Patient-reported outcome measurement in community-acquired pneumonia: feasibility of routine application in an elderly hospitalized population

Melanie A Lloyd, Clarice Y Tang, Emily J Callander, Edward D Janus, Amalia Karahalios, Elizabeth H Skinner, Stephanie Lowe, Harin A Karunajeewa, Melanie A Lloyd, Clarice Y Tang, Emily J Callander, Edward D Janus, Amalia Karahalios, Elizabeth H Skinner, Stephanie Lowe, Harin A Karunajeewa

Abstract

Background: Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide, but few studies have evaluated the feasibility of routine patient-reported outcome measures (PROMs) in this illness. This study investigates the feasibility and limitations of three credible PROM instruments in a representative hospitalized cohort to identify potential barriers to routine application.

Methods: A sample of multimorbid hospitalized subjects meeting a standardized CAP definition was recruited. Demographic and clinical data of those able and unable to participate in PROM assessment were compared. The EQ-5D-5L, CAP-Sym 18 Questionnaire, and Late-Life Function and Disability Instrument (LLFDI) were administered (via face-to-face interview) at admission and discharge and (via phone interview or mail) at 30 and 90 days post-discharge. Feasibility measures included the proportion of individuals able to participate in assessment, attrition rates, data completeness, and instrument completion times. Scores at admission and 30 days post-discharge were examined for association with age.

Results: Of 82 subjects screened, 44 (54%) participated. Cognitive impairment (n = 12, 15%) commonly precluded participation. Seventeen (39%) participants were lost to follow-up by 90 days. Missing data at item level was negligible for all instruments, regardless of the mode of completion. Completion of the three instruments collectively in a face-to-face interview took a median of 17 min (IQ range 13-21) per participant. The burden of reported symptoms at admission was higher for younger participants aged 18-74 years (mean (standard deviation)) CAP-Sym 18 score at admission 34.2 (18.6) vs. 19.0 (11.3) for those aged ≥ 75 years.

Conclusions: Routine application of PROMs can provide valuable information relating to multiple aspects of clinical recovery for individuals hospitalized with CAP. However, heterogeneous demographic characteristics and complex underlying health status introduce challenges to feasibility and interpretability of these instruments in this population.

Trial registration: ClinicalTrials.gov, NCT02835040.

Keywords: Aged; Comorbidity; Inpatients; Multimorbidity; Outcome assessment; Pneumonia.

Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Subject flow through the study. More than one reason for ineligibility may apply to a single participant; hence, the tally does not total 24. Abbreviations: CAP community-acquired pneumonia, NESB non-English speaking background, PROMs patient-reported outcome measures
Fig. 2
Fig. 2
Change in CAP-Sym 18 and EQ-5D visual analog scores over time according to age group. Instrument scoring (y-axis): CAP-Sym18 score: CAP-Symptom Questionnaire score, consists of 18-items rated 0–5 where 0 has not experienced symptom and 5 extremely bothered by that symptom, total possible score between 0 and 90; EQ-5D VAS score: EQ-5D-5L visual analog scale score, rated as 0–100 where 0 is the worst health imaginable and 100 the best health imaginable. Time points (x-axis): ADM admission assessment conducted on first day of hospitalization, DC discharge assessment conducted on day of discharge, 30: 30-day assessment conducted at 30-days post discharge, 90: 90-day assessment conducted at 90 days post discharge

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