Results Of Use Research Articles

Self-perceived outcomes of informative and apologetic self-disclosure: A mixed methods study

PurposeSelf-disclosure statements that are informative, rather than apologetic, have been demonstrated to improve listener perceptions of adults who stutter (Byrd et al., 2017). The purpose of the present study is to investigate the benefits of self-disclosure from the perspective of the speaker and to determine whether self-disclosure statement type is associated with self-perceived outcomes of use. MethodA total of 156 adults who stutter completed a survey adapted from a previous study investigating affective, behavioral, and cognitive outcomes of voluntary stuttering. Survey responses were analyzed using descriptive and inferential statistics to determine if there was a significant relationship between self-disclosure statement type and self-reported outcomes. Additionally, responses to two open-ended questions relating to timing of self-disclosure and self-disclosure experiences in general were analyzed using reflexive thematic analysis. ResultsSelf-disclosure was perceived as beneficial in at least one context by 96.8 % of respondents. Respondents who used an informative self-disclosure statement were more likely to agree that self-disclosure increased confidence and were less likely to report attempting to conceal or avoid stuttering than respondents who used an apologetic self-disclosure statement. Themes relating to additional aspects of self-disclosure experiences included personalized use, social connection, acceptance of stuttering, challenging cognitive distortions, communication is easier, self-empowerment, humor, voluntary stuttering, and vulnerability to prejudice. ConclusionSimilar to studies investigating the influence of self-disclosure on listener perceptions, informative self-disclosure is associated with greater self-perceived benefits than apologetic self-disclosure for adults who stutter.

Do parental control tools fulfil family expectations for child protection? A rapid evidence review of the contexts and outcomes of use

ABSTRACT Among the parental mediation strategies promoted by policymakers to ensure children’s safety in a digital age is the use of parental control tools. A rapid evidence review was conducted to identify which families use parental controls and why, and the outcomes of such use, beneficial or otherwise. Of 1,656 articles returned by a keyword search of five research databases, the full text of 40 studies was coded to answer the research questions. The available research revealed that the use of parental controls depends on the age of the parents and children, their digital skills, parental involvement, and the motivation to reduce exposure to online risk. However, the consequences of use were mixed, with evidence of parental controls having both beneficial and adverse outcomes, limiting other outcomes or simply having no outcomes. While the review found little support for advocating parental controls as a stand-alone strategy, parents valued them when embedded in a broader approach to parental mediation and parent – child relations. The conclusions highlight the importance of a child-centred approach that holistically evaluates the potential of parental controls.

Maternal and Pregnancy Outcomes Following Heart Transplantation in the United States

BackgroundImproved survival following heart transplantation (HT) has led to more recipients contemplating pregnancy, but data on outcomes are limited. ObjectivesThe authors used a national data set to investigate and describe outcomes of pregnancies and deliveries in the United States in HT recipients. MethodsDiagnosis and procedure codes from the 2010-2020 Nationwide Readmissions Database identified delivery hospitalizations, history of HT, comorbid conditions, and outcomes. The authors compared rates of severe maternal morbidity (SMM), nontransfusion SMM, cardiovascular SMM (cSMM), and preterm birth from delivery hospitalization between HT recipients and no-HT recipients. The authors evaluated readmission to 330 days postpartum. Logistic and proportional hazard regressions were performed, adjusting for age, socioeconomic and facility characteristics, and clinical comorbidities. ResultsAmong 19,399,521 deliveries, 105 were HT recipients. Compared with no-HT, HT recipients were at higher risk for all SMM (24.8% vs 1.7%), nontransfusion SMM (20.8% vs 0.7%), cSMM (7.3% vs 0.12%), and preterm birth (43.3% vs 8.2%), all P < 0.001. In adjusted analyses, HT recipients had 16-fold greater odds of SMM, 28-fold greater odds of nontransfusion SMM, 38-fold greater odds of cSMM, and 7-fold greater odds of preterm birth. HT recipients had higher morbidity rates during delivery hospitalization and higher readmission rates within 1 year following delivery (26.9% vs 3.8%; adjusted HR: 6.03 [95% CI: 3.73-9.75]). ConclusionsDelivery with history of HT is associated with significantly increased rates of SMM, preterm birth, and hospital readmission. These results provide data regarding pregnancy outcomes for use when counseling patients with HT history who are considering pregnancy or who are pregnant.

