When do patient-reported outcome measures inform readmission risk?

Area of Science:

• Health Services Research
• Patient-Reported Outcomes
• Health Informatics

Background:

• Healthcare systems increasingly focus on reducing hospital readmissions and emergency department (ED) utilization.
• Patient-reported outcome measures (PROMs) offer valuable insights into patient health status and experiences.
• Understanding the optimal timing for PROM administration is crucial for effective risk stratification.

Purpose of the Study:

• To characterize changes in patient-reported outcome measures (PROMs) from hospital discharge.
• To assess when PROMs best inform the risk of utilization (readmissions or ED visits).

Main Methods:

• A longitudinal cohort study of patients discharged from an urban safety-net hospital.
• Serial administration of Memorial Symptom Assessment Scale (MSAS) and PROMIS Global Health (PROMIS-GH) measures (General Self-Rated Health [GSRH], Global Physical Health [GPH], Global Mental Health [GMH]) at 0, 30, 90, and 180 days post-discharge.
• Time-to-event analysis using Cox proportional hazard models, controlling for covariates, and assessing model fit with likelihood ratio tests.

Main Results:

• 196 patients were recruited, with high survey completion rates (88-100%).
• In-hospital assessments of GMH and GSRH predicted 14-day reutilization.
• Post-hospitalization assessments of MSAS and GPH predicted subsequent utilizations, with each measure improving predictive model fit.

Conclusions:

• Routine measurement of PROMs can identify patients at higher risk for utilization.
• MSAS, GPH, GMH, and GSRH, administered at different time points, all provide valuable information regarding utilization risk.