| ?Objective?1?To understand the attitude,knowledge and practice status of patient-reported outcomes among medical staff.2?To establish a training program based on patient-reported outcomes measurement system for pediatric medical staff;3?To implement training program in pediatric clinic and evaluate training effects.?Methods?This study is divided into three parts:1? Research on attitude,knowledge and practice status of patient-reported outcomes among medical staff(1)Qualitative research of medical staff: Qualitative research methods were used,qualitative interviews with clinical staff were conducted to collect the attitudes and views of patient-reported outcomes both in pediatric and adult clinic and we analyzed the possible barriers of integration of patient-reported outcomes into clinical practice;(2)Status survey: A self-designed questionnaire was used to investigate clinical medical staff in pediatric hospital so as to understand their knowledge and practice status of patient-reported outcomes.2?Establishment of the training program(1)Preliminary scheme of training program: Based on the results of literature review,status survey and qualitative interviews,a preliminary version of training program based on Patient-reported Outcomes Measurement Information System was established.(3)Establishment of the final version of the training program: two rounds of Delphi method were conducted to evaluate the preliminary training program,and the preliminary version of training program was conducted to identify problems and obtain feedback from participants so as to finally confirm the training program.(4)Establishment of evaluation tools: English version of Outcome Measures Questionnaire was translated and tested;curriculum evaluation questionnaire andknowledge questionnaire were also established based on literature review,research team discussion and experts opinions.3.Training Implementation and Effectiveness Evaluation(1)Training implementation: 30 medical medical staff who met the inclusion criteria were chosen to participate in our research in a pediatric hospital in Shanghai,and the final training program was adopted to train medical staff for three days.(2)Evaluation of training effect: The training effect was evaluated with the Chinese version of OMQ,self-designed knowledge test questionnaire and training evaluation questionnaire were also used to evaluate the effect of training program.?Result?1.Attitude,knowledge and practice status of patient-reported outcomes among medical staff(1)Qualitative Study of Medical StaffA total of 10 qualified medical staff were selected from March to May 2018 in different hospitals in Shanghai.Through data analysis,the attitudes of medical staff on patient-reported outcomes can be summarized into five main themes,namely "lack of knowledge","practice integration","value agreement","multiple concern" and "population difference".(2)Status survey on medical staff's knowledge and practice status of patient-reported outcomes214 valid questionnaires were collected from medical staff in different children's hospitals all over China.The data analysis results showed that the cognition and practice scores of medical staff were generally at a low level,with a total score of 47.79±11.975,a total score of knowledge items of 21.90±6.675,and a total score of practical items of25.84±6.372.Pearson correlation analysis showed that there was a significant positive correlation between the total cognition scores and the total practice scores(r=0.691,P<0.05).2?Establishment of the training program(1)Preliminary Construction and Final Determination of Training ProgramBased on the results of previous literature review,status survey and qualitative interviews,a preliminary patient-reported outcomes training program plan based on Ped-PROMIS was constructed.Two rounds of Delphi methods were used to evaluate the preliminary training.The Delphi methods included 15 experts in total,the expertauthority score ranged from 0.85 to 1.0,and the average expert authority score were 0.95.Experts showed consensus on the first-level project,so all the first-level projects were considered to be included;two items had a coefficient of variation more than 0.2 in the second-level indicators which involve the development of patient-reported outcomes measures and the knowledge of measurement testing;there were six items with a coefficient of variation more than 0.2 in the third-level indicators which involved development and test knowledge of PROMIS measures;the coefficient of variation of the course time arrangement of training and the training effect evaluation are also more than0.2.In this study,we adjusted the training program based on the opinions of experts and the results of statistical analysis,main adjustment was to weaken knowledge of development and test of patient-reported outcomes measures,to strengthen the practical knowledge of patient-reported outcomes,adjust the training time arrangement and optimize the training effect evaluation items.The second version of the training program formed after the Delphi method was used for preliminary experiment for medical staff in pediatric hospital.A total of 10 doctors and nurses from a children's hospital in Shanghai were selected to participate in the preliminary experiment.According to the feedback from participants,the second draft of the training program was adjusted,and the content and implementation plan of the training course were finally determined.(2)Establishment of training assessment toolThe English version of the "Outcome Measures Questionnaire" was introduced,the overall Cronbach's alpha value of the Chinese version of OMQ was 0.906,and the Cronbach's alpha value of different dimensions were all more than 0.8.The results of validity analysis showed that the questionnaire had good content validity,and exploratory factor analysis showed that the three common factors could explain 62.602% of the variance,and the load values of different items on the corresponding factors were greater than 0.6.The results of confirmatory factor analysis showed that the fit index of the three-factor model was good,namely "general attitude","negative attitude" and "practice obstacle".In addition,based on literature review,group discussion and expert consultation,a knowledge test questionnaire and a curriculum evaluation questionnaire were designed.The knowledge test was divided into three modules,which are basic knowledge of patient-reported outcomes,knowledge of patient-reported outcomes measures and practical knowledge.There are 25 questions in total,with 4 points for each answer.The content of the curriculum evaluation questionnaire covers five aspects: curriculum content,curriculum setting,teaching methods,teachers and the overall evaluation of the curriculum.There are 18 items in the curriculum evaluation questionnaire,the higher the score,the more satisfied the participants are.3.Implementation of training and effect evaluationA total of 30 medical staffs from a children's hospital in Shanghai who met the inclusion criteria and volunteered to participate in our study were selected from November to December 2018.The training program constructed in the previous research was used to train the medical staff for three days.The analysis of the survey data after the training course showed that the total OMQ score before training was 89.00±10.265,the post-training OMQ total score was 114.87±6.394 which was significantly higher than that of pre-training OMQ score(P=0.000).Comparing the scores of different dimensions of OMQ before and after training,each dimension of OMQ score after training were statistically higher than OMQ score before training(P = 0.000).The score of the knowledge test showed a maximum score of 92 points,a minimum score of 44 points,an average score of 74.27±11.396,and a qualified participants number of 26(86.7%).The average knowledge score(19.20±5.189),the PROMs knowledge module average score(29.60±5.715),and the practice knowledge module average score(25.47±4.754).The results of training evaluation showed that the top three scores were “teachers can answer the questions very well during the training process”,“the lectures and training materials used in the training help me to learn the relevant knowledge of training”,“teachers know very well about the training contents”.Most of the evaluation items had an average score of more than 4.0,indicating that most medical staff had a good appraisal of the training.?Conclusions?1?The knowledge level of PROs of medical staff is generally low.In clinical practice,medical staff have negative attitudes and incorrect understandings on the patient-reported health outcomes.Most clinical medical staff are interested in the knowledge information of patient-reported outcomes,there have training needs for patient-reported outcomes;2?The training program based on literature review?qualitative interview?status survey ? Delphi method and preliminary experiment is a scientific and feasible training program;3?The implementation of the patient report outcome training course formed in this study can effectively improve medical staffs' attitude on patient outcomes measures and improved their knowledge level of patient-reported outcomes;... |
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