Developing a questionnaire for assessing clinician- and patient-reported outcomes in actinic keratosis: Results from an expert panel

Current assessments on topical treatment attributes in actinic keratosis (AK) do not evaluate safety, effectiveness, and satisfaction from both clinician and patient perspectives, creating an unmet need for more comprehensive AK-specific measures that fully capture the patient experience. To develop an actinic keratosis-specific expert panel questionnaire (AK-EPQ) of patient-reported outcomes and clinician-reported outcomes for use in research studies. Using interviews of patients with AK and targeted literature reviews, a 9-person consensus panel of dermatologists with expertise in AK treatment was convened to develop the AK-EPQ to assess AK-specific patient-reported outcomes and clinician-reported outcomes. Nine expert advisers achieved consensus on 11 AK-EPQ items that encompass patient and clinician perspectives of treatment-related local skin reactions, clinical and cosmetic outcomes associated with AK, and satisfaction with treatment; the AK-EPQ will be first implemented in the Patient-Reported Outcomes for Actinic Keratosis study (NCT05260073). The AK-EPQ does not directly measure quality of life, although it can be used with validated quality of life instruments. The newly developed AK-EPQ elicits insights into the patient and clinician experience with AK treatments. Comparative probing of these perspectives may help optimize precision medicine in AK treatment.

A scoping review of heart failure transitional care quality indicators and outcomes for use in clinical care and research.

There are no accepted quality indicators for transitional care following hospitalization for heart failure (HF). Current quality measures focus on 30-day readmissions without accounting for competing risks such as death. In this scoping review of clinical trials, we aimed to develop a set of HF transitional care quality indicators for clinical or research applications following hospitalization for HF. We performed a scoping review using MEDLINE, Embase, CINAHL, HealthSTAR, reference lists and grey literature from January 1990 to November 2022. We included randomized controlled trials (RCTs) of adults hospitalized for HF who received a healthcare service or strategy intervention that aimed to improve patient-reported or clinical outcomes. We independently extracted data and performed a qualitative synthesis of the results. We generated a list of process, structure, patient-reported, and clinical measures that could be used as quality indicators. We highlighted process indicators that were associated with improved clinical outcomes and patient-reported outcomes that had high adherence to COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) and United States Federal Drug Administration (FDA) standards. From 42 RCTs included in the study, we identified a set of process, structure, patient-reported, and clinical indicators that could be used as transitional care measures in clinical or research settings. In this scoping review, we developed a list of quality indicators that could guide clinical efforts or serve as research endpoints in transitional care in HF. Clinicians, researchers, institutions, and policymakers can use the indicators to guide management, design research, allocate resources, and fund services that improve clinical outcomes.

Why it is so challenging to perform economic evaluations of interventions in autism and what to do about it.

Economic evaluation is used to determine the optimal provision of services and programs under budget constraints and to inform public and private payer funding decisions. To maximize value-for-money in the design and delivery of programs and services for persons with autism spectrum disorder (ASD), it's essential to generate high-quality economic evidence to inform budget allocation. There is a paucity however, of economic evaluations of interventions for ASD. This is due in part to challenges in conducting economic evaluations in this population and the lack of guidance on suitable approaches. These challenges are related to the inherent heterogeneity of the autistic population; establishing short- and long-term effectiveness; measurement of costs and the availability of valid instruments for collecting economic data; the appropriateness of outcomes for use in economic evaluation; and achieving statistical power. This commentary addresses a lack of awareness and needed guidance on these issues by discussing the challenges and providing recommendations for how economic evaluations in ASD could be improved to generate high-quality evidence for program funding decision-making.

