Journal article
Development of a Patient-centered Outcome Measure for Emergency Department Asthma Patients
Academic emergency medicine, v 24(5), pp 511-522
01 May 2017
PMCID: PMC5426977
PMID: 28146297
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Background: Measuring outcomes of emergency care is of key importance, but current metrics, such as 72-hour return visit rates, are subject to ascertainment bias, incentivize overtesting and overtreatment at initial visit, and do not reflect the full burden of disease and morbidity experienced at home following ED care. There is increasing emphasis on including patient-reported outcomes, but the existing patient-reported measures have limited applicability to emergency care.
Objective: The objective was to identify concepts for inclusion in a patient-reported outcome measure for ED care and assess differences in potential concepts by health literacy.
Methods: A three-phase qualitative study was completed using freelisting and semistructured interviewing for concept identification, member checking for concept ranking, and cognitive interviewing for question development. Participants were drawn from three tertiary care EDs. Parents of patients (pediatric) or patients (adult) with asthma completed a demographic survey and an assessment of health literacy. Phase 1 participants also completed a freelisting exercise and qualitative interview regarding the definition of success following ED discharge. Phase 2 participants completed a member checking survey based on concepts identified in Phase 1. Phase 3 was a pilot of trial questions based on the highest-ranked concepts from Phase 2.
Results: Phase 1 enrolled 22 adult patients and 37 parents of pediatric patients. Phase 2 enrolled 41 adult patients and 200 parents. Phase 3 involved 15 parents. Across all demographic/literacy groups, Phase 1 participants reported return to usual activity and lack of asthma symptoms as the most important markers of success. In Phase 2, symptom improvement, medication use and access, and asthma knowledge were identified as the most important components of the definition of post-ED discharge success. Phase 3 resulted in five questions for the proposed measure.
Conclusions: A stepwise qualitative process can identify, rank, and formulate questions based on patient-identified concepts for inclusion in a patient-reported outcome measure for ED discharge. The four key concepts identified for inclusion: symptom improvement, medication access, correct medication use, and asthma knowledge are not measured by existing quality metrics.
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Details
- Title
- Development of a Patient-centered Outcome Measure for Emergency Department Asthma Patients
- Creators
- Margaret E. Samuels-Kalow - Massachusetts General HospitalKarin V. Rhodes - Hofstra UniversityMira Henien - Drexel UniversityEmily Hardy - Children's Hospital of PhiladelphiaThomas Moore - Children's Hospital of PhiladelphiaFelicia Wong - William & MaryCarlos A. Camargo - Massachusetts General HospitalCaroline T. Rizzo - Massachusetts General HospitalCynthia Mollen - Children's Hospital of Philadelphia
- Publication Details
- Academic emergency medicine, v 24(5), pp 511-522
- Publisher
- Wiley
- Number of pages
- 12
- Grant note
- K12HL109009 / NATIONAL HEART, LUNG, AND BLOOD INSTITUTE; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Heart Lung & Blood Institute (NHLBI) K12 HL10900904 / NIH; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Lindy Center for Civic Engagement
- Web of Science ID
- WOS:000401165800001
- Scopus ID
- 2-s2.0-85018803954
- Other Identifier
- 991019168547504721
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InCites Highlights
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Emergency Medicine