Social Determinants of Health Needs and Health-related Quality of Life Among Surgical Patients: A Retrospective Analysis of 8512 Patients.

OBJECTIVE: To assess associations between social determinants of health (SDOH) needs and health-related quality of life (HRQOL) among surgical patients. BACKGROUND: Despite the profound impact of SDOH on health outcomes, studies examining the effect of SDOH needs on HRQOL among surgical patients are limited. METHODS: A retrospective study was conducted using responses from the SDOH needs assessment and the Patient-Reported Outcomes Measurement Information Systems Global Health instrument of adults seen in surgical clinics at a single institution. Patient characteristics including socioeconomic status (insurance type, education level, and employment status) were extracted. Stepwise multivariable logistic regression analyses were performed to identify independent predictors of global health scores. RESULTS: A total of 8512 surgical patients (mean age: 55.6±15.8 years) were included. 25.2% of patients reported one or more SDOH needs. The likelihood of reporting at least one SDOH need varied by patient characteristics and socioeconomic status variables. In fully adjusted regression models, food insecurity [odds ratio (OR), 1.53; 95% CI, 1.38-1.70 and OR, 1.49; 95% CI, 1.22-1.81, respectively], housing instability (OR, 1.27; 95% CI, 1.12-1.43 and OR, 1.39; 95% CI, 1.13-1.70, respectively) lack of transportation (OR, 1.46; 95% CI, 1.27-1.68 and OR, 1.25; 95% CI, 1.00-1.57, respectively), and unmet medication needs (OR, 1.31; 95% CI, 1.13-1.52 and OR, 1.61; 95% CI, 1.28-2.03, respectively) were independent predictors of poor physical and mental health. CONCLUSIONS: SDOH needs are independent predictors of poor patient-reported physical and mental health among surgical patients. Assessing and addressing SDOH needs should be prioritized in health care settings and by policymakers to improve HRQOL.

Patterns of Social Needs Predict Quality-of-Life and Healthcare Utilization Outcomes in Patients from a Large Hospital System.

BACKGROUND: Unmet social needs (SNs) often coexist in distinct patterns within specific population subgroups, yet these patterns are understudied. OBJECTIVE: To identify patterns of social needs (PSNs) and characterize their associations with health-related quality-of-life (HRQoL) and healthcare utilization (HCU). DESIGN: Observational study using data on SNs screening, HRQoL (i.e., low mental and physical health), and 90-day HCU (i.e., emergency visits and hospital admission). Among patients with any SNs, latent class analysis was conducted to identify unique PSNs. For all patients and by race and age subgroups, compared with no SNs, we calculated the risks of poor HRQoL and time to first HCU following SNs screening for each PSN. PATIENTS: Adult patients undergoing SNs screening at the Mass General Brigham healthcare system in Massachusetts, United States, between March 2018 and January 2023. MAIN MEASURES: SNs included: education, employment, family care, food, housing, medication, transportation, and ability to pay for household utilities. HRQoL was assessed using the Patient-Reported Outcomes Measurement Information System Global-10. KEY RESULTS: Six unique PSNs were identified: "high number of social needs," "food and utility access," "employment needs," "interested in education," "housing instability," and "transportation barriers." In 14,230 patients with HRQoL data, PSNs increased the risks of poor mental health, with risk ratios ranging from 1.07(95%CI:1.01-1.13) to 1.80(95%CI:1.74-1.86). Analysis of poor physical health yielded similar findings, except that the "interested in education" showed a mild protective effect (0.97[95%CI:0.94-1.00]). In 105,110 patients, PSNs increased the risk of 90-day HCU, with hazard ratios ranging from 1.09(95%CI:0.99-1.21) to 1.70(95%CI:1.52-1.90). Findings were generally consistent in subgroup analyses by race and age. CONCLUSIONS: Certain SNs coexist in distinct patterns and result in poorer HRQoL and more HCU. Understanding PSNs allows policymakers, public health practitioners, and social workers to identify at-risk patients and implement integrated, system-wide, and community-based interventions.

Patient-reported outcome measures for primary hyperparathyroidism: a systematic review of measurement properties.