“A Lot of My Friends Don't Know How It Works”: Student Activists Describe Gaps in College Students' Emergency Contraception Knowledge

IntroductionDespite the high potential need for emergency contraception (EC) among college students, lack of accurate knowledge may decrease the likelihood of its use in this population. We examined knowledge about EC methods, potential outcomes of use, and access among college students in the United States. MethodsWe recruited college students from a listserv devoted to EC campus activism for an online survey about EC knowledge (N = 150) and conducted 24 follow-up in-depth interviews. We describe the share of respondents that correctly answered each question and provide additional context and insight from interview respondents. ResultsGaps in EC knowledge were noted in our sample of college student EC activists. Awareness of different methods of EC was not universal; 38% of the sample was unaware of ulipristal acetate (ella®) and 61% was unaware of the intrauterine device inserted after intercourse as EC. Many respondents also incorrectly perceived additional barriers to acquiring EC such as minimum age or an ID requirement to purchase EC (64% and 49%, respectively). Interview respondents describe how medical providers, such as student health services and pharmacists, can pose barriers to EC access through either their actions or how college students expect they will act. ConclusionsWe document several gaps in knowledge surrounding EC in college students, even in an activist sample. Additional efforts to inform students about the variety of available EC methods and address mistaken perceptions about barriers to access may allow college students to better meet their needs for EC.

Outcomes of physiotherapy for people living with bronchiectasis: qualitative study to inform development of a core outcome set

IntroductionEvidence of the effectiveness of physiotherapy for bronchiectasis is inconsistent, partly due to variation in the selection and reporting of outcomes in clinical trials. This qualitative study is a component of the development of a core outcome set (COS). The COS will identify a minimum group of outcomes for use in clinical trials of physiotherapy considering the views of researchers, patients, and clinicians. ObjectivesTo identify outcomes for use in physiotherapy research that are important to patients and physiotherapists and to explain their significance. MethodsSemi-structured interviews were conducted with adult patients with bronchiectasis who received physiotherapy, in addition to physiotherapists clinically involved in bronchiectasis care. Interviews were audio recorded and transcribed verbatim. Thematic analysis was used to identify, classify, and explain the significance of outcomes. Outcomes were mapped into the list created from literature review and classified into domains. ResultsWe interviewed 18 participants from four countries covering a range of experiences in different settings. Seventy outcomes were identified and grouped into 15 domains. Thirty-three outcomes were not previously reported in the literature. Thematic analysis revealed exacerbations, quality of life, use of healthcare resources, patient-reported symptoms, physical functioning, and sputum as the prominent themes reported by both patients and physiotherapists. ConclusionsThis qualitative study highlighted the importance of considering stakeholder perspectives when planning research trials. Outcomes identified will be used to inform the next phase of COS development. RegistrationThis study is part of the COS development project registered with the Core Outcome Measures in Effectiveness Trials initiative (COMET) https://www.comet-initiative.org/Studies/Details/1931 Contribution of the paper•The impact of physiotherapy in bronchiectasis is complex and multidimensional, generating numerous outcomes to be considered in research.•Some outcomes considered important to patients and physiotherapists may inform future trials as they differed from those reported in literature.•This study ensures that the views of patients and physiotherapists are considered in development of the core outcome set.

Identifying patient-valued outcomes for use in early phase trials of ocular surface disease interventions

BackgroundPatient-reported outcomes (PROs) can be used to evaluate the impact of dry eye symptoms (DES) on daily life. Early-phase clinical trials provide an opportunity to evaluate PRO strategies. Existing measures identified through systematic review omitted important concepts that mattered to patients. The aim of our work was to develop a conceptual map of DES and assess the relative importance of identified concepts. MethodsWeb-based group concept mapping software was used to develop a conceptual map. This semi-quantitative mixed-methods approach consists of three stages 1) statement generation, 2) thematic sorting, 3) rating of statements for importance [1 (not important), 2 (important), 3 (very important)] and relevance [1 (not my experience), 2 (sometimes my experience); 3 (definitely my experience)]. Thirty-nine participants were recruited from two UK-based patient support groups (British Sjögren's Syndrome Association, PemFriends). Three withdrew, two for health reasons and one struggled with the web-based format. Results125 statements and six thematic clusters were generated. The Environmental Impacts cluster scored highest for importance (2.45), followed by Pain and Discomfort (2.35), Eye Treatments (2.32), Daily Impact (2.07), Psychosocial Issues (1.78) and Miscellaneous (1.78). Mapping statements against existing PRO measures confirmed a number of important missing issues including the impact of ‘UV levels’ (2.50), hot dry weather (2.33), the temporal aspects of pain (2.64), and issues with night-driving (2.59). ConclusionsGroup concept mapping identified important issues for people living with DES not currently captured by existing PROs, highlighting the need for additional PRO items to be considered for use in clinical trials.

