Burgess, R, Bishop, A, Lewis, M and Hill, JC (2019) Models used for case-mix adjustment of patient reported outcome measures (PROMs) in musculoskeletal healthcare: A systematic review of the literature. Physiotherapy, 105 (2). pp. 137-146. ISSN 0031-9406

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Case-mix adjustment is an established method to take account of variations across cohorts in baseline patient factors, when comparing health outcomes. Although commonplace, there is a lack of evidence as to the most appropriate case-mix adjustment model to use to enable fair comparisons of PROM data in musculoskeletal services.

To conduct a systematic review summarising evidence of the development, validation, and performance of musculoskeletal case-mix adjustment models, and to make recommendations for future methods.

Searches included; AMED, CINAHL, EMBASE, HMIC, MEDLINE, and grey literature. ELIGIBILITY CRITERIA: Studies; from January 1992-May 2017, English language, musculoskeletal adult population, developing or validating a case-mix adjustment model, using a relevant PROM, and using patient factors feasible for clinical collection.

Two reviewers evaluated selected papers. The CASP Cohort Tool was used to assess quality.

Fourteen studies were included; eight US studies on the Focus on Therapeutic Outcomes model (pooled n=546,726 patients (with pre/post treatment data)) and six UK studies related to the UK National PROMs Programme model (pooled n=282,424 patients (with pre/post treatment data)). The majority used retrospective data, restricted to complete datasets. Both US and UK models showed good predictive ability (R2 18-42%). Common model variables were; baseline PROM score, age, sex, comorbidities, symptom duration, and surgical history. Reduced quality scores were mainly due to acceptability of patient recruitment, and completeness and length of patient follow up.

Significant methodological crossover was found. Further studies are however needed to externally validate and develop models across musculoskeletal settings.

Item Type: Article
Additional Information: This is the accepted author manuscript (AAM). The final published version (version of record) is available online via Elsevier at https://doi.org/10.1016/j.physio.2018.10.002 - Please refer to any applicable terms of use of the publisher.
Uncontrolled Keywords: case-mix adjustment model; musculoskeletal; patient outcomes; PROM
Subjects: R Medicine > R Medicine (General)
R Medicine > RA Public aspects of medicine
R Medicine > RC Internal medicine > RC925 Diseases of the musculoskeletal system
Divisions: Faculty of Medicine and Health Sciences > Primary Care Health Sciences
Related URLs:
Depositing User: Symplectic
Date Deposited: 08 Jan 2019 11:53
Last Modified: 09 Nov 2019 01:30
URI: https://eprints.keele.ac.uk/id/eprint/5645

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