Can Patient Reported Outcomes (PROs) from Population Surveys Provide Accurate Estimates of Pre-Admission Health Status of Emergency Hospital Admissions?

Abstract

Introduction

The use of PROs for assessing the outcomes of emergency hospital admissions requires a means of estimating patients’ pre-admission health status. A possible alternative to asking patients to recall how their health was before the incident causing admission is to use estimates derived from matched samples from population surveys. Our aims were to explore the impact of different methods of matching and to compare the results with estimates based on retrospective reporting.

Methods

First, elective hip arthroplasty patients were matched to respondents to the General Practice Patient Survey using age, sex, socio-economic status and number of comorbidities. The impact of restricting matching for locality and specific co-morbidities was explored. Second, the best matching method was applied to emergency admissions for laparotomy and for percutaneous coronary intervention (PCI) after acute myocardial infarction. Data were stratified by patient characteristics. Differences in mean EQ-5D scores between the patients and matched population respondents were tested using t tests.

Results

Modifying the most basic form of matching by also taking locality and the specific comorbid conditions into account made no significant difference to the mean EQ-5D score for hip arthroplasty patients. Even using the most detailed matching possible, patients’ mean EQ-5D score was significantly different to that of the general population for all three cohorts. The difference was greatest for elective hip arthroplasty (0.22 v 0.64), less so for emergency laparotomy (0.56 v 0.72) and least for PCI (0.79 v 0.71). This reflects hip arthroplasty patients having a long-standing condition characterised by pain and limited mobility, whereas the other two cohorts may have enjoyed reasonable health until an unexpected acute episode led to their emergency admission.

Conclusion

Routine PRO data acquired from population surveys cannot be used as an accurate alternative to retrospectively reported PROMs by patients during their emergency admission episode.

Keywords:

• patient-reported outcome measures
• health status
• health-related quality of life
• self- report
• retrospective
• hospital admission
• general population patient survey

Ethical Approval and Informed Consent

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee (NHS Health Research Authority) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. NHS ethical approval obtained from Health Research Authority North East - Newcastle & North Tyneside 2 Research Ethics Committee (REC Ref: 16/NE/0081) and South East Coast - Brighton & Sussex Research Ethics Committee (REC reference: 16/LO/2053). Written Informed consent was obtained from all individual participants included in the study. Only anonymised large GPPS population means data were used.

Acknowledgments

We thank the patients and staff of the 20 hospitals that participated in the three patient cohort studies, the Site and Study leads.

Site and study leads collaborators: Mike Grocott, David Murray, David Saunders, Jose Lourtie, Steffen Petersen, Fares Haddad, Mahbub Alam, Rej Bumbra, Joyti Saksena, Jamila Kassam, Ursula Knight, Mark Vertue, Joanne Riches, Julie Saunders, Mervyn Andiapen, Jonathan Breeze, Amy Hoare, Alison Pottle, Paula Rogers, Claire Prendergast, Michael Lewis, Gill Pout, Patricia Dickens, James Kirkby-bott, Pauline Bartlett, Guy Titley, Emma Willett, Nina Barratt, Tanuja Shah, Kathleen Holding, Lianne Hufton, Veeranna Shatkar, Ruwan Weerakkody, Caron Baldwin, Sarah Hare, Annette Woods, Ewen Griffiths, Arlo Whitehouse, Jugdeep Dhesi, Jane Okello, Philip Braude, Karen Wilson, Kirsty Gibson, Abdul Quddus, Davina Ross-Anderson, Katherine MacGloin, Hasan Mukhtar, Kathryn Simpson, Kayleigh Gilbert, Mark Vertue, Joanne Riches, Julie Saunders, Mervyn Andiapen, Jonathan Breeze, Amy Hoare, Alison Pottle, Paula Rogers, Claire Prendergast, Michael Lewis, Gill Pout, Patricia Dickens, James Kirkby-bott, Pauline Bartlett, Guy Titley, Emma Willett, Nina Barratt, Tanuja Shah, Kathleen Holding, Lianne Hufton.

Author Contributions

All authors contributed to data analysis, drafting or revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Funding

EK is funded by Economic & Social Research Council doctoral fellowship. Grant Reference: ES/J500021/1.

The research was supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care North Thames at Barts Health NHS Trust. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

Disclosure

The authors declare no conflicts of interest in this work.