Core outcomes for the evaluation of new healthcare programmes - a modified Delphi study.

backgroundNew healthcare programmes that focus on the encounter between patients and healthcare services, such as those advocated for in different forms on "centredness", are being pushed to the forefront of the healthcare agenda to, amongst other goals, combat rising costs. However, lack of consensus regarding which outcomes should be evaluated to cover the needs of all stakeholders creates barriers to prioritising between competing alternatives. The aim of this research was to develop a core outcome set (COS) for the evaluation of new healthcare programmes adopting centredness within the encounter between patients and healthcare services.

methodsA COS was developed according to the Core Outcome Measures in Effectiveness Trials guidelines, using the DelphiManager online platform. A list of outcomes was collected from literature, stakeholder group representatives and patient partners. The outcomes underwent a two-round modified Delphi method with representative groups including managerial decision-makers, researchers, health workers, and patients/patient representatives. Outcomes scored 7-9 (critical) by 70% or more participants and 1-3 (limited importance) by no more than 15% were deemed to have reached consensus at the conclusion of round two. The COS was finalised during the consensus meeting, conducted with patient partners and written input from stakeholder representatives.

resultsAn initial list of 65 outcomes from literature were refined to 51 items at the end of the pilot phase. At the completion of round two, eight outcomes had been scored critical by all stakeholder groups. A further 28 outcomes scored critical by at least one stakeholder group were included during the consensus meeting. The COS included 36 outcomes divided into six categories, i.e., general health, capabilities and support systems, care processes, organisational, economics, and eHealth.

conclusionThis was a first attempt at developing a COS for new healthcare programmes that adopt centredness within the encounter between patients and healthcare services, resulting in 36 outcomes divided into six categories judged critical by many of the included stakeholders. While providing a first step towards understanding stakeholder needs for implementing or participating in these healthcare programmes, variation between groups highlights the difficulties in allocating resources and attributing value to healthcare programmes practicing centredness. PATIENT AND PUBLIC INVOLVEMENT: Two patient partners formed an integral part of the research team by actively participating in the study design, participant recruitment, result analysis and writing of the final manuscript.