BMJ Open Quality最新文献

{"title":"Improving utilisation of the WHO surgical safety checklist at Wollega University Referral Hospital: a multidimensional quality improvement project.","authors":"Ketema Badasa, Mesfin Abera, Mulugeta Abebe, Gudetu Fikadu, Milkias Beki, Misganu Teshome, Megersa Fikadu, Amsalu Takele, Temesgen Tilahun","doi":"10.1136/bmjoq-2023-002599","DOIUrl":"https://doi.org/10.1136/bmjoq-2023-002599","url":null,"abstract":"<p><strong>Background: </strong>The WHO surgical safety checklist aims to improve patient safety by standardising the delivery of care within the operating theatre through a series of essential safety checks. It is a cost-effective tool that has been shown to improve patient safety. However, its utilisation remains low<i>.</i> OBJECTIVES: This quality improvement aimed to improve utilisation of the WHO surgical safety checklist at Wollega University Referral Hospital (WURH) from 56% to 100% from 1 July 2022 to 30 June 2023<i>.</i> METHODS: A hospital-based interventional study was conducted at WURH. A fishbone diagram and a driver diagram were used to identify root causes and how to address them. Six change ideas were developed. The Plan-Do-Study-Act cycle was used to test change ideas. The contribution of each change idea to the set objective was monitored. A run chart was used to assess whether an improved level of performance has been achieved and is being maintained. The result was presented using a run chart and graphs.</p><p><strong>Result: </strong>The percentage of WHO surgical safety checklist utilisation improved from 56% to 100%. The highest percentages of WHO safe surgery checklist utilisation were recorded during the last 2 months of the project (May (100%) and June (100%)). All nursing staff in the operation theatre have received training on the WHO surgical safety checklist.</p><p><strong>Conclusion: </strong>The compliance with WHO surgical safety utilisation was significantly improved at the study area. This was achieved through application of multidimensional change ideas related to health professionals and leadership. Therefore, we recommend the operation theatre team to make the WHO surgical safety checklist utilisation, its culture, and the hospital administration to conduct regular supportive supervisions and conducting a frequent clinical audit on its consistent utilisation. Additionally, in order to ensure the sustainability of the programme, hospital management should provide training to newly assigned staff as well as staff members who were not trained during the intervention phase.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143969853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying context-specific determinants to inform improvement of antimicrobial stewardship implementation in healthcare facilities in Asia: results from a scoping review and web-based survey among local experts.","authors":"Ralalicia Limato, Elza Samantha Elmira, Nguyen Hai Yen, Anh Quan Truong, Duong Hai Yen, Direk Limmathurotsakul, Abhilasha Karkey, Raph L Hamers, Twisha S Patel, Fernanda C Lessa, Elizabeth Dodds-Ashley, Deverick Anderson, H Rogier van Doorn, Huong Vu","doi":"10.1136/bmjoq-2024-003074","DOIUrl":"10.1136/bmjoq-2024-003074","url":null,"abstract":"<p><p>International guidelines are available for the assessment and improvement of antimicrobial stewardship (AMS) programmes: an important strategy to address the escalating global antimicrobial resistance problem. However, existing AMS assessment tools lack contextual specificity for resource-limited settings, leading to limited applicability in Asia. This project aimed to identify relevant themes from current guidance documents to help develop a context-specific assessment tool that can be applied by healthcare facilities (HCFs) to improve local implementation.We performed a sequential approach of a scoping review to identify relevant assessment themes for Asia and an expert survey for getting feedback on the relevance of assessment stems developed from the scoping review. We reviewed English-language published documents discussing AMS implementation or assessment at HCFs globally and in Asia. Themes were derived through content analysis and classified following the predefined context dimensions to develop assessment stems, defined as containing one identified determinant that may influence implementation outcomes. The survey consisting of identified assessment stems was reviewed by 20 locally identified experts in Asia who rated the level of relevance of these stems in AMS implementation in the region.National leadership, training and technical support, and policy and guidance were the most commonly identified themes among 100 themes identified from 73 reviewed documents. From these themes, we developed 131 assessment stems for the expert survey. Of the 131 assessment stems, 117 (89%) were considered relevant for AMS implementation in Asia by at least 80% of respondents. These stems were included in the process of developing a global AMS assessment tool to support HCFs to improve their programmes.In conclusion, national leadership and support represent a distinct and important aspect affecting AMS implementation in HCFs in Asia. The identified assessment themes have substantial value for the formulation of locally relevant implementation strategies tailored to the Asian context.