Using Patient- and Family-Reported Outcome and Experience Measures Across Transitions of Care for Frail Older Adults Living at Home: A Meta-Narrative Synthesis

Kara Schick-Makaroff; Mehri Karimi-Dehkordi; Lena Cuthbertson; Duncan Dixon; S Robin Cohen; Neil Hilliard; Richard Sawatzky

doi:10.1093/geront/gnz162

Using Patient- and Family-Reported Outcome and Experience Measures Across Transitions of Care for Frail Older Adults Living at Home: A Meta-Narrative Synthesis

Gerontologist. 2021 Apr 3;61(3):e23-e38. doi: 10.1093/geront/gnz162.

Authors

Kara Schick-Makaroff¹, Mehri Karimi-Dehkordi², Lena Cuthbertson³, Duncan Dixon⁴, S Robin Cohen^{5

6}, Neil Hilliard⁷, Richard Sawatzky^{8

9

10}

Affiliations

¹ Faculty of Nursing, University of Alberta, Vancouver.
² Department of Medicine and Community Health Sciences, University of Calgary, Vancouver.
³ Office of Patient-Centered Measurement, British Columbia, Ministry of Health, Vancouver.
⁴ Norma Marion Alloway Library, Trinity Western University, Langley.
⁵ Department of Oncology and Medicine, McGill University, Montréal.
⁶ Lady Davis Institute, Palliative Care Research, Montréal.
⁷ Fraser Health, Abbotsford.
⁸ School of Nursing, Trinity Western University, Langley.
⁹ Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, Canada.
¹⁰ Sahlgrenska Academy, University of Gothenburg, Sweden.

Abstract

Background and objectives: Our aim was to create a "storyline" that provides empirical explanation of stakeholders' perspectives underlying the use of patient- and family-reported outcome and experience measures to inform continuity across transitions in care for frail older adults and their family caregivers living at home.

Research design and methods: We conducted a meta-narrative synthesis to explore stakeholder perspectives pertaining to use of patient-reported outcome and experience measures (PROMs and PREMs) across micro (patients, family caregivers, and healthcare providers), meso (organizational managers/executives/programs), and macro (decision-/policy-makers) levels in healthcare. Systematic searches identified 9,942 citations of which 40 were included based on full-text screening.

Results: PROMs and PREMS (54 PROMs; 4 PREMs; 1 with PROM and PREM elements; 6 unspecified PROMs) were rarely used to inform continuity across transitions of care and were typically used independently, rarely together (n = 3). Two overarching traditions motivated stakeholders' use. The first significant motivation by diverse stakeholders to use PROMs and PREMs was the desire to restore/support independence and care at home, predominantly at a micro-level. The second motivation to using PROMs and PREMs was to evaluate health services, including cost-effectiveness of programs and hospital discharge (planning); this focus was rarely at a macro-level and more often split between micro- and meso-levels of healthcare.

Discussion and implications: The motivations underlying stakeholders' use of these tools were distinct, yet synergistic between the goals of person/family-centered care and healthcare system-level goals aimed at efficient use of health services. There is a missed opportunity here for PROMs and PREMs to be used together to inform continuity across transitions of care.

Keywords: Continuity across transitions of Care; Family caregivers; Frail older adults; Frailty; Living at home; Quality of life.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Aged
Delivery of Health Care
Frail Elderly*
Health Personnel
Hospitals
Humans
Patient Reported Outcome Measures*

Grants and funding

144042/CIHR/Canada