BACKGROUND: The quality of patient-reported outcome measures (PROMs) used to assess the outcomes of primary hyperparathyroidism (PHPT), a common endocrine disorder that can negatively affect patients' health-related quality of life due to chronic symptoms, has not been rigorously examined. This systematic review aimed to summarize and evaluate evidence on the measurement properties of PROMs used in adult patients with PHPT, and to provide recommendations for appropriate measure selection. METHODS: After PROSPERO registration (CRD42023438287), Medline, EMBASE, CINAHL Complete, Web of Science, PsycINFO, and Cochrane Trials were searched for full-text articles in English investigating PROM development, pilot studies, or evaluation of at least one PROM measurement property in adult patients with any clinical form of PHPT. Two reviewers independently identified studies for inclusion and conducted the review following the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) Methodology to assess risk of bias, evaluate the quality of measurement properties, and grade the certainty of evidence. RESULTS: From 4989 records, nine PROM development or validation studies were identified for three PROMs: the SF-36, PAS, and PHPQoL. Though the PAS demonstrated sufficient test-retest reliability and convergent validity, and the PHPQoL sufficient test-retest reliability, convergent validity, and responsiveness, the certainty of evidence was low-to-very low due to risk of bias. All three PROMs lacked sufficient evidence for content validity in patients with PHPT. CONCLUSIONS: Based upon the available evidence, the SF-36, PAS, and PHPQoL cannot currently be recommended for use in research or clinical care, raising important questions about the conclusions of studies using these PROMs. Further validation studies or the development of more relevant PROMs with strong measurement properties for this patient population are needed.

Toward an asthma patient-reported outcome measure for use in digital remote monitoring.

OBJECTIVE: To develop and test a patient-reported outcome measure (PROM) for suitability in digital remote asthma symptom monitoring to identify uncontrolled asthma. METHODS: We modified a 5-item PROM that does not require a license, the asthma control measure (ACM), from a one-month to one-week lookback period, and evaluated it using the 5-item asthma control questionnaire (ACQ-5). We recruited subjects with asthma through MTurk, an online platform. RESULTS: In a sample of 498 subjects, the ACM identified uncontrolled asthma with sensitivity 0.99 and specificity 0.65. The two measures correlated with r = 0.81. CONCLUSION: The ACM modified to a weekly lookback period can differentiate patients with well-controlled asthma from those with uncontrolled asthma. This PROM does not require a license and can be used in digital remote monitoring interventions.

A protocol for chronic pain outcome measurement enhancement by linking PROMIS-29 scale to legacy measures and improving chronic pain stratification.

BACKGROUND: Substantial investment has gone into research on the efficacy and effectiveness of pharmaceutical and nonpharmacologic interventions for chronic pain. However, synthesizing this extensive literature is challenging because of differences in the outcome measures used in studies of similar or competing interventions. The absence of a common metric makes it difficult to replicate findings, pool data from multiple studies, resolve conflicting conclusions, or reach consensus when interpreting findings. METHODS: This study has a seven-member Advisory Council of chronic pain experts. Preliminary analyses will be performed on data from several large existing datasets; intermediate analyses will be performed using primary data collected from Amazon's Mechanical Turk (MTurk); and cross-validation will use primary data collected from a nationally-representative, probability-based panel. Target sample size for both primary datasets is 1500. The three study aims are as follows: Aim 1 will develop and evaluate links between the 29-item Patient-Reported Outcomes Measurement Information System (PROMIS®-29) and legacy measures used for chronic pain such as the Roland-Morris Disability Questionnaire (RMDQ) and the Oswestry Disability Index (ODI). We will assess the best method of score linking and create crosswalk tables. Aim 2 will evaluate and refine the Impact Stratification Score (ISS) based on 9 PROMIS-29 items and proposed by the NIH Research Task Force on chronic low back pain. We will evaluate the ISS in terms of other indicators of condition severity and patient prognosis and outcomes and identify cut-points to stratify chronic pain patients into subgroups. Aim 3 will evaluate the strengths and limitations of MTurk as a data collection platform for estimating chronic pain by comparing its data to other data sources. DISCUSSION: The accomplishment of Aims 1 and 2 will allow direct comparison of results across past and future studies of chronic pain. These comparisons will help us to understand different results from seemingly similar studies, and to determine the relative effectiveness of all pharmaceutical and nonpharmacologic interventions for chronic pain across different trials. Aim 3 findings will provide valuable information to researchers about the pros and cons of using the MTurk platform for research-based data collection. TRIAL REGISTRATION: ClinicalTrials.gov: NCT04426812 ; June 10, 2020.