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12056646/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality improvement project to reduce beta-D-glucan turnaround times in an NHS pathology network.","authors":"Madeline Stone, Cassie Pope, Nathan Proudlove","doi":"10.1136/bmjoq-2024-003210","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003210","url":null,"abstract":"<p><p>Beta-D-glucan (BDG) is a cell wall component of many fungi, detecting this in patients' serum permits early diagnosis of invasive fungal infections, particularly in patients with haematological malignancy. In critically ill patients in an intensive-care unit, where the prevalence of invasive fungal infection is lower, the high negative predictive value of BDG facilitates withholding or discontinuation of empirical antifungal therapy, contributing to antifungal stewardship. However, for the results of BDG testing to impact patient management, they need to be available within a clinically useful timeframe.The South West London Pathology (SWLP) network routinely sent samples for BDG testing from hospital trusts in our area to the UK Health Security Agency Mycology Reference Laboratory (MRL) at Bristol for analysis. In 2021, the mean turnaround time (TAT) was more than two times the 5-working-days standard stated in the SWLP user handbook. In this quality improvement project (QIP), we identified that the greatest delay was the MRL posting hardcopy reports. We investigated electronic reporting, first for all patient samples, and then only for intensive-care patients. However, we found that information technology (IT) and staffing limitations meant this was not viable.We then investigated commercial solutions and identified an innovative assay, which enabled the implementation of in-house BDG testing that was a good fit with our available staffing resource and laboratory environment. Our aim was to achieve at least 90% of BDG results authorised within 5 working days of sample receipt. Our QIP improved performance on this from 0.88% to 92.8% and reduced the mean TAT from 11.6 to 2.5 days and at lower unit cost. The change has been well received by our laboratory staff, and our pathology operational leads have had very positive feedback from our clinical teams and our antifungal steward.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12056657/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and implementation of paging and escalation guidelines to improve interprofessional communication on surgical units.","authors":"Michael A Kochis, Lynze R Franko, Kathleen Swierzewski, Alison Parmar, Suzanne Algeri, Rajshri M Gartland","doi":"10.1136/bmjoq-2024-002995","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-002995","url":null,"abstract":"<p><strong>Introduction: </strong>Suboptimal interprofessional communication in the surgical inpatient setting has important implications for patient safety. Our departmental quality committee identified numerous safety events resulting from discordant expectations between surgical floor nurses and surgical residents or advanced practice providers (APPs) who serve as responding clinicians (RCs), and from reluctance to escalate clinical concerns. Alphanumeric paging is frequently used to communicate, but there are opportunities to enhance its effectiveness. This initiative sought to improve perceptions of communication and responsiveness between nurses and RCs by providing a shared language and set of expectations about the urgency of pages, appropriate responses and the process of escalation to other team members if necessary.</p><p><strong>Methods: </strong>An interprofessional team of surgical faculty, nurses and residents solicited input from surgical floor nurses, operating room nurses, residents, APPs and attendings on their perceptions of communication barriers among team members via online surveys and focus groups. Guidelines were iteratively developed. They specify that every page should be classified as STAT, Urgent, Please Call or FYI. Each classification is associated with an expected response time and pathway for contacting alternative team members if no response is received. After 3 months of implementation on our hospital's two main general surgery units, follow-up online surveys with multiple-choice and free-response questions assessed perceived impacts on communication and clinical care. Differences in categorical variables were assessed with χ² tests, and free text was analysed inductively.</p><p><strong>Results: </strong>After implementation, nurses reported favourable effects on communication, including significantly improved responsiveness during night shifts and timeliness from RCs during day shifts. Residents and attendings perceived the intervention to have overall neutral to mildly positive effects on communication.