Future research should evaluate observation care in the context of inpatient hospitalization, emergency care and longer term patient outcomes.
Emphasis is given to sometimes less well-appreciated fractures, which might be missed and can have devastating consequences for longer term patient outcomes.
In particular they should require evidence from clinical trials that examine longer term patient-centred safety and efficacy outcomes.
As with many recent studies [ 13, 6, 25] a simulation model is used to predict longer term patient outcomes and complications for patients in the program.
Use of standardized measures, including for patient characteristics associated with guideline recommendations, evaluation of guideline adherence and longer term patient outcomes will also be important.
Since its initial development, Adjuvant! has been updated a number of times so as to incorporate longer term patient follow-up data, more reliable information on cause of death, and the most recent evidence on treatment efficacy.
11 A recent randomised trial found improvements in physical function at hospital discharge associated with early mobilisation in the ICU but did not address longer term patient benefits or report cost-effectiveness.
In the following quote, Helen describes how despite her desire and tendency to focus on longer term patient-led goals, the practical limitations of the service would nevertheless have influenced what she felt able to focus on.
3 While almost every malignancy can develop bone metastases, it has been estimated that breast cancer, lung cancer, and prostate cancer account for more than 80% of such metastases. 1 However, limited information is available on the clinical course of patients who develop bone metastases, largely due to scarcity of resources for longer term patient follow up.
30 31 This will have an uncertain effect on clinical trial times if HTA agencies demand longer term patient-related outcomes rather than proxy measures on which to judge value, but it may be expected to speed up the total time to adoption and diffusion of those drugs judged to be most clinically and cost-effective.
