Patient-Reported Morbidity Instruments: A Systematic Review

Arvind Oemrawsingh; Nishwant Swami; José M Valderas; Jan A Hazelzet; Andrea L Pusic; Richard E Gliklich; Regan W Bergmark

doi:10.1016/j.jval.2020.02.006

Patient-Reported Morbidity Instruments: A Systematic Review

Value Health. 2020 Jun;23(6):791-811. doi: 10.1016/j.jval.2020.02.006. Epub 2020 May 27.

Authors

Arvind Oemrawsingh¹, Nishwant Swami², José M Valderas³, Jan A Hazelzet⁴, Andrea L Pusic⁵, Richard E Gliklich⁶, Regan W Bergmark⁷

Affiliations

¹ Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands. Electronic address: a.oemrawsingh@erasmusmc.nl.
² University of Massachusetts Medical School, Worcester, MA, USA.
³ International Society for Quality of Life Research, Health Services & Policy Research, University of Exeter Medical School, Exeter, England, UK.
⁴ Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
⁵ Division of Plastic and Reconstructive Surgery, Patient Reported Outcomes, Value, and Experience Center, Brigham and Women's Hospital, Boston, MA, USA.
⁶ Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, MA, USA.
⁷ Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, MA, USA; Center for Surgery and Public Health, Patient Reported Outcomes, Value and Experience Center, Brigham and Women's Hospital, Boston, MA, USA.

PMID: 32540238
DOI: 10.1016/j.jval.2020.02.006

Abstract

Objectives: Although comorbidities play an essential role in risk adjustment and outcomes measurement, there is little consensus regarding the best source of this data. The aim of this study was to identify general patient-reported morbidity instruments and their measurement properties.

Methods: A systematic review was conducted using multiple electronic databases (Embase, Medline, Cochrane Central, and Web of Science) from inception to March 2018. Articles focusing primarily on the development or subsequent validation of a patient-reported morbidity instrument were included. After including relevant articles, the measurement properties of each morbidity instrument were extracted by 2 investigators for narrative synthesis.

Results: A total of 1005 articles were screened, of which 34 eligible articles were ultimately included. The most widely assessed instruments were the Self-Reported Charlson Comorbidity Index (n = 7), the Self-Administered Comorbidity Questionnaire (n = 3), and the Disease Burden Morbidity Assessment (n = 3). The most commonly included conditions were diabetes, hypertension, and myocardial infarction. Studies demonstrated substantial variability in item-level reliability versus the gold standard medical record review (κ range 0.66-0.86), meaning that the accuracy of the self-reported comorbidity data is dependent on the selected morbidity.

Conclusions: The Self-Reported Charlson Comorbidity Index and the Self-Administered Comorbidity Questionnaire were the most frequently cited instruments. Significant variability was observed in reliability per comorbid condition of patient-reported morbidity questionnaires. Further research is needed to determine whether patient-reported morbidity data should be used to bolster medical records data or serve as a stand-alone entity when risk adjusting observational outcomes data.

Keywords: comorbidity; health services; morbidity; patient report; psychometrics; self-report; surveys and questionnaires.

Publication types

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

MeSH terms

Comorbidity
Humans
Morbidity
Outcome Assessment, Health Care
Patient Reported Outcome Measures*
Reproducibility of Results
Risk Adjustment / methods*
Surveys and Questionnaires*