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Strengthening the patient perspective in quality development: a mixed-methods observational study on suitability of
Marie Utsch1, Gavin Brupbacher2,3, Gaia Garuffi4
1Institut für Medizinische Soziologie und Rehabilitationswissenschaft, Charité - Universitätsmedizin Berlin, Berlin, Germany. marie.utsch@charite.de.
Objective:
Healthcare systems increasingly use patient-reported outcome measures (PROMs) to complement traditional clinical and performance-based outcomes by capturing health outcomes from the patient perspective and supporting quality improvement and patient-centred care. In Switzerland, the National competence centre for quality measurements in hospitals and clinics ANQ performs the external quality development program. We conducted a nationwide pilot study in inpatient rehabilitation using the generic PROMIS GH-10 to assess its suitability as an outcome for quality development by evaluating its responsiveness and feasibility of implementation in everyday clinical practice.
Methods:
Our study applied a mixed-method observational design. In a multi-stage expert-based selection process, the PROMIS GH-10 was selected for piloting. In total, 28 rehabilitation clinics recruited patients during the study period and asked them to fill in the PROMIS GH-10 digitally or paper-based at admission and discharge. After the survey, healthcare professionals (HCPs) were asked to document the level of assistance required by patients. Mean T-scores and effect sizes (Cohen's d) were calculated. Assistance requirements were analysed using descriptive statistics. Additionally, qualitative interviews were completed with HCPs to assess facilitating factors and barriers to implementation.
Results:
A sample of 2,083 patients was included, resulting in 1,217 complete pre-post measurements. Mean T-scores (SD) for PROMIS GH-10 subscales physical health (PHS) and mental health (MHS) significantly improved (p < 0.001) from admission to discharge (total sample PHS: 39.3(7.4); 44.4(7.6); d = 0.68; MHS: 44.9(8.0); 48.7(7.5); d = 0.48). Effect sizes on PHS ranged from d = 0.50-0.95 and on MHS from d = 0.33-1.19. Overall, 41% of patients required assistance in answering the PROM. Barriers to implementation from HCP perspective included uncertainties about the benefit of a generic PROM and the lack of staff resources. Facilitators were the questionnaire's brevity and the value of including the patient perspective.
Conclusions:
PROMIS GH-10 showed significant pre-post effects on physical and mental health in Swiss inpatient rehabilitation. Nonetheless, barriers such as increased time needed for assistance in special patient groups should be considered before national implementation.
