Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, East Lansing, MI.
Department of Otolaryngology, Head and Neck Surgery, Henry Ford Health, Henry Ford Cancer, Detroit, MI.
JCO Oncol Pract. 2024 Oct;20(10):1391-1400. doi: 10.1200/OP.23.00356. Epub 2024 Apr 2.
To establish thresholds in the Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference, physical function, fatigue, and depression scores on the basis of their association with subsequent use of the emergency department (ED) or urgent care by people diagnosed with cancer.
Retrospective data from 952 people seen at Henry Ford Cancer and insured through the Health Alliance Plan were analyzed using generalized linear mixed-effects models. The log odds of ED or urgent care use during 14 or 30 days after each patient-reported outcome (PRO) assessment were related to PRO scores, while adjusting for comorbidity, sociodemographic, and tumor characteristics.
Pain interference and physical function were associated with subsequent ED or urgent care visits, but fatigue and depression were not, and the results for 14- and 30-day visits were similar. Thresholds anchored in the likelihood of these visits differed according to cancer stage. For people with advanced cancer, a pain interference score of 60 or higher (odds ratio [OR] 3.75, [95% CI, 1.53 to 7.87]) and a physical function score lower than 40 (OR 2.94, [95% CI, 1.22 to 7.06]) produced the largest ORs with narrowest CIs for 30-day visits. For people with nonadvanced cancer, the thresholds of 65 for pain interference (OR 2.64, [95% CI, 1.40 to 5.01]) and 35 for physical function (OR 1.87, [95% CI, 1.01 to 3.45]) produced largest ORs with narrowest CIs for 30-day visits.
These anchor-based thresholds in PROMIS scores can inform clinicians' actions with the goal of preventing ED or urgent care visits.
基于癌症患者使用急诊室（ED）或紧急护理的后续情况，为患者报告的结局测量信息系统（PROMIS）疼痛干扰、身体功能、疲劳和抑郁评分建立阈值。
使用广义线性混合效应模型分析了在亨利福特癌症中心就诊的 952 名患者（通过健康联盟计划投保）的回顾性数据。将每个患者报告结局（PRO）评估后 14 天或 30 天内 ED 或紧急护理使用的对数几率与 PRO 评分相关联，同时调整了合并症、社会人口统计学和肿瘤特征。
疼痛干扰和身体功能与随后的 ED 或紧急护理就诊相关，但疲劳和抑郁没有，且 14 天和 30 天就诊的结果相似。根据癌症分期，锚定在这些就诊可能性上的阈值有所不同。对于晚期癌症患者，疼痛干扰评分达到 60 或更高（比值比 [OR] 3.75，[95%CI，1.53 至 7.87]）和身体功能评分低于 40（OR 2.94，[95%CI，1.22 至 7.06]）会产生最大的 OR 和最窄的 95%CI 用于 30 天就诊。对于非晚期癌症患者，疼痛干扰的 65 分（OR 2.64，[95%CI，1.40 至 5.01]）和身体功能的 35 分（OR 1.87，[95%CI，1.01 至 3.45]）阈值会产生最大的 OR 和最窄的 95%CI 用于 30 天就诊。
这些基于 PROMIS 评分的基准阈值可以为临床医生的行动提供信息，以达到预防 ED 或紧急护理就诊的目的。
