Can Patient Reported Outcomes (PROs) from Population Surveys Provide Accurate Estimates of Pre-Admission Health Status of Emergency Hospital Admissions?

Esther Kwong,Gary Abel,Nick Black

doi:10.2147/prom.s215513

Abstract

IntroductionThe use of PROs for assessing the outcomes of emergency hospital admissions requires a means of estimating patients’ pre-admission health status. A possible alternative to asking patients to recall how their health was before the incident causing admission is to use estimates derived from matched samples from population surveys. Our aims were to explore the impact of different methods of matching and to compare the results with estimates based on retrospective reporting.MethodsFirst, elective hip arthroplasty patients were matched to respondents to the General Practice Patient Survey using age, sex, socio-economic status and number of comorbidities. The impact of restricting matching for locality and specific co-morbidities was explored. Second, the best matching method was applied to emergency admissions for laparotomy and for percutaneous coronary intervention (PCI) after acute myocardial infarction. Data were stratified by patient characteristics. Differences in mean EQ-5D scores between the patients and matched population respondents were tested using t tests.ResultsModifying the most basic form of matching by also taking locality and the specific comorbid conditions into account made no significant difference to the mean EQ-5D score for hip arthroplasty patients. Even using the most detailed matching possible, patients’ mean EQ-5D score was significantly different to that of the general population for all three cohorts. The difference was greatest for elective hip arthroplasty (0.22 v 0.64), less so for emergency laparotomy (0.56 v 0.72) and least for PCI (0.79 v 0.71). This reflects hip arthroplasty patients having a long-standing condition characterised by pain and limited mobility, whereas the other two cohorts may have enjoyed reasonable health until an unexpected acute episode led to their emergency admission.ConclusionRoutine PRO data acquired from population surveys cannot be used as an accurate alternative to retrospectively reported PROMs by patients during their emergency admission episode.

Highlights

The use of Patient-Reported Outcomes (PROs) for assessing the outcomes of emergency hospital admissions requires a means of estimating patients’ pre-admission health status
Modifying the most basic form of matching by taking locality and the specific comorbid conditions into account made no substantial difference to the estimated EQ-5D mean score
Despite the use of specific comorbidities conferring no benefit over a simple count from the exploratory matching with hip patients, the former was chosen for comparing differences between patients and the population as co-morbidity has submit your manuscript | www.dovepress.com been shown to influence the health status of respondents in the General Practice Patient Survey (GPPS) in prior published research.[23]

Summary

Introduction

The use of PROs for assessing the outcomes of emergency hospital admissions requires a means of estimating patients’ pre-admission health status. A possible alternative to asking patients to recall how their health was before the incident causing admission is to use estimates derived from matched samples from population surveys. The difference was greatest for elective hip arthroplasty (0.22 v 0.64), less so for emergency laparotomy (0.56 v 0.72) and least for PCI (0.79 v 0.71) This reflects hip arthroplasty patients having a long-standing condition characterised by pain and limited mobility, whereas the other two cohorts may have enjoyed reasonable health until an unexpected acute episode led to their emergency admission. Conclusion: Routine PRO data acquired from population surveys cannot be used as an accurate alternative to retrospectively reported PROMs by patients during their emergency admission episode. That study found strong agreement between retrospective and contemporary disease-specific PROs and EQ-5D, with intra-class correlation coefficients of 0.8 for the disease-specific PROs (Oxford Hip Score and Oxford Knee Score), and 0.6 for the EQ-5D.3,4

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