conditions and multimorbidity.
BMC PUBLIC HEALTH,
13 Author URL.
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Ricci-Cabello I, Goncalves DC, Valderas JM (2013). Development of a measure of patient reported experiences and outcomes of patient safety in general practices in England: the PREOS-PC instrument.
QUALITY OF LIFE RESEARCH,
22 Author URL.
Villalonga Olives E, Garcia Forero C, Maydeu-Olivares A, Almansa J, Palacio Vieira JA, Valderas JM, Ferrer M, Rajmil L, Alonso J (2013). Environmental risk and protective factors of adolescents' and youths' mental health: differences between parents' appraisal and self-reports.
QUALITY OF LIFE RESEARCH,
22(3), 613-622.
Author URL.
Villalonga-Olives E, Forero CG, Maydeu-Olivares A, Almansa J, Palacio Vieira JA, Valderas JM, Ferrer M, Rajmil L, Alonso J (2013). Erratum: Environmental risk and protective factors of adolescents' and youths' mental health: Differences between parents' appraisal and self-reports (Quality of Life Research DOI: 10.1007/s11136-012-0167-x). Quality of Life Research, 22(3).
Valderas JM (2013). Getting impatient about person-centred health care.
Eur J Gen Pract,
19(3), 141-142.
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Valderas JM (2013). Increasing clinical, community, and patient-centered health research for preventing and managing multimorbidity.
J Comorb,
3(Spec Issue), 41-44.
Abstract:
Increasing clinical, community, and patient-centered health research for preventing and managing multimorbidity.
The report "Multiple Chronic Conditions: a Strategic Framework," which was developed by the U.S. Department of Health & Human Services (HSS), has identified as one of the key goals for improving health and the provision of healthcare for people with multiple chronic conditions "to increase clinical, community and patient-centered research." in their linked commentary of this special journal issue, Parekh and Goodman identify and consider the potential impact of a number of related research initiatives supported by the National Institutes of Health and the Agency for Health Research and Quality, particularly focusing on two very specific areas: behavioral medicine and secondary analyses of available datasets. In this paper, I comment on both documents and discuss the opportunities offered by the current approaches and highlight related research needs; in particular, the need for an improved and expanded conceptual model of healthcare for people with multimorbidity, and the need for further exploration of the use of multimorbidity-relevant outcomes as part of usual clinical practice. Journal of Comorbidity 2013;3:41-44.
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Palacio-Vieira J-A, Villalonga-Olives E, Maria Valderas J, Herdman M, Alonso J, Rajmil L (2013). Predictors of the use of healthcare services in children and adolescents in Spain.
INTERNATIONAL JOURNAL OF PUBLIC HEALTH,
58(2), 207-215.
Author URL.
Kontopantelis E, Reeves D, Valderas JM, Campbell S, Doran T (2013). Recorded quality of primary care for patients with diabetes in England before and after the introduction of a financial incentive scheme: a longitudinal observational study.
BMJ QUALITY & SAFETY,
22(1), 53-64.
Author URL.
Alonso J, Bartlett SJ, Rose M, Aaronson NK, Chaplin JE, Efficace F, Leplege A, Lu A, Tulsky DS, Raat H, et al (2013). The case for an international patient-reported outcomes measurement information system (PROMIS (R)) initiative.
HEALTH AND QUALITY OF LIFE OUTCOMES,
11 Author URL.
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Salisbury C, Procter S, Stewart K, Bowen L, Purdy S, Ridd M, Valderas J, Blakeman T, Reeves D (2013). The content of general practice consultations: cross-sectional study based on video recordings. British Journal of General Practice, 63(616), e751-e759.
Jowsey T, McRae IS, Valderas JM, Dugdale P, Phillips R, Bunton R, Gillespie J, Banfield M, Jones L, Kljakovic M, et al (2013). Time's Up. Descriptive Epidemiology of Multi-Morbidity and Time Spent on Health Related Activity by Older Australians: a Time Use Survey.
PLOS ONE,
8(4).
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Castellvi P, Ferrer M, Alonso J, en nombre del Comité CientÃfico de BiblioPRO (2013). [The patient-reported outcomes in research: definition, impact, classification, measurement and assessment].
Med Clin (Barc),
141(8), 358-365.
Author URL.
2012
Harrison M, Reeves D, Harkness E, Valderas J, Kennedy A, Rogers A, Hann M, Bower P (2012). A secondary analysis of the moderating effects of depression and multimorbidity on the effectiveness of a chronic disease self-management programme. Patient Education and Counseling, 87(1), 67-73.
Goncalves DC, Gibbons EJ, Fitzpatrick R, Valderas JM (2012). A systematic review and narrative review of qualitative studies about the use of PROs in clinical practice.
QUALITY OF LIFE RESEARCH,
21, 25-25.
Author URL.
Valderas JM, Ferrer M, Mendivil J, Garin O, Rajmil L, Herdmann M, Alonso J, Goncalves DC (2012). Development and testing of standards for individualization of patient reported outcome (PRO) measures using EMPRO.
QUALITY OF LIFE RESEARCH,
21, 43-43.
Author URL.
Griffiths RI, Danese MD, Gleeson ML, Valderas JM (2012). Epidemiology and outcomes of previously undiagnosed diabetes in older women with breast cancer: an observational cohort study based on SEER-Medicare.
