When do patient‐reported outcome measures inform readmission risk?

Abstract

OBJECTIVE: To characterize changes in patient-reported outcome measures from hospital discharge to assess when they best inform risk of utilization as defined by readmissions or emergency department use. PARTICIPANTS:Patients discharged from an urban safetynet hospital. DESIGN:Longitudinal cohort study. MAIN MEASURES:We serially administered the Memorial Symptom Assessment Scale (MSAS) and the PROMIS Global Health short form assessing General Self-Rated Health (GSRH), Global Physical (GPH), and Mental (GMH) Health at 0, 30, 90, and 180 days from hospital discharge. Time to first utilization from each survey was plotted by dichotomizing our sample on each patient-reported measure, and equivalence of the time-to-event curves was assessed using the log-rank test. Cox proportional hazard models were used to control for available covariates including prior utilization during the study, Charlson score, age, gender, and race/ethnicity. We assessed each measure's effect on the fit of the predictive models using the likelihood ratio test. KEY RESULTS:We recruited 196 patients, of whom 100%, 98%, 90%, and 88% completed each respective survey wave. Participants' mean age was 52 years, 51% were women, 60% were non-Hispanic black, and 21% completed the questionnaires in Spanish. In-hospital assessments revealed high symptom burden and poor health status. In-hospital assessments of GMH and GSRH predicted 14-day reutilization, whereas posthospitalization assessments of MSAS and GPH predicted subsequent utilizations. Each measure selectively improved predictive model fit.

Adaptação transcultural e validação da escala de Saúde Global do PROMIS para a língua portuguesa

“…A escala de Saúde Global tem sido amplamente utilizada em diferentes contextos 38,39,40,41,42,43 , já que apresenta boas propriedades psicométricas e tempo reduzido para o preenchimento em relação às medidas tradicionais 44 .…”

Using electronic health record data for substance use Screening, Brief Intervention, and Referral to Treatment among adults with type 2 diabetes: Design of a National Drug Abuse Treatment Clinical Trials Network study

“…Diabetes outcomes include: medication adherence scores (collected by the parent study), healthcare use (number of emergency department and inpatient encounters), and diabetes-related complications (a summary of new diagnoses of medical conditions, including kidney disease, peripheral neuropathy, retinopathy or blindness, hypertension, heart failure, amputation, and stroke) from the EHR. Health related quality of life data are assessed by the Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Short Form to explore their changes over time and associations with substance use and/or hospital admissions [55]…”

Closing the Quality Chasm in Cirrhosis

“…PROs have been defined as “any report of the status of a patient's health condition that comes directly from the patient, without interpretation of the patient's response by a clinician or anyone else.” If the goal of health care systems is to obtain optimal patient outcomes, incorporating the patient perspective via PRO measurements is crucial to centering our field to this goal. Furthermore, PROs have been used in different chronic diseases, identifying those at risk for readmission, predicting mortality, and improving communication and engagement of patients in their own health care …”