Health related quality-of-life is increasingly important in quality improvement efforts for medical conditions but has proved challenging to measure for urolithiasis given the distinct chronic and acute phases of this disease. We evaluated the utility of using the Patient-Reported Outcomes Measurement System (PROMIS(®)) to assess patient experience through stages of the acute stone episode.
PROMIS(®) pain measures (intensity and interference) were obtained from patients at a subspecialty kidney stone clinic. Four types of clinical encounters were considered: emergency department follow-up (ED), trial of passage (TP), stent removal (SR), and one-month post-operative (PO). Raw scores were translated into population normed T-scores where a T-score of 50 is the reference population mean and a score of 60 is one standard of deviation above the mean. T-scores were compared across encounter types using univariate and multivariate analysis.
2018 complete surveys were available for 1162 patients. Mean pain intensity and pain interference T-scores both differed significantly by encounter type (p<0.001). On multivariate analysis, odds ratios of T-scores >60 were higher for both pain intensity and interference for all encounter types relative to PO [ED (37.9, 124.9); TP (5.4, 10.5); SR (9.4, 30.2) (p<0.001)], respectively. Additionally, female gender and younger age were independent risk factors for T-scores >60.
PROMIS(®) pain measures are responsive to the phase of care during symptomatic stone events. Further application of this instrument holds great potential as a valuable tool to improve quality of urolithiasis care.
The Journal of urology. 2017 Jun 03 [Epub ahead of print]
Michael S Borofsky, Giulia I Lane, Suzanne M Neises, Andrew J Portis
University of Minnesota Department of Urology, Minneapolis, MN; HealthEast Kidney Stone Institute, St. Paul, MN., University of Minnesota Department of Urology, Minneapolis, MN., HealthEast Kidney Stone Institute, St. Paul, MN., HealthEast Kidney Stone Institute, St. Paul, MN. Electronic address: .