When do patient-reported outcome measures inform readmission risk?
OBJECTIVE
To characterize changes in patient-reported outcome measures from hospital discharge to assess when they best inform risk of utilization as defined by readmissions or emergency department use.


METHODS
Patients discharged from an urban safety-net hospital.


METHODS
Longitudinal cohort study.


METHODS
We serially administered the Memorial Symptom Assessment Scale (MSAS) and the PROMIS Global Health short form assessing General Self-Rated Health (GSRH), Global Physical (GPH), and Mental (GMH) Health at 0, 30, 90, and 180 days from hospital discharge. Time to first utilization from each survey was plotted by dichotomizing our sample on each patient-reported measure, and equivalence of the time-to-event curves was assessed using the log-rank test. Cox proportional hazard models were used to control for available covariates including prior utilization during the study, Charlson score, age, gender, and race/ethnicity. We assessed each measure's effect on the fit of the predictive models using the likelihood ratio test.


RESULTS
We recruited 196 patients, of whom 100%, 98%, 90%, and 88% completed each respective survey wave. Participants' mean age was 52 years, 51% were women, 60% were non-Hispanic black, and 21% completed the questionnaires in Spanish. In-hospital assessments revealed high symptom burden and poor health status. In-hospital assessments of GMH and GSRH predicted 14-day reutilization, whereas posthospitalization assessments of MSAS and GPH predicted subsequent utilizations. Each measure selectively improved predictive model fit.


CONCLUSIONS
Routine measurement of patient-reported outcomes can help identify patients at higher risk for utilizations. At different time points, MSAS, GPH, GMH, and GSRH all informed utilization risk.
Collaborative Research Unit, Cook County Health & Hospitals System, Chicago, Illinois.
Keiki
K
Hinami
Jennifer
J
Smith
Catherine D
CD
Deamant
Kayle
K
DuBeshter
William E
WE
Trick
D000328:Adult; D000367:Age Factors; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006304:Health Status; D006760:Hospitalization; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D010351:Patient Discharge; D063868:Patient Outcome Assessment; D010359:Patient Readmission / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D044469:Racial Groups; D012307:Risk Factors; D064876:Safety-net Providers / Q000706:statistics & numerical data; D057566:Self Report; D012720:Severity of Illness Index; D012737:Sex Factors