Patient‐Reported Outcomes Predict Future Emergency Department Visits and Hospital Admissions in Patients With Stroke

Abstract

Background Identification of stroke patients at increased risk of emergency department (ED) visits or hospital admissions allows implementation of mitigation strategies. We evaluated the ability of the Patient‐Reported Outcomes Information Measurement System (PROMIS) patient‐reported outcomes (PROs) collected as part of routine care to predict 1‐year emergency department (ED) visits and admissions when added to other readily available clinical variables. Methods and Results This was a cohort study of 1696 patients with ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, or transient ischemic attack seen in a cerebrovascular clinic from February 17, 2015, to June 11, 2018, who completed the following PROs at the visit: Patient Health Questionnaire‐9, Quality of Life in Neurological Disorders cognitive function, PROMIS Global Health, sleep disturbance, fatigue, anxiety, social role satisfaction, physical function, and pain interference. A series of logistic regression models was constructed to determine the ability of models that include PRO scores to predict 1‐year ED visits and all‐cause and unplanned admissions. In the 1 year following the PRO encounter date, 1046 ED visits occurred in 548 patients; 751 admissions occurred in 453 patients. All PROs were significantly associated with future ED visits and admissions except PROMIS sleep. Models predicting unplanned admissions had highest optimism‐corrected area under the curve (range, 0.684–0.724), followed by ED visits (range, 0.674–0.691) and then all‐cause admissions (range, 0.628–0.671). PROs measuring domains of mental health had stronger associations with ED visits; PROs measuring domains of physical health had stronger associations with admissions. Conclusions PROMIS scales improve the ability to predict ED visits and admissions in patients with stroke. The differences in model performance and the most influential PROs in the prediction models suggest differences in factors influencing future hospital admissions and ED visits.

Patient-Reported Quality of Life After Intravenous Alteplase for Stroke in the WAKE-UP Trial

“…26 These assessments have confirmed the additional value of PROMs for stroke outcome evaluation, for example, by revealing high rates of impairment in mental domains not captured by classical outcome scales, 26 identifying patient characteristics associated with persistent impairments, 27 or the predictive value of PROMs for new hospital admissions. 28 Our results confirm that PROMs capture significant and clinically relevant effects of acute reperfusion treatment. Similar observations have been made for stroke thrombectomy, which improved HRQoL assessed by the EQ-5D across all dimensions in the randomized ESCAPE 29 and REVAS-CAT 30 trials.…”

“…26 These assessments have confirmed the additional value of PROMs for stroke outcome evaluation, for example, by revealing high rates of impairment in mental domains not captured by classical outcome scales, 26 identifying patient characteristics associated with persistent impairments, 27 or the predictive value of PROMs for new hospital admissions. 28…”

Use of Patient-Reported Outcomes Measurement Information System Measures in Clinical Research in Patients With Stroke: A Systematic Literature Review

“…The characteristics of the included 27 studies (24,366 patients in total) are summarized in table 1 . 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 Studies were predominantly from the United States origin (22 of 27; 81%). The majority of the studies concerned hospital-based populations with stroke, describing the outcomes of a prospective or retrospective outpatient cohort according to data gathered in regular care, at regular poststroke care visits (20 of 27; 74%).…”

Use of the PROMIS-10 global health in patients with chronic low back pain in outpatient physical therapy: a retrospective cohort study

“…A T-score of 50 represents the mean of the general population [ 28 ], and higher scores indicate better physical and mental health [ 18 , 28 ]. Evidence suggests “low” PROMIS-10 scores in MH and PH are associated with greater risk for future healthcare utilization [ 15 , 30 ]. Further, patients with scores categorized as “low” may indicate worse self-rated health that warrants more in depth assessment from physical therapists.…”