Added value of patient-reported outcome measures (PROMs) after an acute stroke and early predictors of 90 days PROMs

Abstract

Introduction Value-based health care represents a patient-centered approach by valuing Patient-Reported Outcome Measures (PROMs). Our aim was to describe the additional value of PROMs after an acute stroke over conventional outcome measures and to identify early predictors of poor PROMs. Methods Acute stroke patients discharged from a tertiary care hospital followed by a web/phone-based PROMs collection program in the post hospitalization phase. Main PROMs involve anxiety and depression (HADS) (each defined by HADS ≥ 10) and global physical (PHY-) and mental (M-) health (PROMIS-10). PROMIS cut-off raw values of normality were: PHY-PROMIS ≥ 13 and M-PROMIS ≥ 11. An overall health status (OHS) from 0 to 100 was also determined. PROMs related to the different modified Rankin Scale (mRS) grades were defined. Early predictors of PROMs were evaluated. Results We included 1321 stroke patients, mean age 75 (± 8.6) and 55.7% male; 77.7% returned home. Despite a favorable mRS at 3 months (< 3), a relevant rate of patients considered without symptoms or with mild disability showed unfavorable results in the measured PROMs (8% unfavorable OHS, 15% HAD-depression, 12.1% HAD-anxiety, 28.7% unfavorable M-PROMIS and 33.1% unfavorable PHY-PROMIS results). Along follow-up, only PHY-PROMIS and OHS showed significant improvement (p < 0.01 and 0.03, respectively). The multivariate analysis including discharge variables showed that female sex, higher discharge mRS and discharge to socio-rehabilitation-center (SRC) were independent predictors of unfavorable results in PROMs (p < 0.01). When adding 7 days PROMs results, they emerged as the strongest predictors of 3 months PROMs. Conclusions A high proportion of stroke patients show unfavorable results in PROMs at 3 months, even those with favorable mRS, and most results obtained by PROMs during follow-up continued to indicate alterations. Female sex, mRS and discharge to SRC predicted unfavorable results in PROMs, but the strongest predictors of 3 months PROMs were the results of the 7 days PROMs.

Sensitivity to Change and Responsiveness of the Upper Extremity Fugl-Meyer Assessment in Individuals With Moderate to Severe Acute Stroke

“…This discrepancy could be attributed to the known differences in the perception of meaningful recovery by patients and their providers. Additionally, the mRS scale's focus on disability may not entirely reflect the full range of factors that are valuable from the patient perspective, 52 especially as it relates to arm impairment. 53 MCID estimates derived from the GROC Overall Recovery corresponds to a 12-point change on the FMA-UE.…”

Leveraging patient experience data to guide medicines development, regulation, access decisions and clinical care in the EU

“…However, stakeholders are broadening their interest in better understanding the patient perspective in the real-world (routine clinical care) setting where PRO data collection has been of added value ( 17 , 64 ). Considering a clinical care example, a study on patients who suffered acute stroke discharged from a tertiary care hospital demonstrated that the results of a clinician-reported outcome did not align with the patients’ perception obtained through PRO 3 months after the event ( 65 ).…”

Exploring patients’ experience using PROMs within routine post-discharge follow-up assessment after stroke: a mixed methods approach

“…The use of PROMs can also help to make routine healthcare more efficient and facilitate patient-centered care [61][62][63][64][65]. When patients with mild stroke symptoms are discharged, 30% of them still experience functional disability [11,66,67]. Healthcare providers can then use the PROMs (in combination with other measurements) to screen for these disabilities and use the results to decide whether a follow-up consultation at the outpatient clinic is necessary [68].…”

“…Being aware of the problems experienced by the patient is essential for the healthcare provider to ensure the best-suited care is provided. To help healthcare providers recognise these various problems, Patient Reported Outcome Measurements (PROMs) are being used increasingly during consultations in stroke clinical practice [9][10][11]. In addition, PROMs can also help involve the patient in the conversation with the healthcare provider and facilitate a discussion of the most relevant problems during the visit [12][13][14].…”