</p><p><strong>Conclusions: </strong>Paging and Escalation Guidelines are a feasible approach to enhance the perceptions of communication between nurses and RCs by aligning expectations, streamlining responses and decreasing barriers to escalation.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12056627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143979279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changing minds, saving lives: how training psychological safety transforms healthcare.","authors":"Viet Vu, Clément Buléon, Thuy Anh Le, Clara Christina Paula Lua, Frédéric Martin, Rebecca Minehart, Philippe Macaire","doi":"10.1136/bmjoq-2024-003186","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003186","url":null,"abstract":"<p><p>Psychological safety is a crucial component in highly functioning healthcare teams, enabling every member to speak up, take innovative risks and admit mistakes without fear of personal attack or repercussions. Leaders play a significant role in fostering this positive environment that boosts effective communication, enhances teamwork and decision-making and promotes incident reporting. Developing these non-technical skills, along with updated medical knowledge and procedural skills, is a key factor in providing better and safer patient care.Creating and sustaining psychological safety in the workplace requires a cultural and mindset shift that impacts how team members interact with each other. The anaesthesia teams from seven VinMec Healthcare System (VMHS) hospitals across Vietnam faced several critical challenges, including cultural embeddedness, geographical dispersion and a hierarchical structure where deference prevailed.Nonetheless, VMHS leadership established a goal to transform the Anaesthesia and Pain Management Department into one of the safest in Southeast Asia. A multifaceted team comprised of top management, training experts and simulation specialists was essential in driving the initiative forward.The intervention highlights the importance of leadership engagement, structured curriculum design and feedback loops to ensure continuous improvement in staff competency and collaboration. Over 18 months, 112 anaesthesia doctors and nurses completed a series of online learning modules and on-site simulation training sessions. Preliminary outcomes indicate significant progress in non-technical skills such as communication, teamwork and cognitive aid utilisation among participants. There has also been a noticeable reduction in patient safety incident scores across hospitals.This article presents a replicable model for addressing the cultural, practical and logistical challenges of integrating psychological safety into a large healthcare system by introducing an innovative, mixed-method training programme. It provides insights for healthcare leaders seeking to achieve sustainable improvements in patient safety and quality of care.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12049904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143969789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving the safety of heparin usage by standardisation of practice.","authors":"Pak Ling Lui, Su Ching Tan, Pik Wei Goh, Bhuvaneshwari Mohankumar, Peter Min Tun Ye, Kit Ching Tin, Eng Soo Yap, Winnie Z Y Teo","doi":"10.1136/bmjoq-2024-002952","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-002952","url":null,"abstract":"<p><p>Heparin, a high alert anticoagulant medication, is commonly used in medical settings in preventing and treating thrombotic events. However, its administration carries inherent risks for medication errors, bleeding complications and variability in practice standards across healthcare settings. This quality improvement project highlights the importance of standardising heparin administration practices and adopting a culture of adherence to best practices to improve patient safety and outcomes.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12049902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improvement in safety measures to reduce ED returns.","authors":"Ghadah F Almugren, Mufareh Al Katheri, Ali M Al Khathaami, Abdul Hadi Al-Qahtani, Abdulmohsen Al Saawi, Shiela Javellana, Mashael Basakran, Sara Al Yehya, Mohammed S Al Qarni","doi":"10.1136/bmjoq-2024-003015","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003015","url":null,"abstract":"<p><strong>Introduction: </strong>Emergency department (ED) return cases as critical or deceased pose a significant concern for any healthcare organisation and need to be evaluated and addressed.</p><p><strong>Objectives: </strong>A quality improvement initiative was implemented to reduce 50% of the return visits from the baseline proportion of return visits by critical/deceased adult patients to the ED within 72 hours of discharge during 1 year (January 2022-January 2023), which is a robust quality indicator. Additionally, factors that contribute to an admission or revisit within 72 hours of ED discharge were evaluated.