Does the Mode of PROM Administration Affect the Responses of Hospitalized Patients?

Patient-Reported Outcome Measures: An Exploration of Their Utility in Functional Assessment and Rehabilitation

Patient reported outcome measures (PROMs) have had a place in medicine for many years. However, their importance has grown rapidly in recent years due to a number of factors-not the least of which is an increased recognition of importance of the patient’ assessment of their care and outcomes. Despite their growing use, few of us have a good understanding of when they should be favored over alternative measures, how they are developed, the benefits of computerized administration, or how to leverage their incorporation into the electronic health record (EHR) and clinical decision making. This supplement is not intended to cover all aspects of the use of PROMs in clinical and rehabilitation care. Rather it’s goal is to provide an overview of their use and development, as well as the clinical relevance of their increasingly electronic, computerized, and EHR-based administration. It’s papers also highlight how advances in computing capabilities have permitted the use of newer modeling capabilities, such as multidimensional item response theory, to radically expand the capabilities of computerized PROMs.

The supplement emphasizes functional PROMs, however the described methods are easily applicable to other domains. More specially, its papers range from an introduction in the form of a historical overview of PROMs in rehabilitation medicine to the details of novel computerized approaches to improve their efficiency and capacity for individualized, clinically actionable assessments. In summary, we do hope that, whether you are a clinician, administrator, or psychometrician that you will find something of interest in this intriguing and increasingly important, aspect of medicine and rehabilitation.

Ability of the Functional Assessment in Acute Care Multidimensional Computerized Adaptive Test (FAMCAT) to Predict Discharge to Institutional Post-Acute Care

OBJECTIVE

To characterize the ability of the patient-reported Functional Assessment in Acute Care Multidimensional Computerized Adaptive Test (FAMCAT) domains to predict discharge disposition when administered during acute care stays.

DESIGN

Cohort Study. Logistic regression models were estimated to identify the ability of FAMCAT domains to predict discharge to an institution for post-acute care (PAC).

SETTING

Academic Medical Center PARTICIPANTS: Patients admitted to General Medicine Services from June 2016 to June 2019, n = 4,240 INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURE(S)

discharge to an institution RESULTS: In this sample, 10.5% of patients were discharged to an institution for rehabilitation versus home. FAMCAT domain scores were highly predictive of discharge to institutional PAC. Daily Activity and Basic Mobility domains had excellent discriminative ability for discharge to an institution (c-statistic 0.83 and 0.87, respectively). In best fit models accounting for additional characteristics, discrimination was outstanding for Daily Activity (c-statistic 0.91, 95% CI: 0.89, 0.94) and Basic Mobility (c-statistic 0.92, 95% CI: 0.89, 0.94).

CONCLUSION(S)

The FAMCAT Daily Activity and Mobility domains demonstrated excellent discrimination for identifying patients who discharged to an institutional setting for rehabilitation, and outstanding discrimination when adjusted for salient patient factors associated with discharge disposition. Estimates obtained in this investigation are comparable to the best discrimination achieved with clinician-rated measures to identify patients who would require institutional PAC.