Montreal Accord on Patient-Reported Outcomes (PROs) use series - Paper 3: patient-reported outcomes can facilitate shared decision-making and guide self-management.

BACKGROUND: There is a shift toward making health care patient centered, whereby patients are part of medical decision-making and take responsibility for managing their health. Patient-reported outcomes (PROs) capture the patient voice and can be used to engage patients in medical decision-making. OBJECTIVE: The objective of this paper is to present important factors from patients', clinicians', researchers', and decision-makers' perspectives that influence successful adoption of PROs in clinical practice. Factors recommended in this paper were informed by a patient partner. DISCUSSION: Based on themes arising from the Montreal Accord proceedings, we describe factors that influence the adoption of PROs and how PROs can have a positive effect by enhancing communication and providing opportunities to engage patients, carers, and clinicians in care. Consideration of patient factors (e.g., health literacy), family support and networks (e.g., peer-support networks), technology (e.g., e-health), and health care system factors (e.g., resources to implement PROs) is necessary to ensure PROs are successfully adopted. PRO evaluation plans most likely to succeed over the long term are those incorporating PROs identified by patients as necessary for self-management and that coincide with providers' needs for collaboratively developing treatment plans with patients and families.

Use of the LIFE-H in stroke rehabilitation: a structured review of its psychometric properties.

PURPOSE: To perform a structured review of the psychometric properties specific to the stroke population of the Assessment of Life Habits (LIFE-H). This tool measures quality of social participation, an important but under-evaluated aspect of stroke recovery. METHOD: A structured review of publications at MEDLINE; Embase, CINAHL, and the Cochrane Library using the following terms: LIFE-H, life habits, psychometric properties, measurement properties, reliability, repeatability, validity, responsiveness, appropriateness, ceiling effects, and floor effects. RESULTS: Eleven studies were identified specific to stroke. Test-retest reliability was excellent (Intraclass correlation coefficients [ICCs] ranging from 0.80 to 0.95). Inter-rater reliability ranged from adequate to excellent (r = 0.64-0.91) as well as agreement between responses of clients with stroke and their proxies (ICC ranging from 0.73 to 0.82). Convergent validity was adequate to excellent (r = 0.57-0.91) between the LIFE-H and two measures of functional independence. Two studies, one using patients and one using caregivers, suggest the LIFE-H is able to detect change over time. CONCLUSIONS: The LIFE-H is a psychometrically sound measure of quality of social participation for use in post-stroke assessment and is responsive to change.

A visita domiciliar na estratégia saúde da família sob os aspectos do planejamento e da abordagem familiar / Home visit in the family health strategy under the aspects of planning and family approach

(...) O presente trabalho objetiva analisar as visitas domiciliares realizadas pelos profissionais de uma Unidade de Saúde da Família do Rio de Janeiro, no que tange aos aspectos do planejamento e da abordagem familiar. Trata-se de um estudo qualitativo, onde foram utilizadas as técnicas de observação participante e entrevista. Os dados obtidos foram analisados pelo método de análise de conteúdo. Pretendemos com este estudo, propor aos profissionais da equipe uma reflexão sobre o tema e buscar oferecer subsídios que auxiliem no aprimoramento da visita domiciliar. Observamos que o plano de visitas é elaborado de forma individual, sem o estabelecimento de objetivos e metas coletivas. Os procedimentos da VD (antes, durante e depois) também não são padronizados, ficando ao critério de cada profissional. Verificamos a reprodução do modelo biomédico em procedimentos rotineiros da ESF: preenchimento de fichas, abordagens programática dos grupos prioritários, que dificultam a abordagem efetivamente familiar na VD.