162 Chapter 8 with a dashboard for the patient in a comparable way as already exist for the clinician in the EHR of Amsterdam UMC, EPIC. A patient dashboard will most likely improve implementation as it will provide feedback to the patient.24 As a healthcare provider, to interpret the OQUA scores of the patient, clinically meaningful thresholds for these scores need to be set. Meaningful thresholds or clinically relevant change scores can be defined as Normative data and Minimal Important Change (MIC), respectively. Normative data for the OQUA have been determined in a general Dutch population (chapter 6), normative data for patient groups with different diagnosis could and should be defined based on large cohorts. These data by itself will help to create more feeling and basic understanding of the potential value of the OQUA. As shown in chapter 7, ENT surgeons were reluctant to incorporate the OQUA in their practice due to lack of time and usefulness. Cumulative data of patient groups, comparisons between patients with the same disease, but also different ear-diseases could increase the value and the use of this PROM. The currently investigated Minimal Important Change scores will add to the value and usability as an outcome measure. Our ultimate goal is to incorporate the normative data and MIC data of the OQUA of patients with the same disease into the electronic health records, providing decision support tools based on PROM scores (as a “patients-like me” principle). Interpretation of the OQUA Interpretation of the OQUA scores in patients is not as easy as it seems. How do the outcomes compare to the general population? Are OQUA scores in other countries, cultures or age groups comparable? What is a significant change score after intervention and what change score is relevant for the patient? We calculated the normative data of the OQUA in the study described in chapter 6. These normative data are based on the 95e percentile of the data for each of the eight complaints. Using this percentile puts our data on the ‘safe side’. For example, in tinnitus you need to have a really high OQUA subscale score as a patient to have a higher score than the general Dutch population. There are studies who set the norm on a lower percentile, some even as low as the 50st percentile.25 If the OQUA was to be used as a screening or diagnostic tool, for which it was not designed, the norm would potentially lead to false negatives (a patient is incorrectly classified as not having a condition or severity level when in fact they do). This would then potentially lead to the patient not receiving the care they need and/or can risk their condition worsening.
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