BMC CANCER,
12 Author URL.
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Doran T, Kontopantelis E, Fullwood C, Lester H, Valderas JM, Campbell S (2012). Exempting dissenting patients from pay for performance schemes: retrospective analysis of exception reporting in the UK Quality and Outcomes Framework.
BMJ-BRITISH MEDICAL JOURNAL,
344 Author URL.
Full text.
Goncalves DC, Ricci-Cabello I, Valderas JM (2012). Identification and classification of individualized patient-reported outcome measures.
QUALITY OF LIFE RESEARCH,
21, 113-114.
Author URL.
Huntley AL, Johnson R, Purdy S, Valderas JM, Salisbury C (2012). Measures of Multimorbidity and Morbidity Burden for Use in Primary Care and Community Settings: a Systematic Review and Guide.
ANNALS OF FAMILY MEDICINE,
10(2), 134-141.
Author URL.
Valderas JM, Goncalves DC, Alonso J (2012). Patient reported outcome measures: a revised model-based classification system for research and clinical practice.
QUALITY OF LIFE RESEARCH,
21, 104-105.
Author URL.
Valderas JM, Fitzpatrick R, Roland M (2012). Using health status to measure NHS performance: another step into the dark for the health reform in England.
BMJ Qual Saf,
21(4), 352-353.
Abstract:
Using health status to measure NHS performance: another step into the dark for the health reform in England.
The National Health Service in England is moving away from targets based on processes of care and focusing on patient outcomes. This vision is operationalised in the recently published NHS Outcomes Framework, which includes the generalised use of Patient Reported Outcomes (health status and quality of life) as measures of population health at the provider level. This is the first time that such a bold initiative is attempted in the UK and it is not without risks. In this article we elaborate on our experience on the use of Patient Reported Outcomes and identify challenges and likely implications of this approach and suggest less disruptive alternatives.
Abstract.
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2011
Doran T, Kontopantelis E, Valderas JM, Campbell S, Roland M, Salisbury C, Reeves D (2011). Effect of Financial Incentives on Incentivized and Nonincentivized Clinical Activities: Longitudinal Analysis of Data from the UK Quality and Outcomes Framework EDITORIAL COMMENT.
OBSTETRICAL & GYNECOLOGICAL SURVEY,
66(11), 677-679.
Author URL.
Doran T, Kontopantelis E, Valderas JM, Campbell S, Roland M, Salisbury C, Reeves D (2011). Effect of financial incentives on incentivised and non-incentivised clinical activities: longitudinal analysis of data from the UK Quality and Outcomes Framework.
BRITISH MEDICAL JOURNAL,
342 Author URL.
Full text.
Salisbury C, Johnson L, Purdy S, Valderas JM, Montgomery AA (2011). Epidemiology and impact of multimorbidity in primary care: a retrospective cohort study.
BRITISH JOURNAL OF GENERAL PRACTICE,
61(582).
Author URL.
Bower P, Macdonald W, Harkness E, Gask L, Kendrick T, Valderas JM, Dickens C, Blakeman T, Sibbald B (2011). Multimorbidity, service organization and clinical decision making in primary care: a qualitative study.
Fam Pract,
28(5), 579-587.
Abstract:
Multimorbidity, service organization and clinical decision making in primary care: a qualitative study.
BACKGROUND: Primary care professionals often manage patients with multiple long-term health conditions, but managing multimorbidity is challenging given time and resource constraints and interactions between conditions. OBJECTIVE: to explore GP and nurse perceptions of multimorbidity and the influence on service organization and clinical decision making. METHODS: a qualitative interview study with primary care professionals in practices in Greater Manchester, U.K. Interviews were conducted with 15 GPs and 10 practice nurses. RESULTS: Primary care professionals identified tensions between delivering care to meet quality targets and fulfilling the patient's agenda, tensions which are exacerbated in multimorbidity. They were aware of the inconvenience suffered by patients through attendance at multiple clinic appointments when care was structured around individual conditions. They reported difficulties managing patients with multimorbidity in limited consultation time, which led to adoption of an 'additive-sequential' decision-making model which dealt with problems in priority order until consultation resources were exhausted, when further management was deferred. Other challenges included the need for patients to co-ordinate their care, the difficulties of self-management support in multimorbidity and problems of making sense of the relationships between physical and mental health. Doctor and nurse accounts included limited consideration of multimorbidity in terms of the interactions between conditions or synergies between management of different conditions. CONCLUSIONS: Primary care professionals identify a number of challenges in care for multimorbidity and adopt a particular model of decision making to deliver care for multiple individual conditions. However, they did not describe specific decision making around managing multimorbidity per se.
Abstract.
Author URL.
Tabares-Seisdedos R, Dumont N, Baudot A, Valderas JM, Climent J, Valencia A, Crespo-Facorro B, Vieta E, Gomez-Beneyto M, Martinez S, et al (2011). No paradox, no progress: inverse cancer comorbidity in people with other complex diseases.
LANCET ONCOLOGY,
12(6), 604-608.
Author URL.
Pueyo MJ, Baranda L, Valderas J, Starfield B, Rajmil L (2011). Papel del pediatra de atención primaria y coordinación con atención especializada. Anales de PediatrÃa, 75(4), 247-252.
