Aims, Objectives and Background Acute healthcare outcomes for older people living with frailty are not meaningfully measured using only service delivery metrics (time targets) or broad outcomes (mortality). This programme developed and field-tested a novel Patient Reported Outcome Measure (PROM).
Method and Design 1: To define important healthcare goals, interviews were conducted with older people living with frailty during acute care.
2: A systematic review searched for measures previously used for older people with frailty in acute settings. These measures were appraised for content validity with lay collaborators and patient participants.
3: Some areas identified in  had no existing measures, so novel questions were devised, improved, and reduced using co-creation and cognitive interviews with lay collaborators and patient participants.
4: The resulting questions were field-tested for feasibility and psychometric performance with a multi-site cohort of patients.
Results and Conclusion 1: Acute healthcare outcome goals were classified under Autonomy (information, security, control) and Function (physical, psychosocial, symptom relief).
2: Four existing sets of questions measuring Function were identified. EQ-5D provided the best compromise between reliability and burden.
3: There were no existing measures of Autonomy, so seven novel questions were developed and scaled.
4: When Function and Autonomy questions were tested in 128 patients, median completion time was 12 minutes and most participants required researcher assistance. Mean inter-item correlation for novel items was 0.28 with adequate response distribution. Exploratory factor analysis (Table 1) indicated a three-factor structure (RMSEA, 0.043) with good internal consistency (Cronbach’s alpha, 0.73. Range for subscales, 0.62–0.77). 35% returned a post-discharge retest.
Summary From patient interviews, the PROM-OPAC was developed to measure Autonomy (seven novel questions) and Function (EQ5D). In-hospital and follow-up collection appeared feasible, although users required support to overcome accessibility barriers. Validation in multi-site cohorts is ongoing. Potential future applications include system-level metrics, service-level quality improvement, and patient-level shared decision-making.
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