Leveraging Data to Understand and Improve Patients’ Perceived Wellness
Understanding the patients Contessa serves is absolutely critical to our work. Not only do we need to know the best ways to treat patients in the home, but also the perceptions they have of their physical and mental health. Many patients don’t think they are well enough to do many activities, or, on the other end of the spectrum, sick enough to need the care they often do. Our teams rely on the facts to inform their care decisions and on data to understand our patients’ points of view.
Contessa has invested resources and energy into researching patients’ healthcare perceptions. No one knows this information better than Caroline Rogers, Contessa’s Director of Quality and Patient Safety. Though Caroline lives in a quality and safety setting, many of her responsibilities also include data analysis. She works closely with Contessa’s analytics team and dabbles in a great deal of data in her role.
Here, she explains the PROMIS tool, the patient-reported assessment data Contessa leverages to glean and understand patients’ perceptions of their own health. She explains how we measure this information before, during and after their episodes of care with Contessa, and how the assessment’s findings impact the care we deliver:
So, Caroline, what is PROMIS?
The PROMIS tool is a patient-reported outcome measurement survey. While there are several different PROMIS tools, the one that we use for home hospital care is the 10-question global PROMIS tool. It is pretty straightforward and is shorter than some of the other PROMIS assessments out there.
The questions in the survey we use are heavy-hitting and get at a patient’s overall domain of health. They specifically look at physical and mental health.
Where did the PROMIS assessment originate?
The assessment came out of an original program and roadmap from the National Institutes of Health. It was designed to develop a more standardized way to report patient-perceived health statuses and outcomes. The questions that Contessa’s care coordinators ask through this global tool get at a patient’s perceived baseline health status.
When is PROMIS data collected at Contessa?
In Contessa’s program, we gather PROMIS data at two distinct points in our model’s episode. Our core analysis is on our traditional 30-day episodes. For that model, our recovery care coordinators ask the PROMIS questions during the admission process with patients, as well as at the end of their 30-day episode/s. So, usually between days 27 and 30 of their episode, patients are getting the same questions asked of them a second time.
Our scoring process is also the formalized scoring that PROMIS produces. This is a sophisticated equation that utilizes T scores and converts the raw scores from patients to each response so that each question is associated with a different scoring value. Several of the assessment’s questions are fed into a physical health bucket and others in a mental health bucket. We looked at these scores at both the beginning and end/s of episodes amongst 234 patients across all of our markets. Most completed their care with Contessa in 2019 through mid-2020.
Is PROMIS a mix of patient experience and care quality scores?
When Contessa takes patients into the program, we typically don’t know them and haven’t met them yet, so we’re getting a sense of their baseline health. At the end of their episode/s, our team has a better sense of the patient’s experience and wellbeing. By that point, we can think about their new baseline. With that said, there aren’t any questions we ask targeted on experience in the PROMIS survey. Contessa conducts our own surveys after episodes to gather this information separately.
What have we learned from our PROMIS data?
It’s no surprise: Contessa’s patients are really sick. We knew this, but it was staggering to see that only 24% of our patients were reporting that they perceived their physical health as “good” at the start of their episodes. Under our care, we saw those scores increase up to 44% at the end of the episode.
We also saw that the lowest-scoring categories got better. We had fewer patients who scored in the worst perception ranges at the end of the episode versus the beginning, and more patients scoring in the best perception categories. We saw that we helped move patients from below the average health of the US population to at or above the average. Importantly, our care also made incremental improvements in patient’s perceived mental health between the beginning and end of their episodes.
What are the biggest takeaways for you from this data?
To me, it’s the fact that, within a 30-day time span, Contessa is positively contributing to patients’ perceptions of their physical health baselines. Additionally, following-up with them for the duration of the 30-day period, patients are reporting to be in much better physical shape than they were before. That is critical to the recovery process they go through in our care.
Thinking long-term, will Contessa strive for even better PROMIS scores in the future, or focus on maintaining steady scores from patients?
We’ll continue to look at this data on an ongoing basis. We’ll trend them over time so that we can see changes and set goals accordingly. It is possible our team will apply interventions to improve our work and these scores, and then we’ll reflect on the data through that lens. For the time being, our team has been aiming to get a baseline for our entire patient population and understand where they stand at the beginning. In large part, we have achieved that goal and are moving into the next phase of our understanding of our PROMIS scores.
Disclaimer: The author of this post, geriatrician Mark Montoney, MD, was previously Contessa’s Chief Medical Officer. Though he is retired and no longer with the organization, the information in this article is clinically accurate and verified.