Journal of evaluation in clinical practice最新文献

{"title":"When Shared, Assessable, and Ascertainable: If It Is Health","authors":"Turchi Gian Piero, Orrù Luisa, Iudici Antonio, Moro Christian, Pinto Eleonora","doi":"10.1111/jep.70433","DOIUrl":"10.1111/jep.70433","url":null,"abstract":"","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147638897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Influencing Physicians' Code Status Decision-Making: An Experimental Vignette-Based Survey","authors":"Andrea Trippini,&nbsp;Pedro Marques-Vidal,&nbsp;Laura Jones,&nbsp;Ralf J. Jox,&nbsp;David Gachoud","doi":"10.1111/jep.70424","DOIUrl":"10.1111/jep.70424","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>Worldwide hospitals increasingly require a code status to be established for every inpatient. Establishing a code status should be a shared decision-making process between the inpatient and the hospital physician. However, there is no consensus on how code status should be established at admission and which factors influence the decision-making process.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims and Objectives</h3>\u0000 \u0000 <p>To identify physician and patient characteristics influencing physicians' code status decision-making.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Experimental, vignette-based survey in a tertiary university hospital, using a self-report online vignette questionnaire. Each questionnaire contained eleven demographic questions and five clinical vignettes. Three vignettes had one variable altered between two groups, and two vignettes were identical in the two groups. Participants were physicians working in hospital wards admitting adult somatic patients. Physicians were randomly assigned to one of the two groups and had to decide on a code status in case of a cardiac arrest.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 724 invited physicians, 303 (41.8%) participated in this study, 146 in group A and 157 in group B. Physicians from surgery departments were significantly (<i>p</i> &lt; 0.001) more likely to resuscitate than those from the medicine department in four vignettes (multimorbidity, oncology, dementia, and neurology vignettes). Physicians with experience in ICU were significantly (<i>p</i> &lt; 0.05) less likely to recommend resuscitation in three vignettes (multimorbidity, oncology and dementia vignettes). Two patient variables were significantly (<i>p</i> &lt; 0.001) associated with a decision to resuscitate: patient being a physician themself versus not (33.1% vs. 15.8%); younger versus older patient (61.5% vs. 25.5%) despite a terminally ill condition.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Physicians' own characteristics contribute to heterogeneity in decision-making. Physicians' decision-making regarding code status is influenced by patient factors that may not be related to resuscitation outcomes. These results raise important ethical considerations and highlight the need for specific training about code status conversations, resuscitation outcomes, and reflexiveness in decision-making.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70424","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147638963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reconciling Anchor-Based Methods and Distribution-Based Methods for the Estimation of Minimal Important Differences in Health Outcome Measures","authors":"Michael M. Ward","doi":"10.1111/jep.70435","DOIUrl":"10.1111/jep.70435","url":null,"abstract":"","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147638965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"More Doctors, Less Competency? A Quality Crisis in Brazilian Medical Education","authors":"Bráulio Evangelista de Lima,&nbsp;João Victor Rosa de Freitas,&nbsp;Fernanda Patti Nakamoto,&nbsp;Paulo Sérgio Sucasas da Costa,&nbsp;Núbia de Souza Lobato,&nbsp;Claudio Andre Barbosa de Lira","doi":"10.1111/jep.70436","DOIUrl":"10.1111/jep.70436","url":null,"abstract":"&lt;p&gt;Since 2004, Brazil has more than tripled the number of medical schools, increasing from 143 to 448 by 2024, while annual seats rose from 13,820 to 48,491 over the same period [&lt;span&gt;1&lt;/span&gt;]. Expanding medical training capacity is a legitimate response in a continental country facing persistent physician shortages and marked geographic maldistribution, particularly in underserved regions. However, this rapid expansion has not been accompanied by proportional growth in residency training capacity, limiting opportunities for supervised transition to practice and increasing reliance on undergraduate training quality [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Although Brazil has a sophisticated official system for educational assessment, with a strong emphasis on institutional infrastructure, regulatory compliance and programme-level characteristics [&lt;span&gt;2&lt;/span&gt;], student performance has received comparatively less emphasis. However, there is no standardized mechanism for systematically evaluating clinical