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Garratt AM, Engen K, Kjeldberg IR, Nordvik JE, Ringheim I, Westskogen L, Becker F. Use of EQ-5D-5L for Assessing Patient-Reported Outcomes in a National Register for Specialized Rehabilitation. Arch Phys Med Rehabil 2024; 105:40-48. [PMID: 37236496 DOI: 10.1016/j.apmr.2023.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/28/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To compare problems reported on EQ-5D-5L dimensions, index, and EQ visual analog scale (VAS) scores in patients receiving specialized rehabilitation in Norway with general population norms. DESIGN Multicenter observational study. SETTING Five specialist rehabilitation facilities participating in a national rehabilitation register between March 11, 2020, and April 20, 2022. PARTICIPANTS 1167 inpatients admitted (N=1167), with a mean age of 56.1 (range, 18-91) years; 43% were female. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES EQ-5D-5L dimension, index, and EQ VAS scores. RESULTS At admission, mean±SD EQ-5D-5L index scores were 0.48 (0.31) compared to 0.82 (0.19) for general population norms. EQ VAS scores were 51.29 (20.74) compared to 79.46 (17.53) for population norms. Together with those for the 5 dimensions, these differences were all statistically significant (P<.01). Compared to population norms, patients undergoing rehabilitation had more health states as assessed by the 5 dimensions (550 vs 156) and EQ VAS (98 vs 49). As hypothesized, EQ-5D-5L scores were associated with number of diagnoses, admission to/from secondary care, and help with completion. At discharge there were statistically significant improvements in all EQ-5D-5L scores that compare favorably with available estimates for minimal important differences. CONCLUSIONS The large deviations in scores at admission and score changes at discharge lend support to EQ-5D-5L application in national quality measurement. Evidence for construct validity was found through associations with number of secondary diagnoses and help with completion.
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Affiliation(s)
| | - Kathrine Engen
- Department of Rehabilitation, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | | | - Jan Egil Nordvik
- Division for Quality and Clinical Pathways, Norwegian Directorate of Health, Oslo, Norway; Faculty of Health Sciences, Oslo Metropolitan University, Norway
| | - Inge Ringheim
- Division of Physical Medicine & Rehabilitation, Vestfold Hospital Trust, Tønsberg, Norway
| | - Lise Westskogen
- Division for Quality and Clinical Pathways, Norwegian Directorate of Health, Oslo, Norway
| | - Frank Becker
- Division for Quality and Clinical Pathways, Norwegian Directorate of Health, Oslo, Norway; Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway; Department of Physical Medicine and Rehabilitation, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Mokanyk AR, Taylor CL, De la Garza Ramos R, Tadepalli S, Girasulo SA, Rossi MCS, O'Donnell BA, Bauman JA, Sekhar R, Abbed KM, Matmati N, Yanamadala V. System-wide integration of patient reported outcome measure collection through an electronic medical record system: A state-wide retrospective study. J Clin Neurosci 2023; 114:137-143. [PMID: 37392561 DOI: 10.1016/j.jocn.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/09/2023] [Accepted: 06/11/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND AND PURPOSE In spine neurosurgery practice, patient-reported outcome measures (PROMs) are tools used to convey information about a patient's health experience and are an integral component of a clinician's decision-making process as they help guide treatment strategies to improve outcomes and minimize pain. Currently, there is limited research showing effective integration strategies of PROMs into electronic medical records. This study aims to provide a framework for other healthcare systems by outlining the process from start to finish in seven Hartford Healthcare Neurosurgery outpatient spine clinics throughout the state of Connecticut. METHODS On March 1, 2021, a pilot implementation program began in one clinic and on July 1, 2021, all outpatient clinics were implementing the revised clinical workflow that included the electronic collection of PROMs within the electronic health record (EHR). A retrospective chart analysis studied all adult (18+) new patient visits in seven outpatient clinics by comparing the rates of PROMs collection in Half 1 (March 1, 2021-August 31, 2022) and in Half 2 (September 1, 2022-February 28, 2022) across all sites. Additionally, patient characteristics were studied to identify any variables that may lead to higher rates of collection. RESULTS During the study period, 3528 new patient visits were analyzed. There was a significant change in rates of PROMs collection across all departments between H1 and H2 (p < 0.05). Additional significant predictors for PROMs collection were the sex and ethnicity of the patient as well as the provider type for the visit (p < 0.05). CONCLUSIONS This study proved that implementing the electronic collection of PROMs into an already existing clinical workflow reduces previously identified collection barriers and enables PROMs collection rates that meet or exceed current benchmarks. Our results provide a successful step-by-step framework for other spine neurosurgery clinics to implement a similar approach.