Feasibility of Distinguishing Performance Among Provider Groups Using Patient-reported Outcome Measures in Older Adults With Multiple Chronic Conditions.

OBJECTIVE: To examine minimum sample sizes and follow-up times required for patient-reported outcome-based performance measures (PMs) to achieve acceptable reliability as PMs. PARTICIPANTS: We used 2 groups of patients age 65+ with at least 2 of 13 chronic conditions. The first was a sample of Medicare Advantage beneficiaries, who reported health-related quality of life (HRQoL) at baseline and 2 years. The second was a sample of primary care patients, who reported HRQoL at baseline and 6 months. MEASURES: Medicare Advantage beneficiaries completed the Veterans RAND 12-Item Short Form (VR-12), while the primary care sample completed the Patient-Reported Outcomes Measurement Information System 29-Item Profile Measure (PROMIS-29). We constructed binary candidate PMs indicating stable or improved physical or mental HRQoL at follow-up, and continuous PMs measuring mean change over time. RESULTS: In the Medicare Advantage sample, with a sample size per entity profiled of 160, the most promising PM achieved a reliability of 0.32 as a PM. A sample size of 882 per entity would have been needed for this PM to achieve an acceptable reliability of 0.7. In the prospective sample, with a sample size of 27 per clinic, the most promising PM achieved a reliability of 0.16 as a PM. A sample size of 341 patients (at the clinic level) would have been needed for this PM to achieve a reliability of 0.7. CONCLUSIONS: Achieving acceptable reliability for these PMs and conditions would have required minimum sample sizes of 341 at the clinic level or 880 at the health plan level. These estimates can guide the design of future patient-reported outcome-based PMs.

Feasibility and pilot efficacy of a brief smoking cessation intervention delivered by vascular surgeons in the Vascular Physician Offer and Report (VAPOR) Trial.

BACKGROUND: This study determined the feasibility and potential efficacy of an evidence-based standardized smoking cessation intervention delivered by vascular surgeons to smokers with peripheral arterial disease. METHODS: We performed a cluster-randomized trial of current adult smokers referred to eight vascular surgery practices from September 1, 2014, to July 31, 2015. A three-component smoking cessation intervention (physician advice, nicotine replacement therapy, and telephone-based quitline referral) was compared with usual care. The primary outcome was smoking cessation for 7 days, assessed 3 months after the intervention. Secondary outcomes were patients' nicotine dependence and health expectancies of smoking assessed using Patient Reported Outcomes Measurement Information System (PROMIS; RAND Corporation, Santa Monica, Calif). RESULTS: We enrolled 156 patients (65 in four intervention practices, 91 in four control practices), and 141 (90.3%) completed follow-up. Patients in the intervention and control practices were similar in age (mean, 61 years), sex (68% male), cigarettes per day (mean, 14), and prior quit attempts (77%). All three components of the intervention were delivered to 75% of patients in intervention practices vs to 7% of patients at control practices (P < .001). At 3 months, 23 of 57 patients (40.3%) in the intervention group quit smoking (23 of 56 patients quit who completed follow-up, plus 1 death included in the analysis in the denominator as a smoker), and 26 of 84 patients (30.9%) In the control group quit smoking (26 patients of 84 who completed follow-up, including 2 deaths included in the denominator as smokers). This difference (40.3% quit rate in intervention, 31% quit rate in control; P = .250) was not statistically significant in crude analyses (P = .250) or analyses adjusted for clustering (P = .470). Multivariable analysis showed factors associated with smoking cessation were receipt of physician advice (odds ratio for cessation, 1.96; 95% confidence interval, 1.28-3.02; P < .002) and nicotine replacement therapy (odds ratio, 1.92; 95% confidence interval, 1.43-2.56; P < .001). CONCLUSIONS: Implementation of a brief, surgeon-delivered smoking cessation intervention is feasible for patients with peripheral arterial disease. A larger trial will be necessary to determine whether this is effective for smoking cessation.

