Funnel plots of patient‐reported outcomes to evaluate health‐care quality: Basic principles, pitfalls and considerations

Willik, Esmee M van der; Zwet, Erik W. van; Hoekstra, Tiny; Ittersum, Frans J. van; Hemmelder, Marc H; Zoccali, Carmine; Jager, Kitty J.; Dekker, Friedo W.; Meuleman, Yvette

doi:10.1111/nep.13761

Cited by 16 publications

(12 citation statements)

References 29 publications

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“…After this, we mainly used three methods to test the sensitivity of the results of our MR analysis. We tested the heterogeneity of SNPs using IVW and MR-Egger methods, and used funnel plots as validation (23,24). We apply the MR-Egger method to evaluate whether there is horizontal pleiotropy in SNPs (25).…”

Section: Discussionmentioning

confidence: 99%

Relationship between three reproductive factors and lung cancer: a two-sample Mendelian randomization study

Liu,

Zhu,

Jing

et al. 2023

Preprint

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Background There is increasing evidence that sex hormones are involved in the development of lung cancer, but the correlation between reproductive behavior that changes sex hormone levels and lung cancer is not clear. Therefore, we conducted a two-sample Mendelian randomization (MR) analysis to explore the potential relationship between age at first sexual intercourse (AFS), menarche, menopause and lung cancer.Methods We performed MR analysis of the data from genome-wide association study (GWAS) of European ancestry to evaluate the independent effects of three reproductive behaviors on lung cancer over all (LUCA), lung adenocarcinoma (LUAD), squamous cell lung cancer (LUSC) and small cell lung cancer (SCLC). We mainly used inverse variance weighting (IVW) method for MR analysis. Sensitivity was determined by MR-pleiotropy residual sum and outlier (MR-PRESSO) analysis, weighted median analysis, MR-Egger analysis, and Leave-one-out analysis.Results We found that older AFS had a causal relationship with LUCA [odds ratio (OR) = 0.6283, 95% confidence interval (CI) = 0.4959 ~ 0.7961, P = 0.0001], LUAD (OR = 0.7042, 95% CI = 0.4967 ~ 0.9984, P = 0.049) and LUSC (OR = 0.6231, 95% CI = 0.4386 ~ 0.8853, P = 0.0083) by MR analysis.Conclusion Our results observed a causal relationship between older AFS and lower lung cancer risk. It emphasizes the importance of providing sex education since early sexual intercourse may have undesirable effects. In addition, early psychological treatment is also essential.

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Section: Discussionmentioning

confidence: 99%

Relationship between three reproductive factors and lung cancer: a two-sample Mendelian randomization study

Liu,

Zhu,

Jing

et al. 2023

Preprint

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“…The use of aggregated PROM data as a benchmark for quality of care was questioned by doctors due to the large case-mix differences between centres. Recent research in a dialysis setting indeed suggests that case-mix adjustments have to be made [ 60 ], as has also been illustrated in stroke care [ 61 ]. In addition, doctors indicate that it is difficult, if not impossible, to interpret aggregated PROM results without knowing the patient, their comorbidity, their history and their personality.…”

Section: Discussionmentioning

confidence: 99%

Facing the challenges of PROM implementation in Dutch dialysis care: Patients’ and professionals’ perspectives

