Patient-reported outcome and experience measures in geriatric emergency medicine

Abstract

Older people with frailty and health crises have complex physical and social needs. Modern emergency care systems are fast-flowing, using protocols optimised for singleproblem presentations. Systems must incorporate individualised care in order to bestserve people with multiple problems.Healthcare quality is typically appraised with service metrics such as department length of stay and mortality. Worldwide, Patient-Reported Outcome Measures (PROMs) and Experience Measures (PREMs) are increasingly used in research, service development and performance evaluation, paving the ground for their use to support individual clinical decision-making. PROMs and PREMs are person-centred metrics which at individual level inform healthcare decisions and which at strategic level drive improvement through inter-provider effectiveness comparison. To date, there is no PROM or PREM specifically developed for older people with frailty and emergency care needs. Response to Reviewers:Thank you the reviewers for their comments on our article. In our revised manuscript, we have made the necessary corrections to our references.

A systematic review and recommendations for prom instruments for older people with frailty in emergency care

“…This is possible using Patient-Reported Outcome Measures (PROMs) and Patient-Reported Experience Measures (PREMs) [ 6 , 7 ]. By capturing data to monitor and compare individuals’ healthcare outcomes, PROMs can measure care effectiveness and contribute to its improvement [ 8 ]. The use of PROMs is advocated within the International Federation for Emergency Medicine’s recently updated framework on quality and safety [ 9 ].…”

“…To date, generic PROM instruments have been used to report person-centred emergency care outcomes, but these have been evaluated mainly among younger people, and do not account for either the specific goals of people living with frailty or for the inherent challenges in collecting PROMs in busy emergency care environments [ 12 ]. Although there are a number of available instruments that could be used for older people with frailty there is little evidence on their performance in the emergency setting [ 8 ].…”

Validation of a Simple Score for Mortality Prediction in a Cohort of Unselected Emergency Patients

“…ird, an evidence-based prognosis is the foundation for shared decision-making and individualized care [8,[28][29][30].…”

The Experience of Patients in Chronic Care Management: Applications in Health Technology Assessment (HTA) and Value for Public Health

“…Isolated patients worldwide are exposed to preventable mortality up to 50% more than patients who have someone close to rely on [ 35 ]: “an effect on mortality comparable to smoking 15 cigarettes a day, higher than obesity and chronic physical inactivity” [ 36 ]. On similar grounds, Van Oppen and coauthors [ 37 ] argue that PREMs should also be collected in emergency care facilities, once the patient condition has been stabilized and specific questionnaires have been identified and validated: indeed, chronic frail patients often abuse emergency care services as a consequence of isolation and disorientation. Healthcare fragmentation is a thorny health and sustainability problem, especially for those patients who struggle most to receive essential ordinary care, turning the inverse care law a problem of both universal and market-driven healthcare systems [ 38 , 39 ].…”