Possibilities for Shortening the CAHPS Clinician and Group Survey.

BACKGROUND: The Consumer Assessment of Healthcare Providers and Systems (CAHPS) Clinician and Group adult survey (CG-CAHPS) includes 34 items used to monitor the quality of ambulatory care from the patient's perspective. CG-CAHPS includes items assessing access to care, provider communication, and courtesy and respect of office staff. Stakeholders have expressed concerns about the length of the CG-CAHPS survey. OBJECTIVES: This paper explores the impact on reliability and validity of the CAHPS domain scores of reducing the numbers of items used to assess the 3 core CG-CAHPS domains (Provider Communication, Access to Care, and Courteous and Helpful Office Staff). RESEARCH DESIGN: CG-CAHPS data reported here consist of 136,725 patients across 4 datasets including ambulatory clinics, patient-centered medical homes, and Accountable Care Organizations. Analyses are conducted in parallel across the 4 settings to allow evaluations across data source. ANALYSES: Multiple regression and ANOVA techniques were used to evaluate reliability for shorter sets of items. Site-level correlations with the overall rating of the provider were compared to evaluate the impact on validity. The change in practices' rank-ordering as a function of domain revision is also reported. RESULTS: Findings suggest that the Provider Communication (6 items) and Access (5 items) domains can be reduced to as few as 2 items each and Office Staff (2 items) can be reduced to a single item without a substantial loss in reliability or content. CONCLUSIONS: The performance of several of the reduced-length options for CG-CAHPS domains closely matches the full versions and may be useful in health care settings where the full-length survey is impractical due to time or cost constraints.

Measuring Workplace Climate in Community Clinics and Health Centers.

BACKGROUND: The effectiveness of community clinics and health centers' efforts to improve the quality of care might be modified by clinics' workplace climates. Several surveys to measure workplace climate exist, but their relationships to each other and to distinguishable dimensions of workplace climate are unknown. OBJECTIVE: To assess the psychometric properties of a survey instrument combining items from several existing surveys of workplace climate and to generate a shorter instrument for future use. MATERIALS AND METHODS: We fielded a 106-item survey, which included items from 9 existing instruments, to all clinicians and staff members (n=781) working in 30 California community clinics and health centers, receiving 628 responses (80% response rate). We performed exploratory factor analysis of survey responses, followed by confirmatory factor analysis of 200 reserved survey responses. We generated a new, shorter survey instrument of items with strong factor loadings. RESULTS: Six factors, including 44 survey items, emerged from the exploratory analysis. Two factors (Clinic Workload and Teamwork) were independent from the others. The remaining 4 factors (staff relationships, quality improvement orientation, managerial readiness for change, and staff readiness for change) were highly correlated, indicating that these represented dimensions of a higher-order factor we called "Clinic Functionality." This 2-level, 6-factor model fit the data well in the exploratory and confirmatory samples. For all but 1 factor, fewer than 20 survey responses were needed to achieve clinic-level reliability >0.7. CONCLUSIONS: Survey instruments designed to measure workplace climate have substantial overlap. The relatively parsimonious item set we identified might help target and tailor clinics' quality improvement efforts.

Calibration of the Spanish PROMIS Smoking Item Banks.