Experiences and Outcomes of Athletic Trainers Using Complementary and Integrative Health: A Qualitative Study

Purpose: Complementary and integrative health (CIH) is common among patients in the U.S. and is a useful tool for athletic trainers to provide holistic treatment. There is currently minimal literature regarding athletic trainers’ experiences and outcomes of using CIH modalities for patient treatments. The purpose of this project was to explore the experiences and outcomes of collegiate athletic trainers using CIH modalities. Methods: This study used qualitative semi-structured interviews, analyzed by phenomenological approach, using consensual qualitative research analysis. Trustworthiness and credibility of the consensus codebook were established by member checking, multi-analyst triangulation, and auditing. Fourteen athletic trainers (7 females, 7 males, age=38±12 years, years of experience=15±12 years) engaged in an online interview (Zoom, San Jose, CA). All interviews were audio-recorded and transcribed. Results: Four domains (Figure 1) emerged regarding the experiences and outcomes of CIH use by athletic trainers: 1) education, 2) motives, 3) clinical application, and 4) barriers. Participants had divergent educational pathways; self-directed learning was the most common pathway. Motives for using CIH interventions included improved subjective outcomes and patient preference. Participants discussed a variety of modalities and outcomes to assess their implementation. Barriers included stakeholder buy-in and resources. Conclusions: Participants noted improved outcomes via addressing the whole patient when using CIH. As athletic trainers interact with diverse patient populations, CIH interventions may provide more opportunities to include holistic care. However, education on CIH varies between participants. Education surrounding interventions in athletic training, regardless of the level of learning, should focus on quantifiable and meaningful clinical and patient-rated outcomes, which should include CIH approaches. Moreover, additional objective research regarding the outcomes of using CIH as a treatment modality is needed among athletic populations to increase stakeholder buy-in.

Primary Arthroplasty for Unstable and Failed Intertrochanteric Fractures: Role of Multi-Planar Trochanteric Wiring Technique.

The primary objective of the current study is to demonstrate the trochanteric wiring technique. A secondary objective is to evaluate the clinico-radiological outcomes of use of the wiring technique during primary arthroplasty for treatment of unstable and failed intertrochanteric fractures. A prospective study including follow-up of 127 patients with unstable and failed intertrochanteric fractures who underwent primary hip arthroplasty using novel multi-planar trochanteric wiring was conducted. The average follow-up period was 17.8±4.7 months. Clinical assessment was performed using the Harris hip score (HHS). Radiographic evaluation was performed for assessment of union of the trochanter and any mechanical failure. P<0.05 was considered statistically significant. At the latest follow-up, the mean HHS showed significant improvement from 79.9±1.8 (at three months) to 91.6±5.1 (P<0.05). In addition, no significant difference in the HHS was observed between male and female patients (P=0.29) and between fresh and failed intertrochanteric fractures (P=0.08). Union was achieved in all cases of fractured trochanter, except one. Wire breakage was observed in three patients. There were five cases of limb length discrepancy, three cases of lurch, and three cases of wire-related bursitis. There were no cases of dislocation or infection. Radiographs showed stable prosthesis in situ with no evidence of subsidence. Use of the proposed wiring technique was helpful in restoring the abductor level arm and multi-planar stability, which enabled better rehabilitation and resulted in excellent clinical and radiological outcomes with minimal risk of mechanical failure.

Rehabilitation outcomes for people with lung cancer (UNITE): protocol for the development of a core outcome set

IntroductionWith treatment-related improvements in survival, rehabilitation is essential to improve function and health-related quality of life and manage the high symptom burden associated with lung cancer. Despite this, significant heterogeneity...

