University of Groningen, University Medical Center Groningen, University Center for Geriatric Medicine, Hanzeplein 1, 9700 RB, Groningen, Netherlands.
Research Group Living, Wellbeing and Care for Older People, NHL Stenden University of Applied Sciences, Leeuwarden, Netherlands.
Eur Geriatr Med. 2022 Dec;13(6):1377-1389. doi: 10.1007/s41999-022-00698-2. Epub 2022 Oct 7.
Although patient-reported outcome measures (PROMs) might reflect relevant outcomes from patient perspective, they do not always reflect what the individual patient finds important. Our objectives were to assess which PROM was best suited to evaluate patient-relevant outcomes of hospitalisation and to assess which factors predicted this PROM.
A longitudinal study was conducted among hospitalised older patients. Three PROMs were compared with the anchor question 'How much have you benefited from the admission?': a general quality of life measure: EQ-5D; a measure of daily functioning: Katz-15 and a goal-based measure: achievement of self-defined goals. Predictors were examined using logistic regression analyses.
We had 185 cases with baseline and follow-up. Accomplishment of self-defined goals showed a large correlation with the anchor question, whereas EQ-5D and Katz-15 showed no significant correlations. The final regression model had four predictors: being man, having higher confidence in goal achievement and good/excellent quality of life increased the odds for goal accomplishment, while having goals in the category alleviating complaints reduced the odds.
Accomplishment of individual goals represented the benefit experienced by participants best. Subjective indicators of health and functioning are better predictors of goal accomplishment than objective ones. According to participant experience, the hospital appeared successful in managing disease-specific problems, but less successful in ameliorating complaints. Medical decision-making should not only be based on medical indicators, but the input of the patient is at least as important. Quality of life, goals and confidence should be discussed. More attention is needed for symptom experience.
尽管患者报告结局测量（PROM）可能从患者角度反映相关结局，但它们并不总是反映患者认为重要的内容。我们的目的是评估哪种 PROM 最适合评估住院患者的相关结局，并评估哪些因素预测了这种 PROM。
对住院老年患者进行了一项纵向研究。将三种 PROM 与锚定问题“您从住院中受益多少？”进行比较：一般生活质量测量：EQ-5D；日常生活功能测量：Katz-15 和基于目标的测量：实现自我定义的目标。使用逻辑回归分析检查预测因素。
我们有 185 例患者具有基线和随访数据。自我定义目标的实现与锚定问题有很大的相关性，而 EQ-5D 和 Katz-15 则没有显著相关性。最终的回归模型有四个预测因素：男性、对目标实现的信心更高、生活质量良好/优秀，增加了实现目标的几率，而目标属于减轻抱怨的类别则降低了几率。
个人目标的实现最能代表参与者所经历的获益。健康和功能的主观指标比客观指标更能预测目标的实现。根据参与者的经验，医院似乎在管理疾病特异性问题方面取得了成功，但在减轻抱怨方面则不太成功。医学决策不仅应基于医学指标，而且患者的意见至少同样重要。应讨论生活质量、目标和信心。还需要更多关注症状体验。
