17 General Introduction 1 Thesis outline Developing Patient Reported Outcomes Measures (PROMs) for ear and hearing problems presents several key challenges. Firstly, the diverse nature of ear and hearing issues, which range from acute infections to chronic conditions, might necessitates a wide range of PROMs or an ear domain specific PROM that can accurately capture the specific impacts of each condition. Secondly it can be difficult to ensure good reliability and validity of these measures across different populations and age groups. Thirdly, implementing PROMs in routine clinical care can be challenging due to the administrative burden on healthcare providers and patients. Best practices for implementation include simplifying the process of PROM administration, such as using digital platforms that integrate with existing electronic health records (EHR) systems and automating data collection and analysis. Educating both providers and patients on the benefits of PROMs can also increase acceptance and adherence. Additionally, involving patients in the development and selection of PROMs ensures that the measures are relevant and user-friendly. Insights gained from the implementation of PROMs can be used to continuously improve clinical practices and patient outcomes. Regularly reviewing PROM data allows healthcare providers to identify areas for improvement, adapt treatment protocols, and enhance patient education and support. Furthermore, aggregating and analysing PROM data at the population level can inform public health strategies and policy decisions, leading to better resource allocation and more effective healthcare interventions. By making PROMs a central component of clinical practice, the healthcare system can become more patient-centred and outcome-focused. This thesis highlights the abundance of available PROMs in otology and assesses its quality. It also navigates through the development, validation, implementation of the OQUA aiming to answer some of the issues addressed above. In chapter 2 a systematic mapping review of questionnaires in otology is presented. It is a comprehensive overview of all validated closed-ended otology questionnaires for adults found in the literature and of their basic characteristics. In chapter 3 a quality assessment of PROMs in otology for patients with multiple ear complaints is described. When conducting the studies in this dissertation, we used the COSMIN checklist and terminology as described earlier in this chapter. Chapter 4 reports on the multicentre development of the Otology Questionnaire Amsterdam, abbreviated as ‘OQUA’. We initiated this process by asking ourselves the most essential questions
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