“Wake-and-bake” cannabis use: Predictors and cannabis-related outcomes of use shortly after waking

BackgroundGiven recent historical increases in young adults frequent cannabis use and changes in cannabis policies throughout the United States, there is a need to examine high-risk patterns of use. This paper examined predictors and cannabis-related outcomes of “wake-and-bake” cannabis use, operationalized as use within 30min of waking. MethodsParticipants were 409 young adults (Mage=21.61 years, 50.8% female) enrolled in a longitudinal study on simultaneous alcohol and cannabis use (i.e., using alcohol and cannabis at the same time such that their effects overlap). Eligibility criteria included reporting alcohol use 3+ times and simultaneous alcohol and cannabis use 1+ times in the past month. Participants completed twice-daily surveys for six 14-day bursts across two calendar years. Aims were tested using multilevel models. ResultsAnalyses were limited to cannabis use days (9406 days; 33.3% of all sampled days), and thereby to participants who reported using cannabis (384 participants; 93.9% of the sample). Wake-and-bake use was reported on 11.2% of cannabis use days and at least once by 35.4% of participants who used cannabis. On wake-and-bake use days, participants were high for more hours and had greater odds of driving under the influence of cannabis, but did not experience more negative consequences, relative to non-wake-and-bake cannabis use days. Participants who reported more cannabis use disorder symptoms and those reporting higher average social anxiety motives for cannabis use reported more frequent wake-and-bake use. ConclusionsWake-and-bake cannabis use may be a useful marker of high-risk cannabis use, including driving under the influence of cannabis.

Outcomes of use of the quality outcome measure for individuals with dementia (QOMID) with people with Down’s syndrome and dementia

PurposeThis paper aims to describe the outcomes of the use of the Quality Outcome Measure for individuals with dementia (QOMID) within a dementia pathway for people with Down’s syndrome (DS). The QOMID is a tool for clinicians to use with 17 outcome domains, each with descriptors for early, mid and late stage dementia, rated on a four point scale from rarely achieved for the person (1) to consistently and completely achieved for the person (4).Design/methodology/approachData from first time use of the QOMID with 49 people with DS and dementia was analysed to determine if specific outcome domains are more achievable than others, if this differs by stage of dementia and what recommendations are suggested.FindingsResults suggest that there were significant differences in achievability across the domains but that achievability did not vary between early and mid-stages of dementia. The themes with most recommendations were: quality of paperwork and documentation; improving communication with the person with DS and dementia; and working together with health and social care professionals.Practical implicationsResults suggest that outcomes which fall outside of the typical learning disabilities skillset and are dementia specific are being achieved less often. Primarily, recommendations focused on practical solutions such as using visual timetables to communicate with the person and adapting their environment. Further work on integrating the QOMID and stage-related team training for care staff is underway.Originality/valueTo the best of the authors’ knowledge, this is the first detailed analysis of the use of the QOMID in clinical practice with people with DS and dementia.

Perception and Attitude about Utilization of Complementary and Alternative Medicine among Caregivers of the Mentally Challenged in Ebonyi State: A Cross-Sectional Study

Purpose: Mental health issues pose a great challenge to healthcare systems especially in developing countries, and having 35% global burden of sickness/disability, Nigeria shares 13% of it. Individuals, both the victims and relatives desperately try all they can to treat this condition. Informal caregivers including family members and friends play a major role in seeking help and choosing treatment regimen and most of them choose complementary and alternative medicine (CAM). CAM is popular in treating chronic illnesses including mental conditions in sub-Saharan African as stated by WHO. This study displayed both positive and negative perception and attitude of informal caregivers about CAM use for mental health challenges, characteristics of users, types and outcomes of use. &#x0D; Methodology: The study is a quantitative, cross sectional study carried out from 15th February to 15th of November 2022, using self-structured questionnaires. Of 389 questionnaires administered, 381 copies were returned and properly filled (97.5% response). The informal caregivers of the mentally challenged were recruited using convenience sampling method. The participants have mean age and standard deviation of 33.5+/- 8.6years, whose mentally challenged relatives had used CAM for the past 12 months and some current users. The questionnaires included information on socio-demographic data, perception and attitude about CAM use, types in use, and outcomes of use. SPSS versions 25, student test, ANOVA, among others, were used to compare perception and attitude about use of CAM and socio-demographic data of the caregivers. 92% participants confirmed that their mentally challenged relatives use some forms of CAM in treatment. The therapies used included herbal drugs, spiritual intervention, and alternative medical system (homeopathic medicine).&#x0D; Findings: The result revealed both positive and negative perception and attitude about CAM use and most caregivers could not identify any good effects of these therapies but still use them. The findings also showed that some socio-demographic factors affect CAM use. They noted that CAM use alone cannot cure, but also complicate mental illness.&#x0D; Unique Contribution to Theory, Practice and Policy: It was concluded that research on effectiveness and safety of each CAM will help improve mental healthcare.