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Affiliation(s)
- Abigail R Mokanyk
- Department of Neurosurgery, Hartford HealthCare Medical Group, St. Vincent's Medical Center, Bridgeport, CT 06606, USA
| | - Christopher L Taylor
- Frank H. Netter MD School of Medicine, 370 Bassett Rd, North Haven, CT 06473, USA
| | - Rafael De la Garza Ramos
- Department of Neurosurgery, Montefiore Medical Center, Albert Einstein College of Medicine in New York City, USA
| | - Swetha Tadepalli
- University of Connecticut, College of Liberal Art and Sciences, Storrs, CT 06269, USA
| | - Samantha A Girasulo
- University of Connecticut, College of Liberal Art and Sciences, Storrs, CT 06269, USA
| | - Maria C S Rossi
- Department of Neurosurgery, Hartford HealthCare Medical Group, St. Vincent's Medical Center, Bridgeport, CT 06606, USA
| | - Brooke A O'Donnell
- Department of Neurosurgery, Hartford HealthCare Medical Group, St. Vincent's Medical Center, Bridgeport, CT 06606, USA
| | - Joel A Bauman
- Department of Neurosurgery, Hartford HealthCare Medical Group, Hartford, CT 06106, USA
| | - Rajat Sekhar
- Department of Neurosurgery, Hartford HealthCare Medical Group, St. Vincent's Medical Center, Bridgeport, CT 06606, USA; Frank H. Netter MD School of Medicine, 370 Bassett Rd, North Haven, CT 06473, USA
| | - Khalid M Abbed
- Department of Neurosurgery, Hartford HealthCare Medical Group, St. Vincent's Medical Center, Bridgeport, CT 06606, USA; Frank H. Netter MD School of Medicine, 370 Bassett Rd, North Haven, CT 06473, USA
| | - Nabil Matmati
- Department of Neurosurgery, Hartford HealthCare Medical Group, St. Vincent's Medical Center, Bridgeport, CT 06606, USA; Frank H. Netter MD School of Medicine, 370 Bassett Rd, North Haven, CT 06473, USA.
| | - Vijay Yanamadala
- Department of Neurosurgery, Hartford HealthCare Medical Group, St. Vincent's Medical Center, Bridgeport, CT 06606, USA; Frank H. Netter MD School of Medicine, 370 Bassett Rd, North Haven, CT 06473, USA
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Rafiq RB, Yount S, Jerousek S, Roth EJ, Cella D, Albert MV, Heinemann AW. Feasibility of PROMIS using computerized adaptive testing during inpatient rehabilitation. J Patient Rep Outcomes 2023; 7:44. [PMID: 37162607 PMCID: PMC10172423 DOI: 10.1186/s41687-023-00567-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/21/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND There has been an increased significance on patient-reported outcomes in clinical settings. We aimed to evaluate the feasibility of administering patient-reported outcome measures by computerized adaptive testing (CAT) using a tablet computer with rehabilitation inpatients, assess workload demands on staff, and estimate the extent to which rehabilitation inpatients have elevated T-scores on six Patient Reported Outcomes Measurement Information System® (PROMIS®) measures. METHODS Patients (N = 108) with stroke, spinal cord injury, traumatic brain injury, and other neurological disorders participated in this study. PROMIS computerized adaptive tests (CAT) were administered via a web-based platform. Summary scores were calculated for six measures: Pain Interference, Sleep Disruption, Anxiety, Depression, Illness Impact Positive, and Illness Impact Negative. We calculated the percent of patients with T-scores equivalent to 2 standard deviations or greater above the mean. RESULTS During the first phase, we collected data from 19 of 49 patients; of the remainder, 61% were not available or had cognitive or expressive language impairments. In the second phase of the study, 40 of 59 patients participated to complete the assessment. The mean PROMIS T-scores were in the low 50 s, indicating an average symptom level, but 19-31% of patients had elevated T-scores where the patients needed clinical action. CONCLUSIONS The study demonstrated that PROMIS assessment using a CAT administration during an inpatient rehabilitation setting is feasible with the presence of a research staff member to complete PROMIS assessment.
