Using Patient- and Family-Reported Outcome and Experience Measures Across Transitions of Care for Frail Older Adults Living at Home: A Meta-Narrative Synthesis

Abstract

Background and Objectives Our aim was to create a “storyline” that provides empirical explanation of stakeholders’ perspectives underlying the use of patient- and family-reported outcome and experience measures to inform continuity across transitions in care for frail older adults and their family caregivers living at home. Research Design and Methods We conducted a meta-narrative synthesis to explore stakeholder perspectives pertaining to use of patient-reported outcome and experience measures (PROMs and PREMs) across micro (patients, family caregivers, and healthcare providers), meso (organizational managers/executives/programs), and macro (decision-/policy-makers) levels in healthcare. Systematic searches identified 9,942 citations of which 40 were included based on full-text screening. Results PROMs and PREMS (54 PROMs; 4 PREMs; 1 with PROM and PREM elements; 6 unspecified PROMs) were rarely used to inform continuity across transitions of care and were typically used independently, rarely together (n = 3). Two overarching traditions motivated stakeholders’ use. The first significant motivation by diverse stakeholders to use PROMs and PREMs was the desire to restore/support independence and care at home, predominantly at a micro-level. The second motivation to using PROMs and PREMs was to evaluate health services, including cost-effectiveness of programs and hospital discharge (planning); this focus was rarely at a macro-level and more often split between micro- and meso-levels of healthcare. Discussion and Implications The motivations underlying stakeholders’ use of these tools were distinct, yet synergistic between the goals of person/family-centered care and healthcare system-level goals aimed at efficient use of health services. There is a missed opportunity here for PROMs and PREMs to be used together to inform continuity across transitions of care.

Knowledge translation resources to support the use of quality of life assessment tools for the care of older adults living at home and their family caregivers

“…Notable examples include a user's guide on patient-reported outcomes in clinical practice by the International Society of Quality of Life Research [28,46,47], and guidelines for the use of electronic patient-reported outcomes [32,48]. Additional guidance is provided by a range of theories and systematic reviews on QOL assessment [8,14,15,[49][50][51][52]. These resources provide invaluable, detailed, evidence-based information for healthcare providers and organizations motivated to use QOL assessments.…”

“…These tools include health-related QOL measures, patient-reported outcome measures (PROMs), or patient-reported experience measures (PREMs). Our review identified 65 PROMs or PREMs used with older adults living at home, and their family caregivers [8]. This project seeks to support the use of QOL assessment tools for older adults by developing introductory and readily available (www.…”

“…There is increasing interest in using QOL assessment tools to support a patient-, person-or people-centered approach to care [12,13]. These tools are used by different people across micro-(patients, caregivers, and healthcare providers), meso-(healthcare organization managers and leaders), and macro-levels (government) of healthcare [8,[14][15][16][17]. At the micro-level, QOL assessments in clinical practice can improve healthcare provider-patient communication, raise awareness of problems that would otherwise be unidentified, improve care plans, and improve multidisciplinary collaboration [18][19][20][21].…”

Toward improved homecare of frail older adults: A focus group study synthesizing patient and caregiver perspectives

“…Audio recordings were transcribed and annotated using the qualitative data analysis software Nvivo 31,32 . Thematic analysis was used to ascribe inductive “nodes” to relevant quotations and achieve a broad categorization of the interview topics 33 .…”

Patient-reported outcome and experience measures in geriatric emergency medicine

“…Patient-reported outcomes are increasingly recognised as valid approaches to measure the quality and impact of care by clinical practitioners and those involved in health service administration, planning and purchasing. When the data is considered at the 'macro' level on a wide scale [23], PROM and PREM metrics stimulate service improvement and redesign initiatives through measurement and comparison before, during, and after healthcare interventions [4,25]. PROMs and PREMs are used routinely in trial research and some clinical settings [17], for instance to measure treatment effectiveness in elective hip surgery and asthma.…”