SHM Converge Scientific Abstract ePoster Gallery-Development of a Desirability of Outcome Ranking System for Adults With Non-Severe Community-Acquired Pneumonia: A Comparison of Physician and Patient Preferences

Development of a Desirability of Outcome Ranking System for Adults With Non-Severe Community-Acquired Pneumonia: A Comparison of Physician and Patient Preferences

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This study developed a Desirability of Outcome Ranking (DOOR) for adults with non-severe community-acquired pneumonia (CAP). Because outcomes like mortality alone do not capture what matters to patients and clinicians, the researchers used DOOR to rank multiple possible outcomes from least to most desirable.<br /><br />They surveyed hospitalized pneumonia patients and clinicians who care for pneumonia patients using nine clinical vignettes in REDCap. Patient responses came from 20 hospitalized patients (77% response rate). Clinicians were recruited through snowball sampling and included infectious disease, pulmonary, hospitalist, and emergency medicine physicians. Rankings were analyzed with descriptive statistics, Friedman rank sum tests, and Mann-Whitney U tests. Results were also shared with a patient and family advisory council for feedback.<br /><br />The study found that the 9 vignette outcomes could be grouped into 5 general DOOR categories. Rankings differed significantly between patients and physicians in 7 of the cases. In general, patients viewed uncomfortable symptoms, even when not life-threatening, as less desirable than physicians did. Physicians, on the other hand, tended to rate quality-related outcomes such as readmission or hospitalization as worse than patients did.<br /><br />The final DOOR ranking placed the best outcome as being not hospitalized, with no residual pneumonia symptoms and no antibiotic-associated adverse effects. The worst outcome was death. Hospitalization ranked just above death, and several intermediate categories reflected differences in symptom burden and antibiotic complications.<br /><br />The authors conclude that outcome measures for CAP should incorporate both physician and patient preferences, since these perspectives may differ meaningfully. Limitations included the small sample size, limited range of outcomes, and lack of severity gradation within outcomes.

Asset Subtitle

Eli Finer

Meta Tag

Author List Andrea White, Austin Smith, Eli Finer, Harris L. Carmichael, James D. Harrison, Jason Carr, Jessica Howard-Anderson, Joseph Bledsoe, Michael Pulia, Payal Patel, Stephanie K. Edwards, Troy Madsen, Valerie M. Vaughn

Category Research

Concept Desirability of Outcome Ranking

Concept Outcome Ranking

Concept Community-Acquired Pneumonia

Concept Patient Preference

Concept Clinician Preference

Distinguished Non-Finalist

Presenter Organization University of Utah Hospital

Presenting Author Eli Finer

Track Outcomes Research

Keywords

community-acquired pneumonia

DOOR

patient preferences

clinician preferences

clinical vignettes

outcome ranking

hospitalized patients

symptom burden

antibiotic adverse effects

quality of care

Desirability of Outcome Ranking

Outcome Ranking

Community-Acquired Pneumonia

Patient Preference

Clinician Preference