Challenges in measuring patient defined outcomes in diagnostic radiological investigations S Mathers* +, G McKenzie*, E Robertson*, J Proctor* +, R Chesson + *NHS Grampian + The Health Services Research Group Aberdeen, Scotland, UK.

What aspects of health care can be evaluated? Outcome Change due to intervention Process Intervention e.g. surgery, procedure Structure Resources, facilities organisational settings Donabedian, 1980

Outcome measures have been defined... as the results (effects) of processes. They are that part of the situation pertaining after a process which can be attributed to the process. UK Clearing House on Health Outcomes, 1993

Why is outcome measurement important?... to show that an intervention has been appropriate and effective Austin and Clark, 1993

Aim To carry out a systematic review of literature to identify: the prevalence, use of outcome measures in radiology.

Search Strategy Databases searched Abstracts read according to defined criteria Criteria redefined, abstracts to be re-read in light of this Articles to be retrieved Initial paper review Data synthesis 1. Data extraction form 2. Quality checklist Data analysis 1.SPSS 2. Summary tables 3. Meta-analysis Write up and dissemination. Modified from NHS Centre for Reviews and Dissemination, (UK)

46 key words used radiology/diagnostic imaging/x-ray outcomes patient satisfaction efficacy outcome measures utilityadverse reaction waiting times quality of care Databases searched e.g. MEDLINE

Results Citations 4893 Publications retrieved 84 Publication by references 25 Patient focused outcome 22

Final Scrutiny Exclude 8 for a number of reasons e.g. hypothetical studies Included 14 primary patient focused studies

Patient focused outcome papers In total 8 Mammography 2 x USA Low back pain2 x UK Ankle radiography 1 Canada DCBE/US/Mammography1 Norway MRI1 UK Effects of radiation dose1 Canada

Conclusions Dearth of research into patient centred outcomes in radiology Lack of coherent body of work Demonstrates little patient involvement in radiology research

Challenges Imaging procedure only part of investigations and patient final outcome remote from department Blackmore et al 1999 Multi-disciplinary approach to research Revicki et al 1999 Development of suitable outcome measurement tools Would benefit from a qualitative methodology

Future agenda It is important that we develop a culture of outcome measurement in radiology Patient defined outcome is necessary to evaluate our procedures

Acknowledgements The Royal College of Radiologists (UK) (Pump Priming Research Award)