Quality from the Patient’s Perspective: Implementation of an Established Patient-Reported Outcome Platform in a Multidisciplinary Skull Base Tumor Clinic
Notice bibliographique
Résumé
Background: Utilization of patient-reported outcomes (PROs) in clinical care for skull base tumor patients treated in a multidisciplinary management team has been proposed to focus on outcomes most important to patients and to enhance shared decision making. Specific options for treatment, including endoscopic and open surgery as well as chemoradiation have both acute and long-term sequelae. Identification of how these treatments impact the individual patient has implications for both quality of care and the value of the treatment provided. Objective: The aim of the study is to assess the ability to implement real time PROs on an electronic platform within a multidisciplinary skull base clinic. Methods: Descriptive analysis of implementation of PROs for the skull base tumor program at a cancer center is given. Two validated instruments, the Skull Base Inventory (SBI), developed at the Princess Margaret Cancer Center, Toronto, CA and/or Head and Neck Patient Reported Outcomes (HNPROs) developed at Memorial Sloan Kettering Cancer Center, NY, NY were administered at baseline, after intervention, and at follow-up visits. All patients treated for sinonasal, pituitary, or anterior skull base pathology are eligible for electronic PROs assessment as a part of standard of care within a larger initiative of the Head and Neck Service at MSKCC. Results: Since July 2018, patients with pituitary, nasal cavity, and ethmoid pathology have received the SBI and those with malignancies of the maxillary sinus (or other head and neck malignancy) received the HNPROs. Automatic “time out” information technology settings prevent delivery of duplicate surveys. ICD-10 diagnosis codes were used to allow for domain-specific questionnaires based on the specific subsites. For example, a patient with a diagnosis of maxillary sinus cancer will receive questions that include inquiry about numbness, rhinorrhea, epiphora, vision, facial appearance, and cancer worry. Graphical reports provide representation of domains over time. From July 1, 2018 to July 1, 2019, 91 of 124 possible patients with anterior skull base pathology have submitted surveys within a broader context of 2,723 of 3,758 head and neck cancer (nonthyroid) patients having submitted surveys. A total of 76% completed the module on the institutional patient portal and 24% completed on a tablet at the time of physician visit. Median time to completion was 5 minutes. Conclusion: Integration of electronic sinonasal, pituitary, and skull base PROs as part of a multidisciplinary management team is feasible. This has the potential to provide important patient-specific data that can educate patient and clinician alike and assist in decision making. Over time, normative data can be gleaned to demonstrate what a large population of patients have experienced at different time points when pursuing specific treatment options. This can ultimately improve the quality of care and value provided per intervention.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,076 | 0,109 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,003 | 0,002 |
| Communication savante | 0,008 | 0,004 |
| Science ouverte | 0,002 | 0,011 |
| Intégrité de la recherche | 0,001 | 0,004 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».