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Development of a percutaneous coronary intervention patient level composite measure for a clinical quality registry

Authors
  • Ayton, Darshini1
  • Soh, Sze-Ee1, 1
  • Morello, Renata1
  • Ahern, Susannah1
  • Earnest, Arul1
  • Brennan, Angela1
  • Lefkovits, Jeffrey1
  • Evans, Susan1
  • Reid, Christopher1, 2
  • Ruseckaite, Rasa1
  • McNeil, John1
  • 1 Monash University, Melbourne, Australia , Melbourne (Australia)
  • 2 Curtin University, Bentley, Western Australia, Australia , Bentley (Australia)
Type
Published Article
Journal
BMC Health Services Research
Publisher
Springer (Biomed Central Ltd.)
Publication Date
Jan 17, 2020
Volume
20
Issue
1
Identifiers
DOI: 10.1186/s12913-019-4814-6
Source
Springer Nature
Keywords
License
Green

Abstract

BackgroundComposite measures combine data to provide a comprehensive view of patient outcomes. Despite composite measures being a valuable tool to assess post-intervention outcomes, the patient perspective is often missing. The purpose of this study was to develop a composite measure for an established cardiac outcome registry, by combining clinical outcomes following percutaneous coronary interventions (PCI) with a patient-reported outcome measure (PROM) developed specifically for this population (MC-PROM).MethodsTwo studies were undertaken. Study 1: Patients who had undergone a PCI at one of the three participating registry hospital sites completed the 5-item MC-PROM. Clinical outcome data for the patients (e.g. death, myocardial infarction, repeat vascularisation, new bleeding event) were collected 30 days post-intervention as part of routine data collection for the cardiac registry. Exploratory factor analysis of clinical outcomes and MC-PROM data was conducted to determine the minimum number of constructs to be included in a composite measure. Study 2: Clinical experts participated in a Delphi technique, consisting of three rounds of online surveys, to determine the clinical outcomes to be included and the weighting of the clinical outcomes and MC-PROM score for the composite measure.ResultsStudy 1: Routine clinical outcomes and the MC-PROM data were collected from 266 patients 30 days post PCI. The MC-PROM score was not significantly correlated with any clinical outcomes.Study 2: There was a relatively consistent approach to the weighting of the clinical outcomes and MC-PROM items by the expert panel (n = 18) across the three surveys with the exception of the clinical outcome of ‘deceased at 30 days’. The final composite measure included five clinical outcomes within 30 days weighted at 90% (new heart failure, new myocardial infarction, new stent thrombosis, major bleeding event, new stroke, unplanned cardiac rehospitalisation) and the MC-PROM score (comprising 10% of the total weighting).ConclusionsA single patient level composite score, which incorporates weighted clinical outcomes and a PROM was developed. This composite score provides a more comprehensive reported measure of individual patient wellbeing at 30 days post their PCI-procedure, and may assist clinicians to further assess and address patient level factors that potentially impact on clinical recovery.

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