INTRODUCTION: The Patient-Reported Outcomes Measurement Information System (PROMIS) Smoking Initiative has developed item banks for assessing six smoking behaviors and biopsychosocial correlates of smoking among adult cigarette smokers. The goal of this study is to evaluate the performance of the Spanish version of the PROMIS smoking item banks as compared to the original banks developed in English. METHODS: The six PROMIS banks for daily smokers were translated into Spanish and administered to a sample of Spanish-speaking adult daily smokers in the United States (N = 302). We first evaluated the unidimensionality of each bank using confirmatory factor analysis. We then conducted a two-group item response theory calibration, including an item response theory-based Differential Item Functioning (DIF) analysis by language of administration (Spanish vs. English). Finally, we generated full bank and short form scores for the translated banks and evaluated their psychometric performance. RESULTS: Unidimensionality of the Spanish smoking item banks was supported by confirmatory factor analysis results. Out of a total of 109 items that were evaluated for language DIF, seven items in three of the six banks were identified as having levels of DIF that exceeded an established criterion. The psychometric performance of the Spanish daily smoker banks is largely comparable to that of the English versions. CONCLUSIONS: The Spanish PROMIS smoking item banks are highly similar, but not entirely equivalent, to the original English versions. The parameters from these two-group calibrations can be used to generate comparable bank scores across the two language versions. IMPLICATIONS: In this study, we developed a Spanish version of the PROMIS smoking toolkit, which was originally designed and developed for English speakers. With the growing Spanish-speaking population, it is important to make the toolkit more accessible by translating the items and calibrating the Spanish version to be comparable with English-language scores. This study provided the translated item banks and short forms, comparable unbiased scores for Spanish speakers and evaluations of the psychometric properties of the new Spanish toolkit.

Selecting patient-reported outcome measures: "what" and "for whom".

Patient-reported outcomes (PROMs) are becoming more widely implemented across health care for important reasons. However, with thousands of PROMs available and the science of psychometrics becoming more widely applied in health measurement, choosing the right ones to implement can be puzzling. This article provides a framework of the different types of PROMs by organizing them into 4 categories based upon "what" is being measured and "from whom" the questions are asked: (1) condition-specific and domain-specific, (2) condition-specific and global, (3) universal and global, and (4) universal and domain-specific. We delve deeper into each category with clinical examples. This framework can empower health care leaders and policymakers to make more informed decisions when selecting the best PROMs to implement, ensuring PROMs deliver on their potential to promote high quality, patient-centered care.

Health system implementation of the PROMIS Cognitive Function Screener in the Medicare Annual Wellness Visit: framing as abilities versus concerns.

BACKGROUND: Cognitive assessment is a required component of the Medicare Annual Wellness Visit (AWV). In this prospective study, we evaluated acceptability and usefulness of a patient-reported outcome measure (the PROMIS® Cognitive Function Screener, or PRO-CS) to screen for cognitive impairment during the AWV. We compared two versions of the PRO-CS: Abilities and Concerns. METHODS: We developed PRO-CS Abilities and PRO-CS Concerns using items from the PROMIS Cognitive Function item banks. We partnered with a large health system in Pennsylvania to implement an electronic health record (EHR)-integrated version of the 4-item PRO-CS into their AWV workflow. PRO-CS Abilities was implemented in June 2022 and then replaced with PRO-CS Concerns in October 2022. We used EHR data to evaluate scores on Abilities versus Concerns and their association with patient characteristics. We gathered feedback from providers on experiences with the PRO-CS and conducted cognitive interviews with patients to evaluate their preferences for Abilities versus Concerns. RESULTS: Between June 2022 and January 2023, 3,088 patients completed PRO-CS Abilities and 2,614 patients completed PRO-CS Concerns. Mean T-scores for Abilities (54.8) were slightly higher (indicating better cognition) than for Concerns (52.6). 10% of scores on Abilities and 13% of scores on Concerns indicated concern for cognitive impairment (T-score < 45). Both Abilities and Concerns were associated with clinical characteristics as hypothesized, with lower scores for patients with cognitive impairment diagnoses and those requiring assistance with instrumental activities of daily living. Abilities and Concerns had similar negative correlations with depression (r= -0.31 versus r= -0.33) and anxiety (r= -0.28 for both), while Abilities had a slightly stronger positive correlation with self-rated health (r = 0.34 versus r = 0.28). In interviews, providers commented that the PRO-CS could be useful to facilitate conversations about cognition, though several providers noted potential limitations of patient self-report. Feedback from patients indicated a preference for PRO-CS Concerns. CONCLUSIONS: Our findings suggest potential utility of the PRO-CS for cognitive screening in the Medicare AWV. PRO-CS Abilities and Concerns had similar associations with patient clinical characteristics, but the Concerns version was more acceptable to patients.

