Elsevier

Journal of Pediatric Nursing

Volume 55, November–December 2020, Pages 100-109
Journal of Pediatric Nursing

Determining the Effectiveness of Using Patient-Reported Outcomes in Pediatric Clinical Practices

https://doi.org/10.1016/j.pedn.2020.07.005Get rights and content

Highlights

  • This review represents the current status of the impact of PROs in pediatric health care.

  • A weak but trending positive impact of using PROs in pediatric care was noted.

  • Strategies are needed to integrate and sustain PRO use in pediatric care.

Abstract

Problem

Patient-reported outcomes (PROs) are increasingly recognized in pediatric clinical care as adding essential information relevant to actual care. However, the effectiveness of using PROs in pediatric clinical settings has not been fully explored with synthesized evidence. The aim of this study was to evaluate the effectiveness of using patient-reported outcomes in pediatric clinical practices.

Eligibility criteria

We searched four English and three Chinese databases to identify studies that examine the effectiveness of using PROs in pediatric clinical practices published from the inception date of each database to January 2020.

Sample

Ten articles met the inclusion criteria.

Results

There was wide a variation in the ten studies' designs, samples, PROs administered (type, length, timing, mode), and type of outcomes evaluated. The effect sizes of using PROs on three categories of outcomes (patient, process of care and health service) were assessed. Of 70 measured outcomes, 32 were positive, 5 were negative, and 33 were mixed.

Conclusions

Overall, there is a weak but trending positive impact of using PROs in pediatric clinical practice.

Implications

More rigorous study designs with sources of bias controlled are needed to more directly assess the impact of using PROs in pediatric care. If findings continue to be positive, then an implementation model addressing the numerous influencing factors is recommended to integrate PROs into pediatric care.

Section snippets

Method

This systematic review title was registered in PROSPERO(CRD4202016483). The reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline.

The inclusion process

Fig. 1 shows the inclusion process. We identified a total of 2584 potentially relevant publication records through database and hand search. After removing 419 duplicates, three authors (LC, QK and YW) then screened the title and abstract of 2165 articles to assess whether they were research-based and directly related to the topic of the review. The most common reasons for exclusion were a) not research based, b) not related to the research topic, c) not assessing the effect of using PRO or d)

Discussion

This study systematically assessed the effect of using PROs in pediatric clinical settings on patient, process, and health service outcomes. Using PROs in pediatric clinical care had more than six times the number of positive effects than negative effects. Our findings are generally consistent with the positive evidence from studies of PROs in adult patient groups (Boivin et al., 2014; Howell et al., 2015; Ishaque et al., 2019; Yang et al., 2018). However, within the 10 reviewed studies there

Conclusion

Overall, there is a weak but trending positive impact of using PROs in pediatric clinical practice. Needed now are more rigorous study designs that control for sources of bias such as those identified in this review. A stronger test would effectively and sensitively determine the impact of using PROs in terms of patient outcomes, processes of care and health service outcomes. If the outcomes continue the positive trend, subsequently the impact can be expanded to include prescribed PROs

Funding sources

This study was supported by the China National Natural Science Foundation of China Youth Science Foundation (71904030), Shanghai Pujiang Program (2019PJC006).

Author statement

Lei Cheng: Conceptualization, Methodology, Literature search, Data extraction, Writing, Reviewing and Editing,

Qiongfang Kang: Literature search, Data extraction, Reviewing.

Yanqing Wang: Literature search, Data extraction, Reviewing.

Pamela S. Hinds: Data extractionWriting- Reviewing and Editing

Acknowledgment

The authors would like to thank Susan Keller, MLS, MS-HIT, Research Librarian, Children's National Hospital, for her invaluable assistance with the literature search strategy, and Yuri T. Jadotte, MD, PhD, MPH, Associate Professor, Assistant Director of the Northeast Institute for Evidence Synthesis and Translation, Rutgers University, for his thoughtful comments and constructive suggestions during the preparation of this manuscript.

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