Villalonga-Olives E, Forero CG, Erhart M, Palacio-Vieira JA, Valderas JM, Herdman M, Ferrer M, Rajmil L, Ravens-Sieberer U, Alonso J, et al (2011). Relationship Between Life Events and Psychosomatic Complaints During Adolescence/Youth: a Structural Equation Model Approach.
JOURNAL OF ADOLESCENT HEALTH,
49(2), 199-205.
Author URL.
Valderas JM, Mercer SW, Fortin M (2011). Research on patients with multiple health conditions: different constructs, different views, one voice.
J Comorb,
1, 1-3.
Author URL.
Almansa J, Luis Ayuso-Mateos J, Garin O, Chatterji S, Kostanjsek N, Alonso J, Maria Valderas J, Cieza A, Raggi A, Svestkova O, et al (2011). The International Classification of Functioning, Disability and Health: development of capacity and performance scales.
JOURNAL OF CLINICAL EPIDEMIOLOGY,
64(12), 1400-1411.
Author URL.
Glynn LG, Valderas JM, Healy P, Burke E, Newell J, Gillespie P, Murphy AW (2011). The prevalence of multimorbidity in primary care and its effect on health care utilization and cost.
FAMILY PRACTICE,
28(5), 516-523.
Author URL.
2010
Valderas JM, Kotzeva A, Alonso J (2010). Assessing the impact of routinely measuring patient-reported outcomes in clinical practice: critical appraisal of 34 randomized clinical trials.
Author URL.
Garcia-Duran Huet M, Ferrer M, Herdman MJ, Ignacio Arraras J, Escobar A, Garcia-Altes A, Lucas R, Ochoa S, Permanyer G, Quintana JM, et al (2010). BiblioPRO: online library of PRO instruments in Spanish.
Author URL.
Palacio-Vieira JA, Villalonga-Olives E, Alonso J, Valderas JM, Herdman M, Espallargues M, Berra S, Rajmil L (2010). Brief report: the KIDSCREEN follow-up study on Health-related Quality of Life (HRQoL) in Spanish children and adolescents. Pilot test and representativeness. Journal of Adolescence, 33(1), 227-231.
Campbell SM, Kontopantelis E, Reeves D, Valderas JM, Gaehl E, Small N, Roland MO (2010). Changes in Patient Experiences of Primary Care During Health Service Reforms in England Between 2003 and 2007.
ANNALS OF FAMILY MEDICINE,
8(6), 499-506.
Author URL.
Reeves D, Doran T, Valderas JM, Kontopantelis E, Trueman P, Sutton M, Campbell S, Lester H (2010). How to identify when a performance indicator has run its course. BMJ (Online), 340(7752), 899-901.
Reeves D, Doran T, Valderas JM, Kontopantelis E, Trueman P, Sutton M, Campbell S, Lester H (2010). How to identify when a performance indicator has run its course.
BMJ,
340 Author URL.
Harkness E, Macdonald W, Valderas J, Coventry P, Gask L, Bower P (2010). Identifying Psychosocial Interventions That Improve Both Physical and Mental Health in Patients with Diabetes: a systematic review and meta-analysis. Diabetes Care, 33(4), 926-930.
Villalonga-Olives E, Rojas-Farreras S, Vilagut G, Palacio-Vieira JA, Maria Valderas J, Herdman M, Ferrer M, Rajmil L, Alonso J (2010). Impact of recent life events on the health related quality of life of adolescents and youths: the role of gender and life events typologies in a follow-up study.
HEALTH AND QUALITY OF LIFE OUTCOMES,
8 Author URL.
Full text.
Feeny D, Valderas JM, Fayers P, Santana MJ (2010). Overview of Existing and Novel Methodologies for Testing the Effectiveness of Using Patient Reported Outcomes in Clinical Practice.
QUALITY OF LIFE RESEARCH,
19, 11-11.
Author URL.
Villalonga-Olives E, Forero CG, Erhart M, Palacio-Vieira JA, Valderas JM, Herdman M, Ferrer M, Rajmil L, Ravens-Sieberer U, Alonso J, et al (2010). RELATIONSHIP BETWEEN LIFE EVENTS AND PSYCHOSOMATIC COMPLAINTS DURING ADOLESCENCE/YOUTH: a STRUCTURAL EQUATION MODEL APPROACH.
EPIDEMIOLOGIA & PREVENZIONE,
34(5-6), 52-53.
Author URL.
Garin O, Ayuso-Mateos J, Almansa J, Nieto M, Chatterji S, Vilagut G, Alonso J, Cieza A, Svetskova O, Burger H, et al (2010). Validation of the "World Health Organization Disability Assessment Schedule, WHODAS-2" in patients with chronic diseases. Health and Quality of Life Outcomes, 8(1), 51-51.
2009
Herdman M, Garin O, Vilagut G, Ribera A, Permanyer-Miralda G, Ferrer M, Rajmil L, Valderas JM, Alonso J (2009). ASSESSING THE QUALITY OF QUALITY OF LIFE MEASURES IN HEART FAILURE: a COMPARISON OF AVAILABLE INSTRUMENTS.
VALUE IN HEALTH,
12(7), A340-A340.
Author URL.
Valderas JM, Starfield B, Forrest CB, Sibbald B, Roland M (2009). Ambulatory Care Provided by Office-Based Specialists in the United States.