Use of patient-reported outcome measures after breast reconstruction in low- and middle-income countries: a scoping review.

BACKGROUND: Patient-reported outcome measures (PROMs) are increasingly administered in high-income countries to monitor health-related quality of life of breast cancer patients undergoing breast reconstruction. Although low- and middle-income countries (LMICs) face a disproportionate burden of breast cancer, little is known about the use of PROMs in LMICs. This scoping review aims to examine the use of PROMs after post-mastectomy breast reconstruction among patients with breast cancer in LMICs. METHODS: MEDLINE, Embase, Web of Science, CINAHL, and PsycINFO were searched in August 2022 for English-language studies using PROMs after breast reconstruction among patients with breast cancer in LMICs. Study screening and data extraction were completed. Data were analyzed descriptively. RESULTS: The search produced 1024 unique studies, 33 of which met inclusion criteria. Most were observational (48.5%) or retrospective (33.3%) studies. Studies were conducted in only 10 LMICs, with 60.5% in China and Brazil and none in low-income countries. Most were conducted in urban settings (84.8%) and outpatient clinics (57.6%), with 63.6% incorporating breast-specific PROMs and 33.3% including breast reconstruction-specific PROMs. Less than half (45.5%) used PROMs explicitly validated for their populations of interest. Only 21.2% reported PROM response rates, ranging from 43.1 to 96.9%. Barriers and facilitators of PROM use were infrequently noted. CONCLUSIONS: Despite the importance of PROM collection and use in providing patient-centered care, it continues to be limited in middle-income countries and is not evident in low-income countries after breast reconstruction. Further research is necessary to determine effective methods to address the challenges of PROM use in LMICs.

Definitions of Chronic Low Back Pain From a Scoping Review, and Analyses of Narratives and Self-Reported Health of Adults With Low Back Pain.

Among those with low back pain (LBP), individuals with chronic LBP (CLBP) face different treatment recommendations and incur the majority of suffering and costs. However, the way CLBP has been defined varies greatly. This study used a scoping review and qualitative and quantitative analyses of data from LBP patients to explore this variation. CLBP in most recent randomized controlled trials (RCTs) was defined by duration of pain, most commonly ≥3 months. However, individuals with LBP most often define CLBP by frequency. CLBP has also been defined using a combination of duration and frequency (16% of RCTs and 20% of individuals), including 6% of recent RCTs that followed the NIH Pain Consortium research task force (RTF) definition. Although not a defining characteristic of CLBP for individuals, almost 15% of recent RCTs required CLBP to have a healthcare provider diagnosis. In our LBP sample moving from ≥3 months to the RTF definition reduced the CLBP group size by 25% and resulted in a group that used more pain management options and reported worse health across all outcome measures. A pain duration definition offers ease of application. However, refinements to this definition (eg, RTF) can identify those who may be better intervention targets. PERSPECTIVE: This article presents the definitions used for CLBP by researchers and individuals, and the impact of these definitions on pain management and health outcomes. This information may help researchers choose better study inclusion criteria and clinicians to better understand their patients' beliefs about CLBP.

Longitudinal Associations of PROMIS-29 Anxiety and Depression Symptoms With Low Back Pain Impact in a Sample of U.S. Military Service Members.

