The Use of Generic Patient-Reported Outcome Measures in Emergency Department Surveys: Discriminant Validity Evidence for the Veterans RAND 12-Item Health Survey and the EQ-5D

• Published in: Value in health 2022-12, Vol.25 (12), p.1939-1946
• Main Authors: Kwon, Jae-Yung, Cuthbertson, Lena, Sawatzky, Richard
• Format: Article
• Language: English
• Subjects: British Columbia; Clinical Medicine; comorbidity; Cross-Sectional Studies; discriminant validity; Emergency Service, Hospital; EQ-5D; Health Status; Health Surveys; Humans; Klinisk medicin; Patient Reported Outcome Measures; Psychometrics - methods; Quality of Life - psychology; Reproducibility of Results; Surveys and Questionnaires; Veterans; Veterans RAND 12-Item Health Survey
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2022.07.016

This study aimed to compare discriminant validity evidence of 2 generic patient-reported outcome measures (PROMs), the Veterans RAND 12-Item Health Survey (VR-12) and level 5 of EQ-5D (EQ-5D-5L), for use in emergency departments (EDs). Data were obtained via a cross-sectional survey of 5876 patients in British Columbia (Canada) who completed a questionnaire after visiting an ED in 2018. We compared the extent to which the VR-12 and the EQ-5D-5L distinguished among groups of ED patients with different levels of comorbidity burden and self-reported physical and mental or emotional health status. Multivariable logistic regression was used to evaluate the ability of the 2 PROMs to identify patients presenting with a mental health (MH) condition. All the measures produced small effect sizes (ESs) for discriminating comorbidity levels (R2 range: 0.00 [VR-12 mental component summary {MCS}] to 0.10 [VR-12 physical component summary score]). The EQ-5D visual analog scale offered the largest ES for discriminating self-reported physical health (R2 = 0.48), whereas the MCS, the VR-12 MH domain, and the EQ-5D-5L anxiety/depression dimension had the largest ESs for discriminating self-reported mental or emotional health (R2 = 0.42, 0.40, and 0.38, respectively). The MCS produced a medium ES (R2 = 0.42) along with the VR-12 utility score (R2 = 0.27) compared with the EQ-5D-5L index (R2 = 0.19). Having a MH condition was predominantly identified by the MCS (Pratt index = 0.56). The VR-12 PROM provides a more comprehensive measurement of MH than the EQ-5D-5L, which is important to inform healthcare service needs for patients who present in EDs with MH challenges. •The Veterans RAND 12-Item Health Survey (VR-12) and EQ-5D-5L are widely used generic patient-reported outcome measures; nevertheless, these tools should not be viewed as interchangeable.•This study shows that, for patients who presented in emergency departments in the province of British Columbia, the VR-12 physical and mental component summary scores (including the VR-12 utility score) offer greater discrimination of mental or emotional health status than the EQ-5D-5L index score.•The VR-12 is recommended for use in emergency department surveys, when insights into mental or emotional health conditions are relevant.