PROM-ED: Measuring outcomes from the patients' perspective in emergency department care.
Quality Improvement & Outcomes
Measuring the outcome of care is a powerful tool for improvement. In emergency medicine (EM), outcome measurement is often limited by the diversity of conditions and the lack of follow up. In this project, we defined four outcomes valued by a diverse group of patients accessing emergency department (ED) care. These four outcomes were: Symptom relief, understanding their health concenrn, reassurance, and having a plan for follow up care. We then developed a 21 questionnaire called a patient-reported outcome measure (PROM) that can be used to reliably measure these outcomes across a diverse patient population. PROM-ED, the name of this new questionnaire, allows for the first time in EM to gather the perspective of patients on a large scale. The questionnaire was tested for its validity and reliability and is being implemented province wide by the Health Quality Council of Alberta for their quality measurement of ED care. A large trial is also using it to compare the quality of ED care against walk in clinic care.
Patient-centred outcome measures are lacking in emergency medicine (EM). This has limited quality improvement and patient-centred research work in emergency department (ED) care. In the PROM-ED initiative, we developed the first patient-reported outcome measure (PROM) for use with patients after they received care in the ED.
A first AFP grant allowed us to complete a qualitative study with 46 patients in the days following their care in the ED and characterize outcomes valued by a diverse group of ED patients. Based on these four defined outcomes, we searched the literature and developed potential questions that were tested with over 400 patients and used a modified delphi method involving patients and ED clinicians to create a prototype questionnaire. The questionnaire was then tested for validity and reliability with over 400 patients.
The qualitative study allowed us to identify four main outcomes relevant to ED patients: Symptom relief, understanding their health issue, reassurance and having a plan for follow up. Based on this conceptual model, a long list of potential questions was drafted and a modified delphi study involving clinicians and patients allowed us to select 21 questions for inclusion in a questionnaire for testing. PROM-ED was tested for validity and reliability and performed well.
PROM-ED is being implemented by the Health Quality Council of Alberta as part of the ED quality of care measurement and underwent pilot testing at St. Michael’s Hospital. A CIHR multicentre trial is using PROM-ED to compare the value of care in ED against walk in clinic and the questionnaire has been adapted for use in Canadian French and in the UK.
Support and grants: The development of PROM-ED was supported by two AFP grants and subsequent funding by the Ontario SPOR Support Unit.
Vaillancourt S, Cullen JD, Dainty KN, Inrig T, Laupacis A, Linton D, et al. PROM-ED: Development and Testing of a Patient-Reported Outcome Measure for Emergency Department Patients Who Are Discharged Home. Annals of Emergency Medicine. 2020 Aug;76(2):219–29.
Vaillancourt S, Seaton MB, Schull MJ, Cheng AHY, Beaton DE, Laupacis A, et al. Patients’ Perspectives on Outcomes of Care After Discharge From the Emergency Department: A Qualitative Study. Annals of Emergency Medicine. 2017 Nov 1;70(5):648-658.e2.
Dainty KN, Seaton B, Laupacis A, Schull M, Vaillancourt S. A qualitative study of emergency physicians’ perspectives on PROMS in the emergency department. BMJ Qual Saf. 2017 Sep 1;26(9):714–21.