INTRODUCTION: The Impact Stratification Score (ISS) is a measure of the impact of chronic low back pain (LBP) consisting of nine Patient-Reported Outcomes Measurement Information System (PROMIS-29) items, but no studies have examined the ISS or its association with psychological symptoms in military samples. This study examines longitudinal associations between psychological symptoms and the ISS among military service members. MATERIAL AND METHODS: The study involved secondary data analysis of a sample of active duty U.S. military service members aged 18-50 years with LBP (n = 733). Participants completed the PROMIS-29 at three time points during treatment: baseline (time 1, T1), week 6 of treatment (time 2, T2), and week 12 of treatment (time 3, T3). The impact of LBP was quantified using the ISS (ranging from 8 = least impact to 50 = greatest impact). Psychological symptoms were assessed as PROMIS-29 anxiety and depression scores. Separate autoregressive cross-lagged models examined reciprocal associations of ISSs with anxiety, depression, and emotional distress scores from T1 to T3. RESULTS: Within each time point, the ISS was significantly and positively correlated with anxiety and depression. In autoregressive cross-lagged models, anxiety and depression predicted the ISS at the next time point and associations were similar in magnitude (e.g., anxiety T2 to ISS T3: ß = 0.12, P < .001; depression T2 to ISS T3: ß = 0.12, P <.001). The ISS did not predict future depression or emotional distress scores at any time point, but the ISS at T2 was significantly, positively associated with anxiety scores at T3 (ß = 0.07, P = .04). CONCLUSION: Psychological symptoms consistently and prospectively predict the impact of LBP as measured by the ISS among service members undergoing pain treatment. The ISS may also be associated with future anxiety but not depression. PROMIS-29 anxiety and depression items may be useful adjunctive measures to consider when using the ISS to support LBP treatment planning and monitoring with service members.

A novel Scale to Assess Palliative Care Patients' Experience of Feeling Heard and Understood.

CONTEXT: Patient experience of palliative care serves as an important indicator of quality and patient-centeredness. OBJECTIVES: To develop a novel patient-reported scale measuring ambulatory palliative care patients' experience of feeling heard and understood by their providers. METHODS: We used self-reported patient experience data collected via mixed-mode survey administration. We conducted an exploratory factor analysis (EFA) and an expert panel ranking exercise to reduce the 10-item set based on underlying dimensionality. We then used item response theory (IRT) to calibrate remaining items based on psychometric properties and test information and precision. We considered item-level fit and examined the standardized local dependence chi-square statistics. We evaluated candidate items for differential item functioning by survey mode. We evaluated the test-retest reliability and validity of the final scale. RESULTS: The EFA yielded a single factor (9/10 items had loadings > 0.80 on the single factor). We removed two items with the lowest factor loadings and ranked by the expert panel as being least reflective of the overall construct. IRT calibration of the remaining eight items showed high slopes (range 2.66 - 5.18); location parameters were all negative (range -0.90 - -0.36). We removed two more items based on local dependence indices and item-level fit. Combining psychometric information with the expert ratings we established the final 4-item scale, which was reliable (Cronbach's alpha = 0.84; polychoric correlation coefficient = 0.72) and had good convergent validity. CONCLUSIONS: This novel multi-item Feeling Heard and Understood scale can be used to measure and improve ambulatory palliative care patient experience.

A Scoping Review of Chronic Low Back Pain Classification Schemes Based on Patient-Reported Outcomes.

BACKGROUND: In 2014, the National Institutes of Health Pain Consortium Research Task Force recommended that patients with chronic low back pain (CLBP) be stratified by its impact on their lives. They proposed the Impact Stratification Score (ISS) to help guide therapy and facilitate study comparability. The ISS has been evaluated as a continuous measure, but not for use as a stratification or classification scheme. OBJECTIVES: Identify the characteristics of successful schemes to inform the use of the ISS for stratification or classification. STUDY DESIGN: Scoping review of the peer-reviewed literature. METHODS: Search of PubMed, CINAHL, and APA PsycInfo to identify patient self-report-based classification schemes applicable to CLBP. Data were captured on the methods used for each scheme's development, the domains covered, their scoring criteria and what the classification has successfully measured. The study was reviewed and approved by the RAND Human Subjects Protection Committee (2019-0651-AM02). RESULTS: The search identified 87 published articles about the development and testing of 5 classification schemes: 1) The Subgroups for Targeted Treatment (STarT) Back Screening Tool, 2) Multiaxial Assessment of Pain, 3) Graded Chronic Pain Scale, 4) Back Pain Classification Scale, and 5) Chronic Pain Risk Score. All have been shown to be predictive of future outcomes and the STarT Back has been found useful in identifying effective classification-specific treatment. Each scheme had a different classification scoring structure, was developed using different methods, and 3 included domains not found in the ISS. LIMITATIONS: Expanding the search to other databases may have identified more classification schemes. Our minimum number of publications inclusion criterion eliminated dozens of cluster analyses, some of which may have eventually been replicated. CONCLUSIONS: The methods used to develop these successful classification schemes, especially those that use straightforward scoring schemes, should be considered for use in the development of a scheme based on the ISS.

