Patient-reported outcome measurement in community-acquired pneumonia: feasibility of routine application in an elderly hospitalized population

Abstract

Background Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide, but few studies have evaluated the feasibility of routine patient-reported outcome measures (PROMs) in this illness. This study investigates the feasibility and limitations of three credible PROM instruments in a representative hospitalized cohort to identify potential barriers to routine application. Methods A sample of multimorbid hospitalized subjects meeting a standardized CAP definition was recruited. Demographic and clinical data of those able and unable to participate in PROM assessment were compared. The EQ-5D-5L, CAP-Sym 18 Questionnaire, and Late-Life Function and Disability Instrument (LLFDI) were administered (via face-to-face interview) at admission and discharge and (via phone interview or mail) at 30 and 90 days post-discharge. Feasibility measures included the proportion of individuals able to participate in assessment, attrition rates, data completeness, and instrument completion times. Scores at admission and 30 days post-discharge were examined for association with age. Results Of 82 subjects screened, 44 (54%) participated. Cognitive impairment ( n = 12, 15%) commonly precluded participation. Seventeen (39%) participants were lost to follow-up by 90 days. Missing data at item level was negligible for all instruments, regardless of the mode of completion. Completion of the three instruments collectively in a face-to-face interview took a median of 17 min (IQ range 13–21) per participant. The burden of reported symptoms at admission was higher for younger participants aged 18–74 years (mean (standard deviation)) CAP-Sym 18 score at admission 34.2 (18.6) vs. 19.0 (11.3) for those aged ≥ 75 years. Conclusions Routine application of PROMs can provide valuable information relating to multiple aspects of clinical recovery for individuals hospitalized with CAP. However, heterogeneous demographic characteristics and complex underlying health status introduce challenges to feasibility and interpretability of these instruments in this population. Trial registration ClinicalTrials.gov, NCT02835040 .

Improving quality in a complex primary care system—An example of refugee care and literature review

“…Non‐compliance or adherence issues, 28 unreasonable patient expectations, 29 and unmet patient health needs 29 have been identified as other factors that may lead to complex doctor‐patient relationships. Even patient reported outcome measures (PROMS) for a single condition such as community acquired pneumonia are highly complex and difficult to interpret in the diversity of primary care 30 . The nature of primary care is to focus on the person, not the disease.…”

“…Even patient reported outcome measures (PROMS) for a single condition such as community acquired pneumonia are highly complex and difficult to interpret in the diversity of primary care. 30 The nature of primary care is to focus on the person, not the disease. PROMS most often perpetuate simplistic disease-focused management.…”

Research and Effect Evaluation of the Role of Health Education in Obtaining Care for Acquired Pneumonia in Elderly Communities

“…The primary treatment approach for CAP focuses on antimicrobial therapy. Depending on the patientʼs condition, antibiotics such as doxycycline, minocycline, and amoxicillin are administered, or symptomatic treatments such as ibuprofen and acetaminophen are provided [8] . Traditional Chinese medicine has also shown promising therapeutic effects, and studies have demonstrated that integrated traditional and Western medicine treatments effectively improve clinical symptoms and quality of life in patients [9] .…”