ANNALS OF FAMILY MEDICINE,
7(2), 104-111.
Author URL.
Valderas JM, Starfield B, Sibbald B, Salisbury C, Roland M (2009). Defining Comorbidity: Implications for Understanding Health and Health Services.
ANNALS OF FAMILY MEDICINE,
7(4), 357-363.
Author URL.
Rajmil L, Palacio-Vieira JA, Herdman M, Lopez-Aguila S, Villalonga-Olives E, Valderas JM, Espallargues M, Alonso J (2009). Effect on Health-related Quality of Life of changes in mental health in children and adolescents.
HEALTH AND QUALITY OF LIFE OUTCOMES,
7 Author URL.
Full text.
Valderas JM (2009). Identifying studies in Spanish population in PubMed.
GACETA SANITARIA,
23(1), 82-82.
Author URL.
Villalonga Olives E, Maydeu-Olivares A, Palacio-Vieira J, Valderas JM, Rajmil L, Alonso J (2009). RISK FACTORS THAT AFFECT MENTAL HEALTH IN YOUNGSTERS: STRUCTURAL EQUATION MODELING.
GACETA SANITARIA,
23, 57-58.
Author URL.
Valderas JM, Starfield B, Forrest CB, Rajmil L, Roland M, Sibbald B (2009). Routine care provided by specialists to children and adolescents in the United States (2002-2006).
BMC Health Serv Res,
9Abstract:
Routine care provided by specialists to children and adolescents in the United States (2002-2006).
BACKGROUND: Specialist physicians provide a large share of outpatient health care for children and adolescents in the United States, but little is known about the nature and content of these services in the ambulatory setting. Our objective was to quantify and characterize routine and co-managed pediatric healthcare as provided by specialists in community settings. METHODS: Nationally representative data were obtained from the National Ambulatory Medical Care Survey for the years 2002-2006. We included office based physicians (excluding family physicians, general internists and general pediatricians), and a representative sample of their patients aged 18 or less. Visits were classified into mutually exclusive categories based on the major reason for the visit, previous knowledge of the health problem, and whether the visit was the result of a referral. Primary diagnoses were classified using Expanded Diagnostic Clusters. Physician report of sharing care for the patient with another physician and frequency of reappointments were also collected. RESULTS: Overall, 41.3% out of about 174 million visits were for routine follow up and preventive care of patients already known to the specialist. Psychiatry, immunology and allergy, and dermatology accounted for 54.5% of all routine and preventive care visits. Attention deficit disorder, allergic rhinitis and disorders of the sebaceous glands accounted for about a third of these visits. Overall, 73.2% of all visits resulted in a return appointment with the same physician, in half of all cases as a result of a routine or preventive care visit. CONCLUSION: Ambulatory office-based pediatric care provided by specialists includes a large share of non referred routine and preventive care for common problems for patients already known to the physician. It is likely that many of these services could be managed in primary care settings, lessening demand for specialists and improving coordination of care.
Abstract.
Author URL.
Full text.
Garin O, Nieto-Moreno M, Almansa J, Vilagut G, Villalonga-Olives E, Alonso J, Valderas JM, Ayuso JL, Ferrer M (2009). VALIDATION OF THE "WORLD HEALTH ORGANIZATION DISABILITY ASSESSMENT SCHEDULE, WHODAS-II".
GACETA SANITARIA,
23, 53-54.
Author URL.
2008
Valderas JM, Kotzeva A, Espallargues M, Guyatt G, Ferrans CE, Halyard MY, Revicki DA, Symonds T, Parada A, Alonso J, et al (2008). A relevant study was missed in our systematic review on the impact of patient-reported outcomes in clinical practice.
QUALITY OF LIFE RESEARCH,
17(6), 965-966.
Author URL.
Palacio-Vieira JA, Villalonga-Olives E, Valderas JM, Espallargues M, Herdman M, Berra S, Alonso J, Rajmil L (2008). Changes in health-related quality of life (HRQoL) in a population-based sample of children and adolescents after 3 years of follow-up.
QUALITY OF LIFE RESEARCH,
17(10), 1207-1215.
Author URL.
Valderas JM, Ferrer M, MendÃvil J, Garin O, Rajmil L, Herdman M, Alonso J, Scientific Committee on "Patient-Reported Outcomes" of the IRYSS Network (2008). Development of EMPRO: a tool for the standardized assessment of patient-reported outcome measures.
Value Health,
11(4), 700-708.
Abstract:
Development of EMPRO: a tool for the standardized assessment of patient-reported outcome measures.