Evaluation of PROMIS Cognitive Function Scores and Correlates in a Clinical Sample of Older Adults.

In this study we assessed the utility of self-reported cognitive function using two PROMIS® Cognitive Function (PROMIS-CF) items in an observational clinical sample of patients aged 65 and older (n = 16,249) at a large health system. We evaluated the association of PROMIS-CF scores with clinical characteristics and Montreal Cognitive Assessment (MoCA) scores, and we used logistic regression to examine predictors of 1-year decline in PROMIS-CF scores among patients with available data. PROMIS-CF scores were associated with clinical characteristics as hypothesized, with lower (more impaired) scores for patients with cognitive impairment (CI) diagnoses, multiple comorbidities, and those taking cognitive enhancing or interfering medications. PROMIS-CF scores were also positively associated with MoCA scores. Predictors of 1-year decline in PROMIS-CF scores included CI diagnoses, use of cognitive enhancing medications, higher depression scores, and lower social role function. Our findings suggest potential utility of PROMIS-CF items in a brief patient-administered screening tool for CI.

Implementing patient-reported outcomes in routine clinical care for diverse and underrepresented patients in the United States.

BACKGROUND: Patient-reported outcomes (PROs) are used increasingly in routine clinical care and inform policies, reimbursements, and quality improvement. Less is known regarding PRO implementation in routine clinical care for diverse and underrepresented patient populations. OBJECTIVE: This review aims to identify studies of PRO implementation in diverse and underrepresented patient populations, elucidate representation of clinical specialties, assess implementation outcomes, and synthesize patient needs, concerns, and preferences. METHODS: MEDLINE, Embase, Web of Science, CINAHL, and PsycINFO were searched September 2021 for studies aiming to study PRO implementation in diverse and underrepresented patient populations within the United States. Studies were screened and data extracted by three independent reviewers. Implementation outcomes were assessed according to Proctor et al. taxonomy. A descriptive analysis of data was conducted. RESULTS: The search yielded 8,687 records, and 28 studies met inclusion criteria. The majority were observational cohort studies (n = 21, 75%) and conducted in primary care (n = 10, 36%). Most studies included majority female (n = 19, 68%) and non-White populations (n = 15, 54%), while fewer reported socioeconomic (n = 11, 39%) or insurance status (n = 9, 32.1%). Most studies assessed implementation outcomes of feasibility (n = 27, 96%) and acceptability (n = 19, 68%); costs (n = 3, 11%), penetration (n = 1, 4%), and sustainability (n = 1, 4%) were infrequently assessed. CONCLUSION: PRO implementation in routine clinical care for diverse and underrepresented patient populations is generally feasible and acceptable. Research is lacking in key clinical specialties. Further work is needed to understand how health disparities drive PRO implementation outcomes.

Patient-reported outcomes (PROs) allow doctors and researchers to understand the patient perspective, such as how they are doing physically, mentally, or socially. When used, PROs can improve health and increase satisfaction of patients. Many clinics and hospitals are interested in using PROs in everyday care. Doctors, hospitals, and insurance companies are also using information from PROs to decide if the care they give is good quality. Unfortunately, certain groups of patients, such as racial and ethnic minorities and patients with low income, report worse PROs. Because of these differences, it will be important to make sure that PROs are being collected from all people, but not much is known regarding how this has been done. This study demonstrates what is known so far with regard to using PROs in everyday clinical care for these diverse patient groups. Findings from this study show that PROs can be successfully collected, but more work is needed in certain medical fields, and some types of patients have specific needs, concerns, or preferences with regard to PRO collection.