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Evaluation of patient-reported outcomes data in structured diabetes education intervention: 2-year follow-up data of patient empowerment programme

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Abstract

To examine the effects of a structured group-based education programme, patient empowerment programme (PEP), compared with usual care on 2-year changes in patient-reported outcomes (PRO) in patients with diabetes mellitus (DM). A prospective observational study of 715 patients (PEP/non-PEP: 390/325) was conducted to complete the baseline PRO survey and followed up for 2 years. Health-related quality of life (HRQOL) was measured using the short-form 12 at baseline and annually at two follow-up assessments, which yielded physical and mental component summary and SF-6D preference-based scores. Perceived control over diabetes and general health status were measured using the patient enablement instrument (PEI) and global rating scale (GRS) at follow-ups. When compared with non-PEP, PEP participants significantly reported improvement in health condition (GRS score > 0; 24.55 % vs 10.16 %; odds ratio = 2.502; P = 0.018) in 2 years and enabled the self-perceived control over diabetes (PEI score > 0; 72.20 % vs 38.40 %; odds ratio = 3.25; P < 0.001) in 1-year follow-up but no sustained effects in year 2 (52.65 % vs 39.04 %; odds ratio = 1.366; P = 0.265). There were no significant differences between PEP and non-PEP groups in the changes in quality of life scores (all P > 0.05) at 1 year. Although HRQOL scores deteriorated over 2-year period in both groups, PEP participants reported similar changes in HRQOL scores to that of non-PEP. PEP for DM patients preserved self-perceived disease control and health condition, whereas PEP participants perceived their HRQOL similar to that of non-PEP participants. Findings of PRO should be considered alongside clinical outcomes when evaluating the overall benefits of PEP.

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Abbreviations

DM:

diabetes mellitus

PEP:

patient empowerment programme

PRO:

patient-reported outcomes

PCS:

physical component summary

MCS:

mental component summary

PEI:

patient enablement instrument

GRS:

global rating scale

PCORI:

Patient-Centred Outcomes Research Institute

AHRQ:

Agency for Healthcare Research and Quality

ISOQOL:

International Society of Quality of Life Research

HRQOL:

health-related quality of life

NGOs:

non-government organizations

PF:

physical functioning

RP:

role physical

BP:

bodily pain

GH:

general health

VT:

vitality

SF:

social functioning

RE:

role emotional

MH:

mental health

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Acknowledgments

We would like to thank the programme teams at HA head office (including Ms. Margaret Tay, Dr. Alexander Chiu, Dr. K. L. Chung, Dr. Alan Y. L. Kwok, Ms. Michelle Wong, Mr. Gary Ching and Ms. Bonnie Fok), and all cluster representatives and clinical staff in the patient empowerment programme for working with our team in this evaluation. Furthermore, we would like to thank Dr. S. V. Lo and the staff of the Statistics & Workforce Planning Department in the Hospital Authority Strategy and Planning Division for their help in coordinating the development of the evaluation frameworks and site visits and facilitating the data collection. This study has been funded by the Hong Kong Hospital Authority (Ref. no: 8011014157) and the Commissioned Study on Enhanced Primary Care, Food and Health Bureau, HKSAR (Ref. no EPC-HKU-2). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Author contribution

Carlos K. H. Wong is the guarantor of the study. C. K. H. W. wrote the manuscript and researched data. F. W. K. C. contributed to acquisition of data and reviewed/edited the manuscript. W. C. W. W. and C. L. K. L. contributed to study design. Y. F. W., A. K. C. C and P. C. H. reviewed/edited the manuscript, contributed to statistical analysis and interpretation of results. W. C. W. W. and C. L. K. L. reviewed/edited the manuscript.

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Authors and Affiliations

  1. Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China

    Carlos K. H. Wong, Cindy L. K. Lam, Eric Y. F. Wan, Anca K. C. Chan, C. H. Pak & William C. W. Wong

  2. Integrated Care Programs, Hospital Authority Head Office, Hong Kong Hospital Authority, Hong Kong, China

    Frank W. K. Chan

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  1. Carlos K. H. Wong
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Wong, C.K.H., Lam, C.L.K., Wan, E.Y.F. et al. Evaluation of patient-reported outcomes data in structured diabetes education intervention: 2-year follow-up data of patient empowerment programme. Endocrine 54, 422–432 (2016). https://doi.org/10.1007/s12020-016-1015-5

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