The development and validation of a patient-reported outcome measure for older people living with frailty receiving acute care

Background

Older people living with frailty benefit from acute healthcare which is holistic and person-centred. Currently, though, measurement of outcomes from acute healthcare is neither holistic nor person-centred, instead generally relying on service metrics such as time targets and mortality. This thesis reports the development and validation of a Patient-Reported Outcome Measure for Older People with frailty receiving Acute Care (PROM-OPAC).

Methods

The project comprised two research phases and throughout used co-creation with lay and patient representatives to ground outputs in meaningfulness and accessibility. The first phase established conceptual domains for measurement using qualitative enquiry, appraised available PROMs using systematic review, and iteratively drafted a novel measure using cognitive testing. The second phase recruited cohorts at eight UK hospitals and used psychometric approaches to field-test, improve, and validate the instrument.

Results

Meaningful outcomes for acute healthcare among older people living with frailty were categorised as autonomy (information, control, security) and function (physical, psychosocial, symptoms). The EuroQol EQ-5D was mapped as measuring the function outcomes, and novel items devised for autonomy were demonstrated to have content validity. The resulting nine-item PROM-OPAC had promising administration feasibility, adequate reliability, excellent structural validity, and acceptable construct validity.

Conclusions

PROM-OPAC measures the meaningful outcomes of acute healthcare for older people living with frailty with good psychometric performance. The instrument requires clinical appraisal and external validation outside of the research setting.