competency. Furthermore, many newly established institutions lack integration with student-led clinics and hospitals, provide insufficient clinical training settings and have constrained faculty development structures [&lt;span&gt;3&lt;/span&gt;]. Against this regulatory backdrop, the unprecedented scale and speed of medical school expansion have reignited long-standing concerns about the quality of medical education, particularly regarding minimum competency at graduation and the training of future physicians. These concerns have been brought into sharp focus by the release of the first results of the National Examination for the Evaluation of Medical Training (ENAMED). Similar examinations have been implemented in several countries as mechanisms to ensure minimum competence in medical practice. Evidence from other contexts suggests that performance in such examinations may be associated with aspects of subsequent physician performance and patient outcomes, supporting their role as components of broader quality assurance systems in medical education [&lt;span&gt;4, 5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;In this commentary, we argue that the early ENAMED results should be interpreted not merely as isolated examination outcomes, but as a warning signal that Brazil's rapid expansion in medical training capacity may be outpacing its ability to assure minimum competency at graduation, with implications for patient safety, equity and health-system planning.&lt;/p&gt;&lt;p&gt;ENAMED is a Brazilian national examination created by the Ministry of Education, and it was introduced in 2025, with plans to be administered annually to all graduating medical students [&lt;span&gt;6, 7&lt;/span&gt;]. The primary objective of the examination is to assess whether graduating medical students have acquired the competencies and skills required by the Brazilian medical education government legislation [&lt;span&gt;8&lt;/span&gt;]. In addition, the examination aims to: (i) generate evidence to support improvements in undergraduate medical education and stre","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13061353/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147638908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transforming Care through Outcomes Measurement: Experience in a Southern Brazilian Hospital.","authors":"Jonas Michel Wolf, Arthur Pille, Lucas Felipe Kist, Helena Petek, Samanta Brangel Pereira, Mariana Allende Dos Santos, Marilze Alves Quessada, Rafaela Munari da Silva, Mauricio Santiago Soper, Juçara Gasparetto Maccari, Luiz Antônio Nasi","doi":"10.1111/jep.70452","DOIUrl":"https://doi.org/10.1111/jep.70452","url":null,"abstract":"<p><strong>Background: </strong>Standardized outcome measurement is a core component of value-based healthcare, yet real-world evidence on long-term system-wide implementation remains limited.</p><p><strong>Objectives: </strong>To evaluate the longitudinal clinical and patient-reported outcome impact of implementing condition-specific, outcome-driven care pathways across multiple specialties.</p><p><strong>Methods: </strong>Between 2017 and 2024, 9549 patients were enrolled in ten pathways. Patient-Reported Outcomes (PROMs) collection, digital follow-up, and dedicated monitoring teams were progressively introduced. Temporal trends in risk-adjusted clinical outcomes, functional recovery, and quality-of-life measures were analyzed.</p><p><strong>Results: </strong>Annual enrollment increased from 642 to 1728 patients, while PROMs completion rose from 38% to 70.1%. Twelve-month loss to follow-up declined from 29% to 17%. Case-mix complexity increased (≥ 2 comorbidities: 41% to 53%). Despite this, 30-day readmissions fell from 11.8% to 7.5%, 1-year mortality from 6.4% to 5.3%, length of stay from 6.2 to 5.4 days, and surgical complications from 14.6% to 10.2%. Stroke functional independence increased (52% to 64%), heart failure symptom burden declined, and elderly CHF readmissions decreased (13.0% to 7.5%). Arthroplasty patients more frequently achieved clinically meaningful improvement (76% to 89%), while postoperative readmissions declined. In spinal surgery, disability scores improved and persistent opioid use decreased (28% to 16%). Oncology pathways showed better quality-of-life, faster treatment initiation, and fewer emergency visits. Post-COVID and sepsis survivors demonstrated improved functional recovery, and neonatal pathways showed enhanced parental confidence and reduced emergency visits. Twelve quality-improvement initiatives were launched; eight pathways demonstrated statistically significant post-implementation outcome gains.</p><p><strong>Conclusions: </strong>Systematic outcome measurement was associated with sustained improvements in survival, complications, functional recovery, and quality of life, even in increasingly complex populations, supporting its role as a driver of continuous patient-centered care improvement.</p>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 3","pages":"e70452"},"PeriodicalIF":2.