By Gerene Bauldoff, PhD, RN, MAACVPR | Published May 17, 2019
As the field of pulmonary rehabilitation (PR) grows and matures, the focus on quality is developing worldwide. While evidence has provided direction on selected patient-centered outcomes, these outcomes cannot provide the full picture of what PR patients’ experience. This concept of the patient experience is generating a new era of measures called Patient-Reported Experience Measures (PREM).
The goal of PREM is to assess the patient’s reported experience in contrast to patient-reported outcomes like functional performance, health-related quality of life or dyspnea. PREMs can provide a more complete picture of the patient experience of living with a disease and could be used as a benchmark of the care experience. Matthew Hodson and colleagues from the Paul Jones Group in London have published the first paper in the development and validation of a COPD-specific PREM. This same group also participated in the development and validation of the COPD Assessment Test (CAT), the HRQoL instrument.
In this paper, Dr. Hodson and colleagues describe two studies conducted in the development of the COPD PREM (PREM-C9). The first study identified a 38-item list which underwent modeling testing and validity testing. The second substudy tested concurrent validity in COPD patients (n=174), both pre-PR and post-PR. As part of these two studies, hierarchical and Rasch analysis produced a nine-item list (PREM-C9). The new instrument demonstrated fit to the Rasch model (χ² p=0.33) and correlated moderately with CAT (r=0.42), HAD-anxiety (r=0.30) and HAD-depression (r=0.41) (p<0.05). Based on these findings, the PREM-C9 is described as a simple and valid measure of experience of patients living with COPD. The tool itself is provided within the article.
What does this mean for the PR Professional?
While we currently measure and report outcomes for patients undergoing PR, a new era may be dawning where patient experience evaluation will also be indicated. The PREM-C9 is a simple tool with 9 items that resembles the ease of use of the CAT. While this new tool is only indicated in COPD patients, tools for other pulmonary processes seen in PR will be on the horizon.
Reference: Hodson M, Roberts CM, Andrew S, Graham L, Jones PW & Yorke J. (2019). Development and first validation of a patientreported experience measure in chronic obstructive pulmonary disease (PREM-C9). Thorax. Epub ahead of print: [please include 30 April 2019]. doi:10.1136/ thoraxjnl-2018-211732