OBJECTIVE: This study was aimed to develop a tool for the standardized assessment of patient-reported outcomes (PROs) to assist the choice of instruments. METHODS: an expert panel adapted the eight attributes proposed by the Medical Outcomes Trust as evaluation review criteria, created items to evaluate them, and included a response scale for each item. A pilot test was designed to test the new tool's feasibility and to obtain preliminary information concerning its psychometric properties. The Spanish versions of five measures were selected for assessment: the SF-36 Health Survey, the Nottingham Health Profile, the COOP-WONCA charts, the EuroQol-5D, and the Quality of Life Questionnaire EORTC-QLQ-C30. We assessed the new tool's reliability (Cronbach's alpha and intraclass correlation coefficient [ICC]) and construct validity. RESULTS: the new EMPRO (Evaluating the Measurement of Patient-Reported Outcomes) tool has 39 items covering eight key attributes: conceptual and measurement model, reliability, validity, responsiveness, interpretability, burden, alternative modes of administration, and cross-cultural and linguistic adaptations. Internal consistency was high (alpha = 0.95) as was interrater concordance (ICC: 0.87-0.94). Positive associations consistent with a priori hypotheses were observed between EMPRO attribute scores and the number of articles identified for the measures, the years elapsed since the publication of the first article, and the number of citations. CONCLUSION: a new tool for the standardized assessment of PRO measures is available. It has shown good preliminary reliability and validity and should be a useful aid to investigators who need to choose between alternative measures. Further assessment of the tool is necessary.
Abstract.
Author URL.
Valderas JP, Irribarra V, Moreno M, Liberona Y, Acosta AM, Rubio L, De La Cruz R, Yolito M, Escalona M, Perez G, et al (2008). Different effects of roux-en-y gastric bypass (RGYB), sleeve gastrectomy (SG), and medical treatment (MED) of obesity on PYY, hunger and satiety, for similar magnitudes of weight loss: a preliminary report.
Author URL.
Vilagut G, Maria Valderas J, Ferrer M, Garin O, Lopez-Garcia E, Alonso J (2008). Interpretation of SF-36 and SF-12 questionnaires in Spain: physical and mental components.
MEDICINA CLINICA,
130(19), 726-735.
Author URL.
Valderas JM, Alonso J, Guyatt GH (2008). Measuring patient-reported outcomes: moving from clinical trials into clinical practice.
MEDICAL JOURNAL OF AUSTRALIA,
189(2), 93-94.
Author URL.
Valderas JM, Alonso J (2008). Patient reported outcome measures: a model-based classification system for research and clinical practice.
Qual Life Res,
17(9), 1125-1135.
Abstract:
Patient reported outcome measures: a model-based classification system for research and clinical practice.
PURPOSE: the umbrella term Patient Reported Outcomes (PRO) has been successfully proposed for instruments measuring perceived health outcomes, but its relationship to current conceptual models remains to be established. Our aim was to develop a classification system for PRO measures based on a valid conceptual model. METHODS: We reviewed models and classification schemes of health outcomes and integrated them in a common conceptual framework, based on the models by Wilson and Cleary and the International Classification of Functioning (ICF). We developed a cross-classification system based on the minimum common set of consistent concepts identified in previous classifications, and specified categories based on the WHO International Classifications (ICD-10, and ICF). We exemplified the use of the classification system with selected PRO instruments. RESULTS: We identified three guiding concepts: (1) construct (the measurement object); (2) population (based on age, gender, condition, and culture); and (3) measurement model (dimensionality, metric, and adaptability). The application of the system to selected PRO measures demonstrated the feasibility of its use, and showed that most of them actually assess more than one construct. CONCLUSION: This classification system of PRO measures, based on a valid integrated conceptual model, should allow the classification of most currently used instruments and may facilitate a more adequate selection and application of these instruments.
Abstract.
Author URL.
Villalonga-Olives E, Valderas JM, Palacio-Vieira JA, Herdman M, Rajmil L, Alonso J (2008). The adaptation into Spanish of the Coddington Life Events Scales (CLES).
QUALITY OF LIFE RESEARCH,
17(3), 447-452.
Author URL.
Valderas JM, Kotzeva A, Espallargues M, Guyatt G, Ferrans CE, Halyard MY, Revicki DA, Symonds T, Parada A, Alonso J, et al (2008). The impact of measuring patient-reported outcomes in clinical practice: a systematic review of the literature.
Qual Life Res,
17(2), 179-193.
Abstract:
The impact of measuring patient-reported outcomes in clinical practice: a systematic review of the literature.
OBJECTIVE: the purpose of this paper is to summarize the best evidence regarding the impact of providing patient-reported outcomes (PRO) information to health care professionals in daily clinical practice. METHODS: Systematic review of randomized clinical trials (Medline, Cochrane Library; reference lists of previous systematic reviews; and requests to authors and experts in the field). RESULTS: Out of 1,861 identified references published between 1978 and 2007, 34 articles corresponding to 28 original studies proved eligible. Most trials (19) were conducted in primary care settings performed in the USA (21) and assessed adult patients (25). Information provided to professionals included generic health status (10), mental health (14), and other (6). Most studies suffered from methodologic limitations, including analysis that did not correspond with the unit of allocation. In most trials, the impact of PRO was limited. Fifteen of 23 studies (65%) measuring process of care observed at least one significant result favoring the intervention, as did eight of 17 (47%) that measured outcomes of care. CONCLUSIONS: Methodological concerns limit the strength of inference regarding the impact of providing PRO information to clinicians. Results suggest great heterogeneity of impact; contexts and interventions that will yield important benefits remain to be clearly defined.
Abstract.
Author URL.
Valderas JM (2008). Treatment intensification does not always lead to better quality of care in patients with hypertension.
ANNALS OF INTERNAL MEDICINE,
149(5), 362-362.
Author URL.