Measuring vaping-related expectancies in young adults: Psychometric evaluation of the Electronic Nicotine Vaping Outcomes (ENVO) scale

ObjectiveElectronic cigarettes are the most commonly used tobacco products by young adults. Measures of beliefs about outcomes of use (i.e., expectancies) can be helpful in predicting use, as well as informing and evaluating interventions to impact use. MethodsWe surveyed young adult students (N = 2296, Mean age=20.0, SD=1.8, 64 % female, 34 % White) from a community college, a historically black university, and a state university. Students answered ENDS expectancy items derived from focus groups and expert panel refinement using Delphi methods. Factor Analysis and Item Response Theory (IRT) methods were used to understand relevant factors and identify useful items. ResultsA 5-factor solution [Positive Reinforcement (consists of Stimulation, Sensorimotor, and Taste subthemes, α = .92), Negative Consequences (Health Risks and Stigma, α = .94), Negative Affect Reduction (α = .95), Weight Control (α = .92), and Addiction (α = .87)] fit the data well (CFI=0.95; TLI=0.94; RMSEA=0.05) and was invariant across subgroups. Factors were significantly correlated with relevant vaping measures, including vaping susceptibility and lifetime vaping. Hierarchical linear regression demonstrated factors were significant predictors of lifetime vaping after controlling for demographics, vaping ad exposure, and peer/family vaping. IRT analyses indicated that individual items tended to be related to their underlying constructs (a parameters ranged from 1.26 to 3.18) and covered a relatively wide range of the expectancies continuum (b parameters ranged from −0.72 to 2.47). ConclusionsA novel ENDS expectancy measure appears to be a reliable measure for young adults with promising results in the domains of concurrent validity, incremental validity, and IRT characteristics. This tool may be helpful in predicting use and informing future interventions. ImplicationsFindings provide support for the future development of computerized adaptive testing of vaping beliefs. Expectancies appear to play a role in vaping similar to smoking and other substance use. Public health messaging should target expectancies to modify young adult vaping behavior.

Understanding factors influencing residential respite service use by carers of people living with dementia using Andersen’s behavioural model of health services use: A qualitative study

Objectives Residential respite (RR) provides a valuable break for family carers, but little known about its offer, take-up or experiences of carers of people living with dementia. This paper aims to further understandings of factors influencing RR use. Design RR stakeholder workshop and qualitative interviews. Setting Stakeholder or living in the community in own home. Participants RR stakeholders (13); family carers with experience of RR, or had declined it, or were planning to use it for the first time (n = 36). Methods Stakeholders participated in a workshop to discuss provision, models and funding of RR. Family carer interviews focused on expectations, experiences and outcomes of use of RR. Data were analysed thematically and mapped against Andersen’s model of health service use. Results Identifying need for RR does not necessarily transpire into use. Planning and ease of booking were crucial for carers, but many felt there was little support with this. Systemic factors concerning funding, planning and booking RR act as barriers to its use. Conclusion Findings highlight how systemic factors influence RR use. Discussing respite need in routine care planning or reviews may support carers and people living with dementia to consider RR, but system changes are needed to address barriers.

Introduction of a New Method to Monitor Patient-Relevant Outcomes and Costs: Using a Quality Improvement Project in Transcatheter Aortic Valve Implantation Care as an Example.

