1. PROM feedback compared to usual care for improve processes and outcomes of care.
| PROM feedback compared to usual care for improve processes and outcomes of care: additional analyses not included in Summary of Findings. | ||||||
| Patient or population: Ambulatory adult patients. Setting: Primary and secondary care settings in North America and Europe. Intervention: PROM feedback reported to physicians or both patients and physicians. Comparison: Usual care. | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with usual care | Risk with PROM feedback | |||||
| Symptoms | Dyspnoea | |||||
| SMD ‐0.11 (‐0.32 to 0.11) indicating no difference between PROM feedback and usual care | ‐ | 765 (5 randomised trials) | ⊕⊝⊝⊝ Very low 1, 2, 3 | We are uncertain about the effect of PROM feedback on dyspnoea. | ||
| Nausea | ||||||
| SMD ‐0.08 (‐0.76 to 0.59) indicating no difference between PROM feedback and usual care | ‐ | 239 (2 randomised trials) | ⊕⊝⊝⊝ Very low 1, 2, 3 | We are very uncertain about the effect of PROM feedback on nausea. | ||
| Cough | ||||||
| SMD ‐0.14 (‐0.75 to 0.48) indicating no difference between PROM feedback and usual care | ‐ | 122 (2 randomised trials) | ⊕⊝⊝⊝ Very low 1, 2, 3 | The evidence is very uncertain about the effect of PROM feedback on cough. | ||
| Depressive symptoms | ||||||
| SMD ‐0.12 (‐0.19 to ‐0.05) indicating no difference between PROM feedback and usual care | ‐ | 3449 (16 randomised trials) | ⊕⊕⊕⊝ Moderate 1 | PROM feedback probably results in a slight reduction in depressive symptoms. | ||
| Anxiety symptoms | ||||||
| SMD ‐0.17 (‐0.31 to ‐0.03) indicating no difference between PROM feedback and usual care | ‐ | 2334 (8 randomised trials) | ⊕⊝⊝⊝ Very low 1, 4 | We are very uncertain about the effect of PROM feedback on anxiety. | ||
| Clinician severity ratings | SMD 0.36 (0.12 to 0.6) favouring PROM feedback vs usual care. | ‐ | 312 (3 randomised trials) | ⊕⊝⊝⊝ Very low 1, 4 | We are very uncertain about the effect of PROM feedback on clinician severity ratings. | |
| Pharmacological treatment | Study population | RR 1.21 (0.91 to 1.59) | 2528 (10 randomised trials) | ⊕⊕⊕⊝ Moderate 3 | The evidence suggests that PROM feedback probably makes little or no difference for pharmacological treatment. Pharmacological treatment was assessed using chart review. Two additional studies reported little or no difference between groups, a third study reported that those allocated to the intervention were more Liley to have their pharmacological treatment changed. |
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| 195 per 1,000 | 256 per 1,000 (171 to 365) | |||||
| Hospital admissions | Study population | RR 0.96 (0.82 to 1.11) | 1681 (4 randomised trials) | ⊕⊕⊕⊝ Moderate 1 | PROM feedback probably results in little to no difference in hospital admissions. | |
| 66 per 1,000 | 60 per 1,000 (45 to 79) | |||||
| Visits | Visits | |||||
| Study population | RR 1.09 (0.92 to 1.30) | 2777 (8 randomised trials) | ⊕⊝⊝⊝ Very low 1, 2, 3 | The evidence is very uncertain about the effect of PROM feedback on visits. | ||
| 502 per 1,000 | 514 per 1,000 (410 to 619) | |||||
| ER visits | ||||||
| Study population | RR 0.83 (0.68 to 1.01) | 812 (3 randomised trials) | ⊕⊕⊕⊝ Moderate 3 | PROM feedback may reduce ER visits slightly. | ||
| 434 per 1,000 | 359 per 1,000 (293 to 427) | |||||
| Unscheduled visits | ||||||
| Study population | RR 1.43 (0.55 to 3.74) | 333 (2 randomised trials) | ⊕⊕⊝⊝ Low 2, 3 | PROM feedback likely results in little to no difference in unscheduled visits. | ||
| 401 per 1,000 | 551 per 1,000 (194 to 862) | |||||
| Number of visits | ||||||
| SMD 0.02 (‐0.17 to 0.21) indicating no difference between PROM feedback and usual care. | ‐ | 2505 (7 randomised trials) | ⊕⊝⊝⊝ Very low 2, 4 | The evidence is very uncertain about the effect of PROM feedback on number of visits. | ||
| Referral | Study population | RR 2.00 (1.58 to 2.54) | 2519 (10 randomised trials) | ⊕⊝⊝⊝ Very low 1, 4 | The evidence is very uncertain about the effect of PROM feedback on referral. |
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| 66 per 1,000 | 148 per 1,000 (113 to 190) | |||||
| Counselling (provided or referred to) | Study population | RR 1.61 (1.02 to 2.53) | 815 (4 randomised trials) | ⊕⊝⊝⊝ Very low 1, 4 | The evidence is very uncertain about the effect of PROM feedback on counselling (provided or referred to). | |
| 246 per 1,000 | 396 per 1,000 (251 to 622) | |||||
| Patient satisfaction | SMD 0.12 SD higher (0.12 lower to 0.36 higher) indicating no difference between PROM feedback and usual care. | ‐ | 2760 (10 randomised trials) | ⊕⊝⊝⊝ Very low 3, 4 | The evidence is very uncertain about the effect of PROM feedback on patient satisfaction (overall). | |
| Patient perceptions | Self efficacy | |||||
| SMD ‐0.05 (‐0.21 to 0.32) indicating no difference between PROM feedback and usual care. | ‐ | 349 (2 randomised trials) | ⊕⊕⊕⊝ Moderate 2 | PROM feedback likely results in little to no difference in self efficacy. | ||
| Unmet needs | ||||||
| SMD ‐0.10 (‐0.22 to 0.02) indicating no difference between PROM feedback and usual care. | ‐ | 1025 (3 randomised trials) | ⊕⊕⊕⊝ Moderate 2 | PROM feedback probably results in little to no difference in unmet needs. | ||
| Patient‐physician relationship | ||||||
| SMD 0.12 (‐0.12 to 0.36) indicating no difference between PROM feedback and usual care. | ‐ | 282 (2 randomised trials) | ⊕⊕⊝⊝ Low 1, 3 | PROM feedback may result in little to no difference in patient‐physician relationship. | ||
| Quality of care | SMD 1.47 (1.00 to 2.17) favouring PROM feedback vs usual care. | ‐ | 1403 (2 randomised trials) | ⊕⊕⊝⊝ Low 1, 2 | PROM feedback may increase the quality of care but the evidence is uncertain. | |
| Length of stay | SMD 0.18 (‐0.12 to 0.49) indicating no difference between PROM feedback and usual care. | ‐ | 174 (2 randomised trials) | ⊕⊕⊝⊝ Low 1, 2 | The evidence is very uncertain about the effect of PROM feedback on length of stay | |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; SMD: standardised mean difference; RR: Risk ratio; OR: Odds ratio; | ||||||
| GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
1 We downgraded one point for high risk of unblinding due to nature of intervention for most studies.
2 We downgraded one point for imprecision due to the small number of studies with wide confidence intervals included in meta‐analysis.
3 We downgraded one point for inconsistency due to high heterogeneity.
4 We downgraded two points for inconsistency due to very high heterogeneity.