</p><p><strong>Methodology: </strong>The implementation of initiatives began in January 2022 to monitor the ED return cases. Interventions were developed using the plan-do-study-act cycles in January 2022. Cycle 1 captured ED returns within 72 hours that were flagged by daily systemic trigger notifications received through the email by the dashboard and the cases were analysed by our quality improvement specialists team daily in January 2022. In any sentinel or severe event, an escalation via SMS to the leadership ensured immediate attention and action. Cycle 2 included patient safety leadership meetings within 24 hours of the return visit. This was initiated in April 2022 and discussed with all stakeholders for the immediate implementation of recommendations and action plans to improve the system and address individual concerns. Cycle 3 included a comprehensive consultation checklist integrated into the HIS in July 2023 to ensure that all necessary steps and consultations were completed during discharge. This included specific questions regarding the consultant's awareness about the treatment plan provided to the patient.</p><p><strong>Results: </strong>A statistical process control chart was used to present the data through the dashboard from January 2021 to January 2023 and continued until December 2023. The results revealed significant improvements. Overall, the number of return patients in the ED reduced by 46.60% from 0.13% in 2021 to 0.08% in 2022 and 2023.</p><p><strong>Conclusion: </strong>The project was highly effective for patients. It reduced the morbidity and mortality for these patients over time; however, it also increased immature admissions. Continuous monitoring and application of different measures to analyse ED return cases are recommended.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12049976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving patient access to symptomatic treatment through self-serving nausea stations at Peace Arch Hospital emergency department.","authors":"Ivjot Samra, Akash Manes, Ryan Dragoman, Amir Behboudi, Bianca Grosu","doi":"10.1136/bmjoq-2024-003189","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003189","url":null,"abstract":"<p><strong>Background: </strong>Nausea is a common complaint among patients waiting at the emergency department (ED). Previous research indicates that isopropyl alcohol (IPA) can provide symptomatic relief for nausea. However, the number of studies investigating this effect is limited, especially in ED settings. This study investigates the effect of IPA administration on patients presenting with nausea to the ED. We aim to provide symptomatic relief to 20% of these patients.</p><p><strong>Methods: </strong>In the Peach Arch Hospital (PAH) ED, patients who reported feeling nauseous were provided with a single IPA swab, instructional materials and feedback surveys. Patients inhaled IPA at a self-serving booth and completed a standardised survey immediately after. Patients were included in the study if they presented with nausea and excluded if they were under the age of 18, were pregnant, were allergic to alcohol, had cognitive impairment and/or were taking disulfiram. Multiple plan-do-study-act cycles were implemented to refine this study, including changes in feedback collection, instructional materials and presentation of IPA swabs.</p><p><strong>Results: </strong>The total number of surveys completed over the 25-week period was 41 (n=41). These surveys showed that IPA inhalation is effective in improving nausea symptoms in the ED, with 53% of survey respondents suggesting 'great improvement' or 'good improvement'. 88% of respondents felt there was improvement in symptoms. There were very limited participants (12%) who reported that IPA administration showed 'no improvement'.</p><p><strong>Conclusions: </strong>Self-serving nausea treatment stations may be an effective strategy in alleviating symptoms for patients awaiting to be seen by a physician while in the ED. These stations can enhance patient care through rapid treatment, optimise resources by reducing workload on nursing staff, and empower patients to manage their own symptoms.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12049867/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reduction of inappropriate perioperative neurology outpatient referrals for perioperative risk assessment and antithrombotic risk management in a major academic hospital.","authors":"Bridget Ng Si Min, Yingke He, Yu Zhi Pang, Eunice Kok Jie Yi, Zhao Han Goh, Fernandina Setiawan, Ignasius Jappar, Deidre Anne De Silva, Hairil Rizal Bin Abdullah","doi":"10.1136/bmjoq-2024-003038","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003038","url":null,"abstract":"<p><p>Perioperative stroke, a rare but serious complication, refers to any thrombotic, embolic or haemorrhagic cerebrovascular event lasting more than 24 hours, occurring intraoperatively or within 30 days of surgery. Preoperative assessment is critical for