Patient Reported Outcome Measures

PurposeThis study aimed to identify and synthesize factors associated with response to digitally collected patient-reported outcome measures (PROMs) among adult patients, to inform efforts to improve response rates.MethodsWe performed a systematic review of systematic and scoping reviews across five databases. Risk of bias was assessed using A MeaSurement Tool To Assess Systematic Reviews (AMSTAR) and included in a best-evidence synthesis. Additionally, a meta-analysis was conducted using the primary studies from the included reviews that specifically reported on digitally collected PROMs.ResultsWe identified 43 factors positively, negatively, or not associated with response to digital PROMs, clustered in six domains. Some were modifiable, including the overload or overlap of questions, PROMs irrelevant to the patient, automatic reminders, system usability, and clinicians' follow-up with PROMs. Others were non-modifiable, such as race, language barriers, visual impairments, and comorbidities; many of these factors are shaped by patients' broader social and health-related circumstances and may therefore point to underlying structural or contextual barriers (e.g., limited access to resources, lower literacy, or health-related limitations). Such barriers may ultimately contribute to unequal access to care and are potentially actionable.ConclusionsFactors associated with response to digitally collected PROMs can be clustered into six domains: sociodemographic characteristics, physical health, psychosocial status, PROM characteristics, technological factors, treatment characteristics, and external influences. Although not all factors are directly modifiable, they can inform targeted and tailored interventions to improve response rates across diverse populations and support more equitable access to care. This review provides a structured overview to guide such efforts. Potential interventions could include language simplification, item reduction, follow-up during consultation, tailored reminders, and interface adaptations for patients with specific needs.

BackgroundMultiple gingival recessions can lead to esthetic impairments and may require surgical root coverage. Esthetic outcome measures can be assessed from both professional and patient perspectives. Several objective and subjective outcome measures have been applied for these evaluations.AimTo systematically review and conduct a meta-analysis of the available literature on professional esthetic assessments and patient-related outcome measures (PROMs) following surgical root coverage procedures for the treatment of multiple gingival recessions.Materials and methodsA computerized systematic search was conducted in the MEDLINE (via PubMed), EMBASE, and Cochrane Central Register of Controlled Trials databases up to May 2024 to identify eligible studies meeting the inclusion criteria.ResultsA total of 32 randomized controlled trials involving 1012 patients and 3589 multiple gingival recessions were included. No case-series studies meeting the inclusion criteria were retrieved. Meta-analyses demonstrated that root coverage procedures statistically significantly improved both professionally assessed and patient-reported esthetic outcomes. The overall weighted mean Root Coverage Esthetic Score (RES) was 8.31 (95% CI: 8.11-8.50), with comparable results across coronally advanced flap (CAF) and tunnel (TUN) techniques, particularly when combined with autogenous connective tissue grafts or graft substitutes. Patient-reported esthetic satisfaction, measured primarily by visual analog scales (VAS), showed a pooled mean of 8.59 (95% CI: 8.29-8.89). Mean root coverage (MRC) reached 82.6% (95% CI: 71.3-93.9), and complete root coverage (CRC) was 62.7% (95% CI: 57.0-68.4). Statistically significant reductions in recession depth (mean difference = 2.22 mm) and gains in keratinized tissue (0.74 mm), gingival thickness (0.56 mm), and clinical attachment level (2.17 mm) were observed. Postoperative pain was low across techniques (VAS 0-10 mean: 2.67; VAS 0-100 mean: 24.34). Metaregression revealed a positive association between MRC and RES (R2 = 0.345) but no significant correlation between MRC and patient esthetic perception (R2 = 0.091), underscoring the divergence between clinical and patient-reported outcomes.ConclusionsThe results of this systematic review and meta-analysis, focusing on multiple gingival recessions, suggest that (a) CAF and TUN with the adjunctive use of autogenous graft support esthetic improvement from both professional and patient perspectives and (b) CAF and TUN with the adjunctive use of autogenous graft or graft substitutes are effective in root coverage outcomes with a minimal postoperative morbidity.

BackgroundLong-term services and supports (LTSS) serve > 9 million adults in the United States. We examined prevalence and quality of life (QoL)-related outcomes of consumer-reported unmet LTSS needs in publicly-funded LTSS.MethodsWe pooled cross-sectional data from the 2016-2017, 2017-2018, 2018-2019, 2021-2022, and 2022-2023 National Core Indicators-Aging and Disability Adult Consumer Surveys. We included 61,829 adults (34% with age ResultsAmong respondents, 18,004 (weighted-estimate, 29%) reported unmet LTSS needs. Prevalence of unmet needs varied across sociodemographic strata, care settings (higher in community-based than in residential-care settings), and funding programs (lower in PACE than in Medicaid programs). Individuals with unmet needs were significantly less likely to report being active in the community (PR, 0.65; 95% CI, 0.62-0.68) and satisfied with how they spend their day (PR, 0.62; 95% CI, 0.60-0.64). Post hoc analyses revealed potential dose-response associations between increasing degree of unmet LTSS needs and outcomes.ConclusionsConsumer-reported unmet LTSS needs are frequent, vary greatly across care settings and funding programs, and are associated with poorer QoL-related outcomes; highlighting substantial system-level gaps in the fragmented LTSS landscape and the need for coordinated investments and structural reforms to better meet the needs of individuals relying on these services.