What are the most effective ways to measure patient health outcomes of primary health care integration through PROM instruments? – Key messages
University of British Columbia
Patient Reported Outcome Measures (PROMs) are used to collect information from patients about their self-perceived health outcomes and quality of life that is not captured in other common outcome metrics (i.e., morbidity and mortality). This information is important for routine monitoring and ongoing evaluation of healthcare technologies and services.
The focus of this expedited knowledge synthesis project was on generic PROM instruments that measure a range of health outcomes relevant to a wide variety of clinical and population health contexts.
In collaboration with stakeholders (health researchers, clinicians and decision makers) we identified important instrument properties (psychometric and administrative) relevant to the integration of PROMs in primary care.
Our work considered 9 widely-cited generic PROM instruments and involved a review of existing reviews to aggregate information about the instruments' psychometric properties (e.g., ability to detect change, validity, reliability and generalizability).
The project adopted an integrated knowledge translation approach and concluded with an end-of-project workshop involving all of our project stakeholders. The full results of the project were presented and discussed with the purpose of identifying preferred instruments for implementation in BC. The workshop consensus was for further consideration of (a) the SF-36 and related instruments, (b) the Patient-Reported Outcomes Measurement Information System Global Health Scale (PROMIS-GHS) and (c) the EuroQol EQ-5D.
Regarding psychometric evidence reported in the reviews, the SF-36 (and its related instruments) was the strongest instrument in most of the properties considered. The PROMIS-GHS also performed well, but there is a smaller evidence base in part because its recent development. Evidence regarding cross-cultural validity was strongest for the EQ-5D.
All three instruments performed reasonably well in terms of patient burden (time for completion, word count and readability level) and coverage of important health outcome domains. The SF-36 instruments and EQ-5D are available in many languages.
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