miércoles, 17 de junio de 2015

When do patient-reported outcome measures inform readmission risk? - PubMed - NCBI

When do patient-reported outcome measures inform readmission risk? - PubMed - NCBI

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Measuring Patient-Reported Outcomes Can Help Identify Patients at Higher Risk for Hospital Readmission, AHRQ Study Finds

Despite widespread efforts to accurately predict which patients are at greatest risk for being readmitted to the hospital within 30 days of discharge, patient-reported outcome measures are infrequently used in predictive models. To find out whether patients’ self-reported views of their health services can accurately predict readmission, a research team at Cook County Health and Hospital System in Chicago administered the Memorial Symptom Assessment Scale and the Patient Reported Outcomes Measurement Information System (PROMIS) Global Health short form to 196 patients at discharge. Patients also took the health assessment surveys at 30, 90 and 180 days after discharge. Patients who scored poorly on the PROMIS measures of general self-rated health and mental health were at greater risk of rehospitalization within 14 days of discharge, researchers found. However, low scores by patients on the Memorial Symptom Assessment Scale and the PROMIS measures of global physical health were better able to predict readmission. Because the sample size of the population was relatively small, researchers acknowledged that the findings may be limited. They recommended that systems to obtain patient-reported outcomes be developed as a routine part of clinical care. The study, “When Do Patient-Reported Outcome Measures Inform Readmission Risk?” andabstract were published online on April 9 in Journal of Hospital Medicine.

 2015 May;10(5):294-300. doi: 10.1002/jhm.2366. Epub 2015 Apr 9.

When do patient-reported outcome measures inform readmission risk?



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.


Patients discharged from an urban safety-net hospital.


Longitudinal cohort study.


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.


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.


Routine measurement of patient-reported outcomes can help identify patients at higher risk for utilizations. At different time points, MSAS, GPH, GMH, and GSRH all informed utilization risk. Journal of Hospital Medicine 2015;10:294-300. © 2015 Society of Hospital Medicine.
© 2015 Society of Hospital Medicine.

[PubMed - in process]

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