163 General discussion & future perspectives 8 This is important to realise when discussing the results with a patient. Of the assessed multiple complaint PROMs, discussed in chapter 5 of this thesis, no large data sets are available to be used as normscore. The reported ear complaints measured by the OQUA in the general population (chapter 6) reveal an overall low prevalence of complaints, with different patterns emerging across different age groups. Surprisingly, overall higher scores in complaints were seen among the younger aged. We argued that perhaps the younger generation is more sensitive and more susceptible for complaints that others would accept as ‘normal’. Older generations, ‘Traditionalists’ (born between 1922-1945) and ‘Baby Boomers’ (born between 1945-1964)) are brought up in a world with less luxury and work as the highest personal fulfilment, whereas ‘Millennials’ (born between 1977-1995) and ‘Generation Z’ (born between 1996-2010) are more focused on their personal life and more aware of their health (problems). In literature, these generations (Gen Z and Millennials) rated significantly worse on mental health indices during the Covid-19 period, pointing out that they are a psychologically vulnerable population due to their mental health and maladaptive coping behaviours.26 Although the evidence in literature is limited, this hypothesis of potential generational difference might (partly) explain our findings. Finally, to better interpret and use individual and group data from the OQUA for shared decision making, it is essential to establish Minimal Important Change (MIC) scores. This will be discussed in the last paragraph of this chapter. Trying to improve otologic care by using the OQUA The OQUA can be valuable in a wider perspective than just in a single patient evaluation. First of all, in Value based Healthcare, aggregated PROM data may be used to provide real-world evidence about treatment effectiveness and safety27,28, and accountability to payers and the public. As the OQUA is a multiple complaint PROM that can be used for all patients with an ear complaint or ear disease, nationwide, or even multinational implementation can contribute to this evidence. Secondly, the OQUA data can provide a good basis for national guidelines and care evaluation, especially if it is incorporated in the Dutch Otologic Quality registry. It will contribute to ear disease specific group scores and provide a structured feedback loop for both patients and clinicians, highlighting areas for improvement in healthrelated quality of life, symptom control, and treatment satisfaction. The design of
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