2007
Morcillo C, Valderas JM, Roca JM, Oliveró R, Núñez C, Sánchez M, Bechich S (2007). Computed Tomographic Measurement of Coronary Artery Calcification in the Assessment of Cardiovascular Risk: a Descriptive Study. Revista Española de CardiologÃa (English Edition), 60(3), 268-275.
Valderas JM, Starfield B, Salisbury C (2007). Definitions of chronic health conditions in childhood.
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION,
298(14), 1636-1636.
Author URL.
Guyatt GH, Ferrans CE, Halyard MY, Revicki DA, Symonds TL, Varricchio CG, Kotzeva A, Valderas JM, Alonso J, Clinical Significance Consensus Meeting Group, et al (2007). Exploration of the value of health-related quality-of-life information from clinical research and into clinical practice.
Mayo Clin Proc,
82(10), 1229-1239.
Abstract:
Exploration of the value of health-related quality-of-life information from clinical research and into clinical practice.
Quality-of-life (QOL) instruments used in clinical research can provide important evidence to inform decisions about alternative treatments. This is particularly true when patients, such as those with cancer who are contemplating toxic chemotherapy, face tradeoffs between quantity of life and QOL or when the primary goal of therapy is to improve how patients feel. Surrogate measures (cardiac function, exercise capacity, bone density, tumor size) are inadequate substitutes for direct measurement of QOL. Quality-of-life measures will be most valuable when they comprehensively measure aspects of QOL that are both important to patients and likely to be influenced by therapy, when the QOL measurement instruments are valid (measuring what is intended) and responsive (able to detect all important changes, even if small), and when the results are readily interpretable (determining whether treatment-related changes are trivial, small but important, or large). Researchers are finding new, imaginative ways to help clinicians understand the magnitude of treatment impact on QOL. Additionally, QOL measures may be useful in clinical practice. Recent results from well-designed randomized controlled trials suggest that information on patient QOL provided to clinicians might, in some circumstances, result in benefits for these patients. Further investigation is warranted to confirm these observations and to define the particular combination of methods and settings most likely to yield important benefits.
Abstract.
Author URL.
Valderas Martinez JM (2007). Geographic filters for PubMed.
REVISTA ESPANOLA DE SALUD PUBLICA,
81(4), 421-422.
Author URL.
Morcillo C, Valderas JM, Roca JM, Oliveró R, Núñez C, Sánchez M, Bechich S (2007). La determinación de calcio coronario con tomografía computarizada en la evaluación del riesgo cardiovascular: un estudio descriptivo. Revista Española de CardiologÃa, 60(3), 268-275.
Valderas JM (2007). Measurement of health and disability.
LANCET,
370(9586), 483-484.
Author URL.
Valderas JM, Starfield B, Roland M (2007). Multimorbidity's many challenges - a research priority in the UK.
BRITISH MEDICAL JOURNAL,
334(7604), 1128-1128.
Author URL.
Balagué M, MarÃa Valderas J, BolÃbar B (2007). Oportunidades y aspectos organizativos de la investigación en atención primaria. Medicina ClÃnica, 128(18), 711-714.
Codina GarcÃa F, Morató I, Valderas JM, Rajmil L (2007). Rendimiento escolar y salud en adolescentes de Lloret de Mar (Girona). Atención Primaria, 39(11), 623-624.
Valderas JM, Alonso J (2007). Response to Cella et al, May 2006 - Supplement 1 medical care.
MEDICAL CARE,
45(10), 1008-1008.
Author URL.
Valderas JM (2007). Why do team-authored papers get cited more?.
SCIENCE,
317(5844), 1496-1496.
Author URL.
GarcÃa FC, Morató I, Valderas JM, Rajmil L (2007). [School performance and health in adolescents in Lloret de Mar (Girona)].
Aten Primaria,
39(11), 623-624.
Author URL.
Valderas MartÃnez JM (2007). [Use of geographic restrictions in PubMed].
Rev Esp Salud Publica,
81(4), 421-422.
Author URL.
2006
Valderas JM, Mendivil J, Parada A, Losada-Yáñez M, Alonso J (2006). Construcción de un filtro geográfico para la identificación en PubMed de estudios realizados en España. Revista Española de CardiologÃa, 59(12), 1244-1251.
Valderas JM, Mendivil J, Parada A, Losada-Yanez M, Alonso J (2006). Development of a geographic filter for PubMed to identify studies performed in Spain.
REVISTA ESPANOLA DE CARDIOLOGIA,
59(12), 1244-1251.
Author URL.
2005
Tarrado X, Castañón M, Thió M, Valderas JM, Garcia Aparicio L, Morales L (2005). Comparative Study between Isolated Intestinal Perforation and Necrotizing Enterocolitis. European Journal of Pediatric Surgery, 15(2), 88-94.
Vilagut G, Ferrer M, Rajmil L, Rebollo P, Permanyer-Miralda G, Quintana JM, Santed R, Valderas JM, Ribera A, Domingo-Salvany A, et al (2005). El Cuestionario de Salud SF-36 español: una década de experiencia y nuevos desarrollos. Gaceta Sanitaria, 19(2), 135-150.
Morcillo C, Valderas JM, Aguado O, Delás J, Sort D, Pujadas R, Rosell F (2005). Evaluación de una intervención domiciliaria en pacientes con insuficiencia cardíaca. Resultados de un estudio aleatorizado. Revista Española de CardiologÃa, 58(6), 618-625.
