환자 자기평가 건강상태(PRO) 도입 방안 마련 연구

Abstract

In Korea, Patient-Reported Outcomes (PRO) is mainly used at the hospitals for treatment or academic researches, but is not used to assess the quality of care. Recently the Korean government is trying to change the health insurance compensation system to focus on patient health outcomes. Therefore, the need to strengthen outcome indicators is increasing. Also it is inappropriate to apply outcome indicators such as mortality or readmission rate to patients with chronic and complex diseases, which are increasing due to population aging. The objective of this study is to develop the criteria for determining the area in which PRO will be used in the quality assessment of care and apply it to select the priority area for using PRO. We formed group (N=9). This group was consisted of academic and clinical experts (N=5), members of the quality evaluation committee (N=2) and patient representatives (N=2). By conducting two round Delphi surveys, the criteria for selecting areas using PRO were confirmed. The Lawshe's (1975) content validity ratio was used. We investigate the importance and feasibility of evaluating each candidate criterion. After developing the criteria for selecting PRO using area, we tried to find area using PRO. The group members were surveyed to determine which areas were currently appropriate for using PRO among the areas for which ICHOM (International Consortium for Health Outcomes Measurement) presented a set of patient-centered outcome measures. The five areas with the highest ‘appropriate’ response rate were evaluated on a 9-point scale for each selection criterion using the RAND/UCLA appropriateness method. Then the agreement of opinions and the score was calculated. Afterwards, in the second round, the members of group discussed areas of using PRO based on these results. The criteria were consisting of 3 categories and 8 items. The importance and feasibility categories of PRO evaluation included (1) disease burden, (2) PRO significance on outcome, and (3) degree of impact on patients' lives, and the feasibility category included (4) availability of PROM. (5) possibility of self-report, (6) degree of clinical use, and (7) possibility of use of existing project. The usability category of the measurement results included (8) the possibility of improving the quality of care. In ICHOM, among the areas with set of patient-centered outcome measures, the five areas in which group members responded that the using PRO in Korea was appropriate(hip replacement surgery, knee replacement surgery, breast cancer, depression and anxiety, colorectal cancer, and lung cancer). Hip and knee replacement received high scores in selection criteria excluding disease burden, and in committee discussions, it was evaluated that it would be relatively feasible to use PRO because it has the advantage about the specific measurement target and the PRO. However, there was the opinion that it was necessary to consider that most patients were old. Since it was difficult to consider the introduction of hip replacement surgery and knee replacement surgery at the same time, after discussion within the research team, it was decided to review the introduction of knee replacement surgery first. Pain and function were selected as PROs to be evaluated through a literature review and opinions of clinical physician. Considering the PROMs physicians use in Korea, literature review, and opinions of clinical physician regarding PROMs for measuring pain and function, the candidate PROMs selected were KOOS-PS, OKS, and KSS. However, additional review with the Korean Knee Society is necessary to confirm PROMs.