Title:Involving patients in setting priorities for healthcare improvement: a cluster randomized trial

Transcription

1 Author's response to reviews Title:Involving patients in setting priorities for healthcare improvement: a cluster randomized trial Authors: Antoine Boivin MD, PhD (antoine.boivin@usherbrooke.ca) Pascale Lehoux PhD (pascale.lehoux@umontreal.ca) Réal Lacombe MD, MPH (real_lacombe@ssss.gouv.qc.ca) Jako Burgers MD, PhD (J.Burgers@nhg.nl) Richard Grol PhD (R.Grol@iq.umcn.nl) Version:3Date:5 December 2013 Author's response to reviews: see over

2 Montreal, December 4, 2013 Editor Implementation Science Topic: Resubmission of an original research article Dear Editor, We are pleased to submit a revised version of our article entitled Involving patients in setting priorities for healthcare improvement: a cluster randomized trial. We have carefully reviewed the article in light of reviewers excellent suggestions. Details of changes to the original manuscript are described in the attached table. We thank you again for your interest in this manuscript and are looking forward to your decision. Best wishes, Antoine Boivin, MD, PhD Assistant professor and researcher Charles-Lemoyne Hospital Research Center Université de Sherbrooke - Longueuil Campus 150 Place Charles-Lemoyne, Bureau 200 (9e étage) Longueuil (QC) J4K 0A8, Canada +1 (514) antoine.boivin@usherbrooke.ca

3 Details of changes to the original manuscript Reviewers comments General comments Strenghts of the study identified by reviewers: 1. The policy drivers for patient involvement are well rehearsed and it is extremely refreshing for the concept to be subject to appropriately scientific scrutiny. Furthermore, for that scrutiny to identify significant impact of patient involvement, and for that impact to have the potential for far wider policy decision-making, is both significant and important. I considered the question posed by the authors as both new and well-defined (VT) 2. The real world nature of the study strengthens the findings as replicable and applicable in other settings, and on a larger scale. (VT) 3. Such experimental design is unique and makes a significant contribution to the field (FPG) This statement is overstated: Our study sought to fill a pressing knowledge gap by... no one study can fill a whole gap. One study can contribute part of the puzzle (RO) Expand on what is know about public involvement in strategic aspects of healthcare (FPG) Introduction section Change "local health authority" for "local health and social services centres" (FPG) Authors responses We reframed the introduction and discussion to better position the article in relation with existing studies. We reframed this statement in the introduction. The discussion and abstract are now more explicit about the limitations of the study and directions for future research. The introduction now refers more explicitly to the theoretical and observational literature on public involvement in strategic aspects of healthcare This has been changed everywhere in the article, and we added a reference to a short overview of the Quebec healthcare system, to facilitate

4 Unclear sentence: Recruiting participants who are representative of ordinary patients... I think they mean The challenge of Recruiting... (RO) Methods section Distinguish how many patients v. professionals were involved in the pilot (FPG) Expand on who were the expert panel for indicator selection, and how this was done (individual rating of each indicator based on its relevance for canadian primary healthcare, and measurability with existing information systems (FPG) How were patients recruited in practices (FPG) Results The authors could report whether there were any costs involved in the control groups? (FPG) 95% CIs should be included around the reported percentages the study has low numbers and it is important to see whether these differences are substantiated. Same for the mean scores on the Likert scales. (RO) Discussion The manuscript would be strengthened by a clearer discussion about whether the priorities in the intervention group were better than the control group. It is not enough to just reflect that they are different. (RO) understanding by an international audience. We changed this sentence. We added this information in the design section. Details were added in the quality indicator section. Details were added in the recruitment section. We added some information about the relative costs of priority-setting in intervention vs. control groups. We added 95% confidence intervals for all reported results, and distinguished statistical significance results at the p<0,05 and p<0,01 level to substantiate reported differences between intervention and control sites. We added a supplementary file (with 95% confidence intervals) for mean Likert scales scores of professionals intention to use the selected quality indicators for healthcare improvement. The article now highlights the fact that priorities established with patients were aligned with generic components of the Chronic Care Model and Medical Home, as opposed to the technical quality of single disease management. Our study was not designed to assess if patient

5 The authors mention that the deliberation used a nominal group technique, but provide little information about how the deliberation was conducted in both the intervention and control groups. This is a bit of a black box (FPG) The patient involvement was large, and the costs documented can the authors indicate what might be the optimal size of a patient consultation group? (RO) FPG: François-Pierre Gauvin RO: Richard Osborne VT: Victoria Thomas involvement leads to better priorities, and we leave it up to readers to make this judgment. This article focuses on the quantitative outcomes results of the trial. In a related publication (quoted in the discussion section), we analyze in more depth the qualitative process evaluation of the intervention arm of the trial, seeking to open the black box of the intervention and help explain the observed effects. The relative contribution of the consultation component of the intervention (and the issue of size) is beyond the scope of this article, and is discussed in our process evaluation paper quoted in the discussion section. We nonetheless added some details about costs in the result section.