Morcillo C, Valderas JM, Aguado O, Delas J, Sort D, Pujadas R, Rosell F (2005). Evaluation of a home-based intervention in heart failure patients. Results of a randomized study.
REVISTA ESPANOLA DE CARDIOLOGIA,
58(6), 618-625.
Author URL.
Rebollo P, Valderas JM, Ortega F (2005). Evolución en España de los impedimentos descritos para la utilización, en la práctica clínica, de las mediciones del estado de salud percibido. Medicina ClÃnica, 125(18), 703-705.
Valderas JM, Ferrer M, Alonso J (2005). Health-related quality of life instruments and other patient-reported outcomes.
Medicina Clinica,
125(SUPPL. 1), 56-60.
Abstract:
Health-related quality of life instruments and other patient-reported outcomes
In the last few years, many different instruments assessing health-related quality of life and the broader concept of Patient-Reported Outcomes (PRO) have been developed. Following the recommendations of the Scientific Advisory Committee of the Medical Outcomes Trust, the ePRO checklist provides a modular assessment for PRO instruments based on eight key attributes: conceptual and measurement model, reliability, validity, responsiveness, interpretability, respondent and administrative burden, alternative forms, and cross-cultural adaptation. Selected criteria describing each attribute in detail are also listed. The availability of explicit guidelines is expected to promote the development of better PRO measurement instruments.
Abstract.
MarÃa Valderas J, Ferrer M, Alonso J (2005). Instrumentos de medida de calidad de vida relacionada con la salud y de otros resultados percibidos por los pacientes. Medicina ClÃnica, 125, 56-60.
Antoñanzas F, RodrÃguez R, Antonio Sacristán J, Illa R (2005). Los medicamentos en la Unión Europea: el tándem comercio-salud. Gaceta Sanitaria, 19(2), 151-167.
Valderas JM, Rue M, Guyatt G, Alonso J (2005). The impact of the VF-14 index, a perceived visual function measure, in the routine management of cataract patients. Quality of Life Research, 14(7), 1743-1753.
Valderas JM, Ferrer M, Alonso J (2005). [Health-related quality of life instruments and other patient-reported outcomes].
Med Clin (Barc),
125 Suppl 1, 56-60.
Abstract:
[Health-related quality of life instruments and other patient-reported outcomes].
In the last few years, many different instruments assessing health-related quality of life and the broader concept of Patient-Reported Outcomes (PRO) have been developed. Following the recommendations of the Scientific Advisory Committee of the Medical Outcomes Trust, the ePRO checklist provides a modular assessment for PRO instruments based on eight key attributes: conceptual and measurement model, reliability, validity, responsiveness, interpretability, respondent and administrative burden, alternative forms, and cross-cultural adaptation. Selected criteria describing each attribute in detail are also listed. The availability of explicit guidelines is expected to promote the development of better PRO measurement instruments.
Abstract.
Author URL.
Vilagut G, Ferrer M, Rajmil L, Rebollo P, Permanyer-Miralda G, Quintana JM, Santed R, Valderas JM, Ribera A, Domingo-Salvany A, et al (2005). [The Spanish version of the Short Form 36 Health Survey: a decade of experience and new developments].
Gac Sanit,
19(2), 135-150.
Abstract:
[The Spanish version of the Short Form 36 Health Survey: a decade of experience and new developments].
OBJECTIVE: the Short Form-36 Health Survey (SF-36) is one of the most widely used and evaluated generic health-related quality of life (HRQL) questionnaires. After almost a decade of use in Spain, the present article critically reviews the content and metric properties of the Spanish version, as well as its new developments. METHODS: a review of indexed articles that used the Spanish version of the SF-36 was performed in Medline (PubMed), the Spanish bibliographic databases IBECS and IME. Articles that provided information on the measurement model, reliability, validity, and responsiveness to change of the instrument were selected. RESULTS: Seventy-nine articles were found, of which 17 evaluated the metric characteristics of the questionnaire. The reliability of the SF-36 scales was higher than the suggested standard (Cronbach's alpha) of 0.7 in 96% of the evaluations. Grouped evaluations obtained by meta-analysis were higher than 0.7 in all cases. The SF-36 showed good discrimination among severity groups, moderate correlations with clinical indicators, and high correlations with other HRQL instruments. Moreover, questionnaire scores predicted mortality and were able to detect improvement due to therapeutic interventions such as coronary angioplasty, benign prostatic hyperplasia surgery, and non-invasive positive pressure home ventilation. The new developments (norm-based scoring, version 2, the SF-12 and SF-8) improved both the metric properties and interpretation of the questionnaire. CONCLUSIONS: the Spanish version of the SF-36 and its recently developed versions is a suitable instrument for use in medical research, as well as in clinical practice.
Abstract.
Author URL.
2004
Sampietro-Colom L, Espallargues M, Reina MD, Marsó E, Valderas JM, Estrada MD (2004). Citizen's opinions, experiences and perceptions around cataract and hip and knee replacement surgical waiting lists.
Atencion Primaria,
33(2), 84-94.
