Strengthening the patient perspective in quality development: a mixed-methods observational study on suitability of the PROMIS GH-10 in Swiss inpatient rehabilitation

Abstract

Healthcare systems increasingly use patient-reported outcome measures (PROMs) to complement traditional clinical and performance-based outcomes by capturing health outcomes from the patient perspective and supporting quality improvement and patient-centred care. In Switzerland, the National competence centre for quality measurements in hospitals and clinics ANQ performs the external quality development program. We conducted a nationwide pilot study in inpatient rehabilitation using the generic PROMIS GH-10 to assess its suitability as an outcome for quality development by evaluating its responsiveness and feasibility of implementation in everyday clinical practice. Our study applied a mixed-method observational design. In a multi-stage expert-based selection process, the PROMIS GH-10 was selected for piloting. In total, 28 rehabilitation clinics recruited patients during the study period and asked them to fill in the PROMIS GH-10 digitally or paper-based at admission and discharge. After the survey, healthcare professionals (HCPs) were asked to document the level of assistance required by patients. Mean T-scores and effect sizes (Cohen’s d) were calculated. Assistance requirements were analysed using descriptive statistics. Additionally, qualitative interviews were completed with HCPs to assess facilitating factors and barriers to implementation. A sample of 2,083 patients was included, resulting in 1,217 complete pre-post measurements. Mean T-scores (SD) for PROMIS GH-10 subscales physical health (PHS) and mental health (MHS) significantly improved (p < 0.001) from admission to discharge (total sample PHS: 39.3(7.4); 44.4(7.6); d = 0.68; MHS: 44.9(8.0); 48.7(7.5); d = 0.48). Effect sizes on PHS ranged from d = 0.50–0.95 and on MHS from d = 0.33–1.19. Overall, 41% of patients required assistance in answering the PROM. Barriers to implementation from HCP perspective included uncertainties about the benefit of a generic PROM and the lack of staff resources. Facilitators were the questionnaire’s brevity and the value of including the patient perspective. PROMIS GH-10 showed significant pre-post effects on physical and mental health in Swiss inpatient rehabilitation. Nonetheless, barriers such as increased time needed for assistance in special patient groups should be considered before national implementation.