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Affiliation(s)
- Riyad Bin Rafiq
- Department of Computer Science and Engineering, University of North Texas, Denton, TX, 76201, USA.
| | - Susan Yount
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Evanston, USA
| | - Sara Jerousek
- Ann & Robert H. Lurie Children's Hospital, Chicago, USA
| | - Elliot J Roth
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Evanston, USA
| | - David Cella
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Evanston, USA
| | - Mark V Albert
- Department of Computer Science and Engineering, University of North Texas, Denton, TX, 76201, USA
- Department of Biomedical Engineering, University of North Texas, Denton, USA
| | - Allen W Heinemann
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Evanston, USA
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, USA
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Tulsky DS, Kisala PA. Overview of the Spinal Cord Injury-Functional Index (SCI-FI): Structure and Recent Advances. Arch Phys Med Rehabil 2021; 103:185-190. [PMID: 34756875 DOI: 10.1016/j.apmr.2021.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 11/02/2022]
Abstract
The Spinal Cord Injury - Functional Index is a system of patient reported outcomes (PRO) measures of functional activities developed specifically with and for individuals with spinal cord injury (SCI). The SCI-FI was designed to overcome limitations in measurement of the full range of activities and breadth of content of physical functioning commonly used in SCI research. Generic measurement tools of physical function (i.e., those focused on the general population) tend to overemphasize mobility and do not contain enough items at the lower end of the functional range (e.g., appropriate for individuals with tetraplegia). The SCI-FI consists of nine item response theory (IRT)-calibrated item banks that represent relevant and meaningful item content for individuals with SCI, span a wide range of functional abilities, and subdivide physical functioning into important subdomains, including basic mobility, self-care, and fine motor function. Since the original publication of the SCI-FI in 2012, there have been significant advances in and publications on the reliability and psychometric properties of the measures. The manuscripts presented in this special section clarify the SCI-FI structure and present new research on the SCI-FI measurement system.
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Affiliation(s)
- David S Tulsky
- Center for Health Assessment Research and Translation (CHART), University of Delaware, Newark, DE; Departments of Physical Therapy and Psychological and Brain Sciences, University of Delaware, Newark, DE.
| | - Pamela A Kisala
- Center for Health Assessment Research and Translation (CHART), University of Delaware, Newark, DE
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Ruan Y, Chen W, Zhuang C, Lin H. Health-Related Perceptions of Older Adults/Patients with Degenerative Lumbar Diseases (ODLs) are associated with their Quality of Life: a Mixed-Methods Study. Patient Prefer Adherence 2021; 15:2303-2311. [PMID: 34675494 PMCID: PMC8518139 DOI: 10.2147/ppa.s328532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 09/24/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE This study aimed to elucidate the quality of life of older adults/patients with degenerative lumbar diseases (ODLs) and analyse its association with some of their health-related perceptions. MATERIALS AND METHODS This mixed-methods study consisted of a questionnaire survey and an in-depth interview, which was designed within this study. ODLs were recruited from January 12, 2017 to June 27, 2018. The independent sample t-test and grounded theory coding method were employed for data analysis. RESULTS Of the 125 participants who returned valid questionnaires, 18 were included in the in-depth interviews. ODLs' quality of life was associated with the following health-related perceptions: "life barriers", "subjective health status", and "treatment outcomes" across the domains of physiology, psychology, social relations, and environment. CONCLUSION Our findings indicate that ODLs' quality of life is associated with their health-related perceptions. Thus, to improve older adults' quality of life, more attention should be paid to enhancing non-medical factors such as their health-related perceptions.
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Affiliation(s)
- Yuhui Ruan
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - Weisin Chen
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Chenyang Zhuang
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Hong Lin
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
- Institute of Medical Science Popularization, Fudan University, Shanghai, People’s Republic of China
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