Abstract:
Citizen's opinions, experiences and perceptions around cataract and hip and knee replacement surgical waiting lists
Objectives. The aim of this study is to describe the views, perceptions and personal experience around elective cataract and hip and knee replacement waiting lists in Catalonia in order to improve their management. Design. Qualitative methodology: four focus groups for each procedure. Place. Conducted between February-March 2000 at the Catalan Health Services headquarters. Participants. Each focus group induded consultants (ophtalmologists, orthopedic surgeons, rheumatologists, rehabilitators, GPs), other related health professionals (nurses, social workers, physiotherapists, opticians/optometrist, GPs), patients and relatives and general population. Participants were selected through researchers and the clinical scientific committees. All of them followed a pre-established inclusion criteria. Main measures. The analysis of the information was performed using the content analysis technique (contents of sessions were transcripted and information classified according to themes). Results. Ten themes were identified. Waiting lists were argued to be a consequence of lack of resources, bad management and conflict of interest among consultants. Overall, the health care authority responsibility for the solution was acknowledged, although some participants claim more citizen participation. Among proposed solutions, prevention and education, more resources and improved management were found. Furthermore, a better physician-patient communication was considered essential. All the groups disagreed with the implicit current prioritisation system, however none wanted to assume the responsibility. Conclusions. Citizen's perceptions and personal experiences point to a multifactorial approach to waiting lists management, which would ameliorate the problem and lead to a better social acceptance.
Abstract.
Valderas JM, Alonso J, Prieto L, Espallargues M, Castells X (2004). Content-based interpretation aids for health-related quality of life measures in clinical practice. An example for the visual function index (VF-14). Quality of Life Research, 13(1), 35-44.
Kotzeva A, Alonso J, Espallargues M, Ferrans C, Guyatt G, Halyard M, Parada A, Revicki D, Symonds T, Valderas JM, et al (2004). IMPACT OF MEASURING PATIENT-REPORTED OUTCOMES IN CLINICAL PRACTICE: a SYSTEMATIC REVIEW.
Author URL.
Sampietro-Colom L, Espallargues M, Reina MD, Marsó E, Valderas JM, Estrada MD (2004). Opiniones, vivencias y percepciones de los ciudadanos en torno a las listas de espera para cirugía electiva de catarata y artroplastia de cadera y rodilla. Atención Primaria, 33(2), 86-94.
Sampietro-Colom L, Espallargues M, Reina MD, Marsó E, Valderas JM, Estrada MD (2004). Opiniones, vivencias y percepciones de los ciudadanos en torno a las listas de espera para cirugía electiva de catarata y artroplastia de cadera y rodilla. Atención Primaria, 33(2), 86-94.
Valderas MartÃnez JM, Ferrer Menduiña X (2004). The Difficult Measurement of Inhalation Technique [1]. Atencion Primaria, 33(4).
Sampietro-Colom L, Espallargues M, Reina MD, Marsó E, Valderas JM, Estrada MD (2004). [Citizens opinions, experiences and perceptions about waiting lists for elective cataract surgery and hip and knee replacement. ].
Aten Primaria,
33(2), 86-94.
Abstract:
[Citizens opinions, experiences and perceptions about waiting lists for elective cataract surgery and hip and knee replacement. ].
OBJECTIVES: the aim of this study is to describe the views, perceptions and personal experience around elective cataract and hip and knee replacement waiting lists in Catalonia in order to improve their management. DESIGN: Qualitative methodology: four focus groups for each procedure. PLACE: Conducted between February-March 2000 at the Catalan Health Services headquarters. PARTICIPANTS: Each focus group included consultants (ophtalmologists, orthopedic surgeons, rheumatologists, rehabilitators, GPs), other related health professionals (nurses, social workers, physiotherapists, opticians/optometrist, GPs), patients and relatives and general population. Participants were selected through researchers and the clinical scientific committees. All of them followed a pre-established inclusion criteria. MAIN MEASURES: the analysis of the information was performed using the content analysis technique (contents of sessions were transcripted and information classified according to themes). RESULTS: Ten themes were identified. Waiting lists were argued to be a consequence of lack of resources, bad management and conflict of interest among consultants. Overall, the health care authority responsibility for the solution was acknowledged, although some participants claim more citizen participation. Among proposed solutions, prevention and education, more resources and improved management were found. Furthermore, a better physician-patient communication was considered essential. All the groups disagreed with the implicit current prioritisation system, however none wanted to assume the responsibility. CONCLUSIONS: Citizen's perceptions and personal experiences point to a multifactorial approach to waiting lists management, which would ameliorate the problem and lead to a better social acceptance.
Abstract.
Author URL.
Valderas MartÃnez JM, Ferrer Menduiña X (2004). [The difficult measurement of inhalation technique].
Aten Primaria,
33(4).
Author URL.
2003
Perez S, Losada G, Piqueras M, Vila MA, Dalfo A, Valderas JM (2003). Diagnosis and management of hipertension in primary care: Difference between intervention.
Author URL.
2000
Valderas JM, Alonso J, Prieto L, Valderas JM (2000). Assessing the psychometric properties of the visual function index VF-14.
Author URL.
Espallargues M, Valderas JM, Alonso J (2000). Provision of Feedback on Perceived Health Status to Health Care Professionals. Medical Care, 38(2), 175-186.
Valderas JM, Espallargues M, Alonso J (2000). Provision of feedback on perceived health status to health care professionals - Response.
MEDICAL CARE,
38(8), 878-879.
Author URL.