Patient-reported Outcome Measurement in Community-acquired Pneumonia: Feasibility of Routine Application in an Elderly Hospitalized Population

Overview

Journal Pilot Feasibility Stud

Publisher Biomed Central

Date 2019 Aug 3

PMID 31372236

Authors

Melanie A Lloyd

Clarice Y Tang

Emily J Callander

Edward D Janus

Amalia Karahalios

Elizabeth H Skinner

Stephanie Lowe

Harin A Karunajeewa

Affiliations

Soon will be listed here.

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 ( = 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.

Citing Articles

Feasibility of implementing a codesigned patient reported outcome measures (PROMs) collection system for older adults in acute and sub-acute hospital settings.

Snowdon D, Marsh L, Srikanth V, Beare R, Barnden R, Parker E Qual Life Res. 2025; .

PMID: 40019679 DOI: 10.1007/s11136-025-03931-0.

References

. EuroQol--a new facility for the measurement of health-related quality of life. Health Policy. 1990; 16(3):199-208. DOI: 10.1016/0168-8510(90)90421-9. View

Haley S, Jette A, Coster W, Kooyoomjian J, Levenson S, Heeren T . Late Life Function and Disability Instrument: II. Development and evaluation of the function component. J Gerontol A Biol Sci Med Sci. 2002; 57(4):M217-22. DOI: 10.1093/gerona/57.4.m217. View

Logsdon R, Gibbons L, McCurry S, Teri L . Assessing quality of life in older adults with cognitive impairment. Psychosom Med. 2002; 64(3):510-9. DOI: 10.1097/00006842-200205000-00016. View

Clermont G, Angus D, Linde-Zwirble W, Griffin M, Fine M, Pinsky M . Does acute organ dysfunction predict patient-centered outcomes?. Chest. 2002; 121(6):1963-71. DOI: 10.1378/chest.121.6.1963. View

Lamping D, Schroter S, Marquis P, Marrel A, Duprat-Lomon I, Sagnier P . The community-acquired pneumonia symptom questionnaire: a new, patient-based outcome measure to evaluate symptoms in patients with community-acquired pneumonia. Chest. 2002; 122(3):920-9. DOI: 10.1378/chest.122.3.920. View

Torres A, Muir J, Corris P, KUBIN R, Duprat-Lomon I, Sagnier P . Effectiveness of oral moxifloxacin in standard first-line therapy in community-acquired pneumonia. Eur Respir J. 2003; 21(1):135-43. DOI: 10.1183/09031936.03.00045202. View

Barlow G, Lamping D, Davey P, Nathwani D . Evaluation of outcomes in community-acquired pneumonia: a guide for patients, physicians, and policy-makers. Lancet Infect Dis. 2003; 3(8):476-88. DOI: 10.1016/s1473-3099(03)00721-7. View

Mundy L, Leet T, Darst K, Schnitzler M, Dunagan W . Early mobilization of patients hospitalized with community-acquired pneumonia. Chest. 2003; 124(3):883-9. DOI: 10.1378/chest.124.3.883. View

El Moussaoui R, Opmeer B, Bossuyt P, Speelman P, de Borgie C, Prins J . Development and validation of a short questionnaire in community acquired pneumonia. Thorax. 2004; 59(7):591-5. PMC: 1747065. DOI: 10.1136/thx.2003.015107. View

10.

Sayers S, Jette A, Haley S, Heeren T, Guralnik J, Fielding R . Validation of the Late-Life Function and Disability Instrument. J Am Geriatr Soc. 2004; 52(9):1554-9. DOI: 10.1111/j.1532-5415.2004.52422.x. View

11.

Torres O, Munoz J, Ruiz D, Ris J, Gich I, Coma E . Outcome predictors of pneumonia in elderly patients: importance of functional assessment. J Am Geriatr Soc. 2004; 52(10):1603-9. DOI: 10.1111/j.1532-5415.2004.52492.x. View

12.

Kristman V, Manno M, Cote P . Loss to follow-up in cohort studies: how much is too much?. Eur J Epidemiol. 2004; 19(8):751-60. DOI: 10.1023/b:ejep.0000036568.02655.f8. View

13.

Bowling A . Mode of questionnaire administration can have serious effects on data quality. J Public Health (Oxf). 2005; 27(3):281-91. DOI: 10.1093/pubmed/fdi031. View

14.

El Solh A, Pineda L, Bouquin P, Mankowski C . Determinants of short and long term functional recovery after hospitalization for community-acquired pneumonia in the elderly: role of inflammatory markers. BMC Geriatr. 2006; 6:12. PMC: 1557854. DOI: 10.1186/1471-2318-6-12. View

15.

El Moussaoui R, Opmeer B, de Borgie C, Nieuwkerk P, Bossuyt P, Speelman P . Long-term symptom recovery and health-related quality of life in patients with mild-to-moderate-severe community-acquired pneumonia. Chest. 2006; 130(4):1165-72. DOI: 10.1378/chest.130.4.1165. View

16.

Terwee C, Bot S, de Boer M, van der Windt D, Knol D, Dekker J . Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2006; 60(1):34-42. DOI: 10.1016/j.jclinepi.2006.03.012. View

17.

Harris P, Taylor R, Thielke R, Payne J, Gonzalez N, Conde J . Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2008; 42(2):377-81. PMC: 2700030. DOI: 10.1016/j.jbi.2008.08.010. View

18.

Denkinger M, Igl W, Coll-Planas L, Bleicher J, Nikolaus T, Jamour M . Evaluation of the short form of the late-life function and disability instrument in geriatric inpatients-validity, responsiveness, and sensitivity to change. J Am Geriatr Soc. 2009; 57(2):309-14. DOI: 10.1111/j.1532-5415.2008.02095.x. View

19.

Snijders D, Daniels J, de Graaff C, van der Werf T, Boersma W . Efficacy of corticosteroids in community-acquired pneumonia: a randomized double-blinded clinical trial. Am J Respir Crit Care Med. 2010; 181(9):975-82. DOI: 10.1164/rccm.200905-0808OC. View

20.

Welte T, Torres A, Nathwani D . Clinical and economic burden of community-acquired pneumonia among adults in Europe. Thorax. 2010; 67(1):71-9. DOI: 10.1136/thx.2009.129502. View