et al. 2023

Self Cite

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Background Patient Reported Outcome Measures (PROMs) are increasingly used in routine clinical practice to facilitate patients in sharing and discussing health-related topics with their clinician. This study focuses on the implementation experiences of healthcare professionals and patients during the early implementation phase of the newly developed Dutch set of dialysis PROMs and aims to understand the process of early implementation of PROMs from the users’ perspectives. Methods This is a qualitative study among healthcare professionals (physicians and nursing staff: n = 13) and patients (n = 14) of which 12 were receiving haemodialysis and 2 peritoneal dialysis. Semi-structured interviews were used to understand the barriers and facilitators that both professionals and patients encounter when starting to implement PROMs. Results The early PROM implementation process is influenced by a variety of factors that we divided into barriers and facilitators. We identified four barriers: patient´s indifference to PROMs, scepticism on the benefits of aggregated PROM data, the limited treatment options open to doctors and organizational issues such as mergers, organizational problems and renovations. We also describe four facilitators: professional involvement and patient support, a growing understanding of the use of PROMs during the implementation, quick gains from using PROMs such as receiving instant feedback and a clear ambition on patient care such as a shared view on patient involvement and management support. Conclusions In this qualitative study carried out during the early implementation phase of the Dutch dialysis PROM set, we found that patients did not yet consider the PROM set to be a useful additional tool to share information with their doctor. This was despite the professionals’ primary reason for using PROMs being to improve patient–doctor communication. Furthermore, the perceived lack of intervention options was frustrating for some of the professionals. We found that nurses could be important enablers of further implementation because of their intensive relationship with dialysis patients.

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“…The indirectly standardized ratios for different sites were described in the funnel plot with 95% and 99.8% Poisson limits. [ 16 , 17 ] All the analysis was performed in SAS, version 9.4 (SAS Institute, Cary, North Carolina, USA) and R 3.6.1. A two-sided P value of 0.05 was used to determine the statistical significance.…”

Section: Methodsmentioning

confidence: 99%

“…Then, the indirectly standardized ratio for each site was calculated as the observed amount of ACS usage divided by the expected number of ACS usage. The indirectly standardized ratios for different sites were described in the funnel plot with 95% and 99.8% Poisson limits [16,17] . All the analysis was performed in SAS, version 9.4 (SAS Institute, Cary, North Carolina, USA) and R 3.6.1.…”

Section: Methodsmentioning

confidence: 99%

Use of antenatal corticosteroids among infants during gestational age at 24 to 31 weeks in 57 neonatal intensive care units of China: a cross-sectional study

Zhao

Feng

Dai

et al. 2023

Chinese Medical Journal

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Background:Antenatal corticosteroids (ACS) can significantly improve the outcomes of preterm infants. This study aimed to describe the ACS use rates among preterm infants admitted to Chinese neonatal intensive care units (NICU) and to explore perinatal factors associated with ACS use, using the largest contemporary cohort of very preterm infants in China.Methods:This cross-sectional study enrolled all infants born at 24+0 to 31+6 weeks and admitted to 57 NICUs of the Chinese Neonatal Network from January 1st, 2019 to December 30th, 2019. The ACS administration was defined as at least one dose of dexamethasone and betamethasone given before delivery. Multiple logistic regressions were applied to determine the association between perinatal factors and ACS usage.Results:A total of 7828 infants were enrolled, among which 6103 (78.0%) infants received ACS. ACS use rates increased with increasing gestational age (GA), from 177/259 (68.3%) at 24 to 25 weeks’ gestation to 3120/3960 (78.8%) at 30 to 31 weeks’ gestation. Among infants exposed to ACS, 2999 of 6103 (49.1%) infants received a single complete course, and 33.4% (2039/6103) infants received a partial course. ACS use rates varied from 30.2% to 100% among different hospitals. Multivariate regression showed that increasing GA, born in hospital (inborn), increasing maternal age, maternal hypertension and premature rupture of membranes were associated with higher likelihood to receive ACS.Conclusions:The use rate of ACS remained low for infants at 24 to 31 weeks’ gestation admitted to Chinese NICUs, with fewer infants receiving a complete course. The use rates varied significantly among different hospitals. Efforts are urgently needed to propose improvement measures and thus improve the usage of ACS.

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Funnel plots of patient‐reported outcomes to evaluate health‐care quality: Basic principles, pitfalls and considerations

Cited by 16 publications

References 29 publications

Relationship between three reproductive factors and lung cancer: a two-sample Mendelian randomization study

Relationship between three reproductive factors and lung cancer: a two-sample Mendelian randomization study

Facing the challenges of PROM implementation in Dutch dialysis care: Patients’ and professionals’ perspectives

Use of antenatal corticosteroids among infants during gestational age at 24 to 31 weeks in 57 neonatal intensive care units of China: a cross-sectional study

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