Routine outcome monitoring is becoming standard in care evaluations, but costs are still underrepresented in these efforts. The primary aim of this study was therefore to assess if patient-relevant cost drivers can be used alongside clinical outcomes to evaluate an improvement project and to provide insight into (remaining) areas for improvement. Data from patients who underwent transcatheter aortic valve implantation (TAVI) between 2013 and 2018 at a single center in the Netherlands were used. A quality improvement strategy was implemented in October 2015, and pre- (A) and post-quality improvement cohorts (B) were distinguished. For each cohort, clinical outcomes, quality of life (QoL), and cost drivers were collected from the national cardiac registry and hospital registration data. The most appropriate cost drivers in TAVI care were selected from hospital registration data using a novel stepwise approach with an expert panel of physicians, managers, and patient representatives. A radar chart was used to visualize the clinical outcomes, QoL and the selected costs drivers. We included 81 patients in cohort A and 136 patients in cohort B. All-cause mortality at 30 days was borderline significantly lower in cohort B than in cohort A (1.5% vs 7.4%, P = .055). QoL improved after TAVI for both cohorts. The stepwise approach resulted in 21 patient-relevant cost drivers. Costs for pre-procedural outpatient clinic visits (€535, interquartile range [IQR] = 321-675, vs €650, IQR = 512-890, P < .001), costs for the procedure (€1354, IQR = 1236-1686, vs €1474, IQR = 1372-1620, P < .001), and imaging during admission (€318, IQR = 174-441, vs €329, IQR = 267-682, P = .002) were significantly lower in cohort B than in cohort A. Possible improvement potential was seen in 30-day pacemaker implantation and 120-day readmission. A selection of patient-relevant cost drivers is a valuable addition to clinical outcomes for use in evaluation of improvement projects and identification of room for further improvement.

Evaluation for All?

This article discusses some of the challenges of current evaluation work in higher education (HE). Despite years of interest in this space, the sector is still struggling to capture what is working to enhance student outcomes. Our own recent work as evaluators for QAA Scotland’s Enhancement Themes seeks to address this impasse. This article will provide an overview of the Enhancement Themes work in Scotland and how evaluation is being re-positioned as the crux of activity within higher education institutions wishing to demonstrate effectiveness. A case study will be presented which illustrates how this could be achieved by describing the ongoing creation and piloting of a ‘Universal Evaluation Framework’ which aims to liberate colleagues from their fears around evaluation capabilities. The intended outcomes of use include the development of evaluation capabilities, increased confidence in evaluating change in HE spaces, and an evidence base for decision making regarding student outcomes. The interactive tool will enable colleagues to plan, design, implement and learn from their evaluations and record their reflections. Digital records extend this learning into publication, possible scholarship and, more tellingly, as evidence. This case study outlines a potentially game changing tool which aims to engage colleagues and capture evidence of what works in an accessible and transparent way. In contrast to other approaches to evaluation capacity building in UK HE, this tool aims to support all, regardless of levels of evaluation experience, role, and starting points. Our framework will be universal and accessible, and intuitively and inclusively designed.

Abstract WMP28: Ethnic Differences In Use Of Rehabilitation In The First 90 Days Following Incident Stroke

Introduction: Mexican Americans (MAs) have worse stroke outcomes than non-Hispanic whites (NHWs). One possible explanation is that MAs receive less intense rehabilitation than NHWs. Our objective was to examine ethnic differences in use and type of rehabilitation in the first 90-days following stroke. Methods: Stroke cases were identified from the population-based Brain Attack Surveillance in Corpus Christi Project from Oct 2019-Oct 2021 and followed for 90 days for self-reported use of post-acute rehabilitation care. Sociodemographics, risk factors, stroke severity and treatment were ascertained from interviews and medical records. Functional outcome and depression were assessed at 90 days. Propensity score (PS) methods were used to balance characteristics by ethnicity and PS scores and other covariates were included in a logistic regression model of the association between ethnicity and the primary outcome of use of any rehabilitation. Results: Five hundred fifty-four stroke patients were included, with 66% MA and 49% women. MAs were younger, had lower education and income, worse pre-stroke function, more comorbidities, greater average BMI and worse functional outcome and depression at 90-days than NHWs. One-third of participants did not receive any rehabilitation. MAs (66.9%) were more likely to use any rehabilitation following stroke than NHWs (55.9%; p-value=0.01). After adjustment, MAs were 1.9 times (95% CI: 1.2-2.9) more likely to use any rehabilitation than NHWs. MAs were more likely to use outpatient (11.3% vs 4.8%) and home health rehabilitation (38.0% vs 29.8%) than NHWs, while no differences were noted in use of rehabilitation in inpatient or skilled nursing facilities. Conclusion: A high proportion of stroke survivors report no rehabilitation in the first 90 days following stroke. MAs report greater use of less intense forms of rehabilitation than NHWs despite worse outcomes. Future research should investigate barriers to use of more intense rehabilitation care, particularly in MAs, with the goal of maximizing recovery and reducing ethnic disparities.