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147773421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Practical Method for Monitoring Patient Safety Culture: Applying Net Promoter Score and Lot Quality Assurance Sampling.","authors":"Julio J Lopez-Picazo, Inmaculada Vidal-Abarca, Juana M Marín-Martinez","doi":"10.1111/jep.70441","DOIUrl":"10.1111/jep.70441","url":null,"abstract":"<p><strong>Rationale: </strong>Patient safety culture is a key component of health care quality, yet its integration into routine monitoring systems is often limited. Existing assessments tend to focus on cross‑sectional snapshots rather than providing practical, process‑level information that can support continuous improvement in integrated health care organisations.</p><p><strong>Aims and objectives: </strong>To design and pilot a practical method for monitoring patient safety culture across key care processes within an integrated health care area, using Net Promoter Score (NPS) and Lot Quality Assurance Sampling (LQAS) to identify strengths, weaknesses, and improvement priorities.</p><p><strong>Method: </strong>A descriptive cross‑sectional study was conducted in six care processes (primary care, outpatient consultation, hospitalisation, emergencies, surgery, and supportive care). Patient safety culture was assessed using validated AHRQ instruments (HSOPS and MOSPS), administered via structured telephone interviews. NPS was used to summarise favourable and unfavourable perceptions into a single polarity score. LQAS was applied to classify each process into acceptable or unacceptable results and to identify priority improvement lots. A process‑level monitoring plan was developed based on dimensions with critical NPS values and rejected lots.</p><p><strong>Results: </strong>A total of 126 professionals participated (88% response rate). Safety‑culture perceptions varied substantially across processes. 'Teamwork within units' emerged as a consistent strength, while 'work pressure and pace' and 'staffing' were frequent concerns. NPS showed 93% concordance with AHRQ classifications. LQAS identified 132 rejected lots (49.5%), including 25 (9.4%) flagged as high‑priority weaknesses.</p><p><strong>Conclusion: </strong>The combined use of NPS and LQAS offers a practical, scalable approach for monitoring patient safety culture at the process level. This method supports prioritisation, resource allocation, and the integration of safety‑culture information into routine governance and improvement activities.</p>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 3","pages":"e70441"},"PeriodicalIF":2.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13096758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147729146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Safety, Feasibility, and Usability of a Virtual Nursing Handover From the Post-Anesthesia Care Unit to the Ward.","authors":"Dezarae Shue Yen Ang, Tianshun Lim, Andrea Chau Lin Choh, Ser Cheng Ng, Min Yi Tan, Fazila Aloweni, Shu Hui Lim, Peng Sheng Lau, Wing Chu Kwok, Clarabelle Sharmani Gason, Ruli Lu, Kai Yunn Teo, Aye Too Chang, Eileen Xueli Seah, Shi Wei Tan, Chai Lian Teng, Jing Fu, Siew Teing Leong, Meh Meh Goh, Salimah Bte Mohd Ayoob, Shin Yuh Ang","doi":"10.1111/jep.70442","DOIUrl":"10.1111/jep.70442","url":null,"abstract":"<p><strong>Rationale: </strong>Traditional in-person handovers from the Post-Anaesthesia Care Unit (PACU) to inpatient wards often require PACU nurses to leave their post-operative patients for extended periods, which may delay the handover and management of other patients awaiting transfer. Alternatively, the PACU nurse-in-charge may hand over patient information to another individual to assist with in-person handover in the inpatient ward. Multiple care transitions increase the risk of omission of critical handover information, which compromises patient safety. A Virtual Nursing Handover (VNH) model may address these workflow and safety challenges by enabling direct, real-time communication between PACU and ward nurses, while reducing unnecessary staff movement.</p><p><strong>Aims and objectives: </strong>To evaluate the safety, feasibility, and usability of a VNH from the PACU to the inpatient ward.</p><p><strong>Methods: </strong>This process innovation study was underpinned by the Technology Acceptance Model (TAM). A three-component evaluation was conducted to assess the safety, feasibility, and usability of a VNH from the PACU to the inpatient ward. The study was undertaken in an acute care hospital in Singapore between October and November 2024. Handover safety was evaluated using structured audits based on the Queensland Health Handover Audit Tool, aligned with National Safety and Quality Health Service standards. The tool comprised 17 items assessing handover completeness and safety, along with additional open-ended questions to capture technical quality and notable observations. Feasibility was assessed using implementation metrics, including handover duration, adherence to the intended workflow, and technical reliability. Usability was evaluated using the System Usability Scale (SUS) administered to PACU and ward nurses, supplemented by qualitative feedback. Consistent with the TAM, safety and feasibility were interpreted as indicators of perceived usefulness, while usability reflected perceived ease of use. Quantitative data were analysed using SPSS version 26.0, and qualitative data were analysed thematically.