identifying high-risk patients and mitigating stroke risks. Despite established guidelines, a lack of standardised protocols at our institution led to inappropriate neurology referrals and unnecessary suspension of antithrombotics. At our preoperative evaluation clinic, which assesses 100-120 patients daily, challenges arose in managing patients at risk of perioperative stroke. An analysis from April to September 2022 revealed that 83.3% of 24 neurology referrals were inappropriate, causing surgical delays due to medicolegal concerns, surgery postponement fears and unclear guidelines. To address this, a quality improvement project was launched to reduce inappropriate neurology referrals by 15% in 6 months. The secondary aim was to create standardised management guidelines and evaluate both the incidence of surgical postponements and perioperative stroke outcomes.The project employed the plan-do-study-act framework, with interventions including the development of easily accessible standardised protocols and staff education through roadshow education platforms. Postintervention analysis showed a statistically significant 16.6% reduction in inappropriate neurology referrals (p=0.04), surpassing the 15% reduction target. Surgical postponements due to preoperative neurology consultations also decreased. There were no perioperative strokes reported during the project period, ensuring that the patient safety was not compromised. Additionally, the intervention resulted in cost savings of approximately $2134 annually by avoiding unnecessary consultations.This project highlights the effectiveness of multidisciplinary collaboration in reducing inappropriate neurology referrals and improving perioperative stroke risk management. The standardised guidelines have streamlined workflows and enhanced patient care, with sustained efforts planned to ensure long-term adherence to these protocols. Future directions include expanding the implementation of standardised protocols to other specialties within the institution.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12049957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electronic Patient Reported Outcome Measures and quality of life in cancer (E-PROMISE): systematic review of the evidence and meta-analysis.","authors":"Noor Husain, Zarrin Ansari, Muhammad Aaqib Shamim, Zahid Zahiri, Mamta Singh, Russell Kabir, Shambo Samrat Samajdar, Dinesh Dhodi, Bijaya Kumar Padhi, Aiman Zehra Kazmi, Suelen Queiroz, Abdulqadir J Nashwan, Pradeep Dwivedi","doi":"10.1136/bmjoq-2024-003209","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003209","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this systematic review and meta-analysis (SRMA) was to evaluate the impact of electronic patient-reported outcomes (ePROs) on health-related quality of life (HRQoL) in patients with cancer.</p><p><strong>Design: </strong>We performed SRMA of randomised controlled trials (RCTs) comparing ePRO interventions with usual care in patients with cancer. The primary outcome was HRQoL. We used a random effects model a priori due to the anticipated clinical heterogeneity. Subgroup analyses and meta-regressions were performed to explore sources of heterogeneity. After assessing the risk of bias using risk-of-bias tool (RoB V.2), we rated the evidence certainty using the Grading of Recommendations, Assessment, Development and Evaluations framework.</p><p><strong>Eligibility criteria: </strong>We included studies meeting the following criteria: (1) RCTs; (2) patients diagnosed with any type of cancer, undergoing or having completed treatment; (3) comparing ePROs with usual care without ePRO interventions; (4) assessing the effect on HRQoL.</p><p><strong>Information sources: </strong>We systematically searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials up to April 2024.</p><p><strong>Results: </strong>We screened 7706 records to include 36 RCTs with 9608 patients. ePRO interventions showed a standardised mean difference (SMD) of 0.35; 95% CI 0.18 to 0.51 compared with usual care. Patients receiving ongoing therapy had an SMD of 0.39 (95% CI 0.21 to 0.58), while those who had completed therapy had an SMD of 0.12 (95% CI 0.01 to 0.22), with a significant subgroup difference (p=0.01). No statistically significant differences were observed across the method of ePRO assessment, cancer site, metastasis status, therapy status, average age or duration of ePRO use. The results remained consistent with Bayesian and other sensitivity analyses.</p><p><strong>Conclusions: </strong>ePRO interventions improve HRQoL more than usual care in patients with cancer, with greater effect in those currently undergoing therapy. This improvement is independent of cancer type, duration of ePRO use or patient age. Future research should address sources of heterogeneity, explore long-term impacts and develop strategies to increase patient engagement and adherence to ePRO systems.</p><p><strong>Prospero registration number: </strong>CRD42024531708.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}