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Feasibility of collecting and assessing patient-reported outcomes for emergency admissions: laparotomy for gastrointestinal conditions
  1. Esther Kwong1,
  2. Jenny Neuburger1,
  3. Dave Murray2,
  4. Nick Black1
  1. 1 Departement of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
  2. 2 Anaesthetic Department, James Cook University Hospital, Middlesbrough, UK
  1. Correspondence to Dr Esther Kwong; esther.kwong{at}lshtm.ac.uk

Abstract

Introduction Audit of emergency surgery is usually limited to immediate clinical outcomes relating to outcomes during the acute hospital episode with little attempt to capture patients’ views of their longer-term outcomes. Our aim was to determine the response rate to patient-reported outcome measures (PROMs) for patients who underwent an emergency laparotomy for gastrointestinal conditions, identify response bias and explore the feasibility of comparing outcomes with their prior health based on their recalled view collected during their admission.

Methods Patients undergoing emergency laparotomy in 11 hospitals were recruited to complete a retrospective questionnaire containing the EQ-5D-3L and Gastrointestinal Quality of Life Index (GIQLI). Response rate for 3-month mailed follow-up questionnaire and potential response biases were assessed. Patients’ outcomes were compared with their baseline using χ2 and paired t-test to assess for differences.

Results Of 255 patients contacted at 3 months, 190 (74.1%) responded. Responders were more likely to be older, female and more affluent. Patients’ health improved significantly as regards the GIQLI (93.3 vs 97.9; p=0.048) and the subscale on symptoms (51.9 vs 59.6; p<0.001). No significant change in subscales on emotion or physical aspects or for overall health status (EQ-5D: 0.58 vs 0.64; p=0.06). According to the social subscale, patients had deteriorated (11.0 vs 9.8; p<0.0006). Differences in change scores by patient characteristics were slight, suggesting minimal response bias.

Conclusion This approach offers the opportunity for assessing the impact of treatment, from the patient’s perspective and the potential to evaluate emergency laparotomy care using PROMs.

  • patient reported outcome measures
  • health status
  • health-related quality of life
  • retrospective
  • response rate feasibility
  • emergency admissions
  • emergency laparotomy

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: http://creativecommons.org/licenses/by/4.0

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Footnotes

  • Collaborators NELA PROMs project team: Dave Murray, Mike Grocott, David Saunders, Jose Lourtie, Esther Kwong, Nick Black

    NELA PROMs Site and study leads: Michael Lewis, Gill Pout, Patricia Dickens, James Kirkby-Bott, Pauline Bartlett, Guy Titley, Emma Willett, Nina Barratt, Tanuja Shah, Kathleen Holding, Lianne Hufton, Veeranna Shatkar, Ruwan Weerakkody, Caron Baldwin, Sarah Hare, Annette Woods, Ewen Griffiths, Arlo Whitehouse, Jugdeep Dhesi, Jane Okello, Philip Braude, Karen Wilson, Kirsty Gibson, Abdul Quddus, Davina Ross-Anderson, Katherine MacGloin, Hasan Mukhtar, Kathryn Simpson, Kayleigh Gilbert

  • Contributors EK was the Principal Investigator of the study. NB is the Doctoral Supervisor. EK and NB wrote the paper with input from JN and DM.

  • Funding EK is funded by Economic and Social Research Council doctoral fellowship (grant reference: ES/J500021/1). DM has been funded by NELA for his time as National Clinical Lead (2012–2017) and Chair of the Project Team (since 2017). The research was supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care North Thames at Barts Health NHS Trust.

  • Disclaimer The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee (NHS Health Research Authority) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. NHS ethical approval was obtained from South East Coast–Brighton and Sussex Research Ethics Committee (REC reference: 16/LO/2053) and was incorporated in the NIHR Research Network Portfolio.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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