</p><p><strong>Results: </strong>A total of 31 handover safety audits were conducted. Adherence to handover safety standards was high, with all audits meeting at least 15 of the 17 audit criteria (≥ 88%). The VNH demonstrated high feasibility, resulting in an estimated time saving of approximately 4.7 h per day for PACU nurses. No major technical failures were observed, and handovers were conducted as intended. In contrast, system usability was rated below average, with a mean SUS score of 41.9.</p><p><strong>Conclusion: </strong>VNH from the PACU to the inpatient ward was safe and feasible in routine clinical practice; however, suboptimal usability may limit technology acceptance. Further system refinement is required to improve user experience and support sustained adoption.</p>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 3","pages":"e70442"},"PeriodicalIF":2.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147729228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lessons Learned From the Implementation of a Pragmatic Trial Evaluating Non-Pharmacological Approaches to Dementia Care in US Nursing Homes.","authors":"Carin Wong, Catherine V Piersol, Felicia Chew, Cara Lekovitch, Victoria Shier, Mike Morris, Jenny Martínez, Julie Britton, Natalie E Leland","doi":"10.1111/jep.70451","DOIUrl":"https://doi.org/10.1111/jep.70451","url":null,"abstract":"<p><strong>Rationale: </strong>The consistent delivery of effective evidence into nursing home practice has been shown to enhance quality of care and residents' outcomes. Pragmatic trials enable the evaluation of efficacious interventions in a real-world context, including care of residents living with Alzheimer's Disease and Related Dementias (ADRD). Yet, there are limited pragmatic trials conducted in nursing homes and even less evidence on the strategies to successfully conduct such research in this setting.</p><p><strong>Objective: </strong>To identify the lessons learned from a pragmatic trial and provide recommendations for future successful studies in United States (US) nursing homes.</p><p><strong>Methods: </strong>Drawing on a case example of a recently completed pragmatic trial, we used the Comparative Effectiveness Research Framework to guide the thematic analysis of study documentation to identify challenges, strategies used, and recommendations for future pragmatic trials in US nursing homes.</p><p><strong>Results: </strong>Five themes emerged from this case example: 1) establish and sustain community partner collaboration, 2) context analysis and appropriate implementation plan, 3) study adaptability, 4) data collection in a 'real world' setting, and 5) broad dissemination. Within each theme, strategies we used, challenges we encountered, and recommendations for future studies were identified. Examples of recommendations include empowering community partners to be engaged in the research, co-design with community partners, account for the dynamic nature of the nursing home setting, and maintain communication with organization leaders.</p><p><strong>Conclusions: </strong>Successful completion of pragmatic trials in US nursing homes requires active engagement of community partners throughout the research process. The emergent lessons learned and recommendations highlight the complex nature of this care setting, the need to be proactive in implementation planning, and the pivotal role of community partners. Moving forward, there is a need for greater emphasis on systematically sharing experiences more broadly to advance the science of pragmatic trials in US nursing homes.</p>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 3","pages":"e70451"},"PeriodicalIF":2.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13103693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147772589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"English Is Not Neutral: Implications for Evaluating Artificial Intelligence in Medical Writing.","authors":"Shigeki Matsubara","doi":"10.1111/jep.70455","DOIUrl":"https://doi.org/10.1111/jep.70455","url":null,"abstract":"","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 3","pages":"e70455"},"PeriodicalIF":2.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147773579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to \"Prediction Performance of Earlier Studies for Later Studies in Cochrane Reviews\".","authors":"","doi":"10.1111/jep.70443","DOIUrl":"https://doi.org/10.1111/jep.70443","url":null,"abstract":"","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"32 3","pages":"e70443"},"PeriodicalIF":2.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147773630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}