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Evaluating the Health of Socioeconomically Disadvantaged Patients with Chronic Neurological Disorder

Beatriz Thames

University of Texas Medical Branch

Introduction: Patient-reported outcome measures (PROMs) are questionnaires used in patient care and clinical research to assess quality of life (QOL). Patient-Reported Outcome Measurement Information System (PROMIS) consists of many reliable instruments for evaluating patients’ QOL through various domains, which can guide interventions to optimize QOL and health outcomes. The PROMIS Global Health (PGH) is a PROM designed to quickly assess physical and mental health. Four questions each account for mental and physical subscores, and two questions address general health and satisfaction with social activities. St. Vincent´s Student-Run Free Clinic (STVSC) serves the uninsured, migrant, and low-income population that has limited access to healthcare. These unique socioeconomic burdens adversely affect QOL. Among the patients that STVSC serves are those with physically and mentally debilitating chronic neurologic conditions. We aim to quantify QOL in these patients using the PGH. Methods: In this cross-sectional analysis, STVSC patients with chronic headaches or seizures are given a PGH, some PROMIS item bank questions, and items from the Multidimensional Index of Life Quality. The online PROMIS scoring system provided a T-score for physical and mental health for each completed PGH. The remaining items were grouped into “Symptom Control,” “Community Relationships,” and “Financial” domains. Spearman’s rank correlation was used to compare the global physical and mental health scores with scores of the other three domains and two leftover questions (general health and satisfaction with social activities) from the PGH. A minimum rho coefficient of 0.3 and an alpha of .05 were specified a-priori. Results: Preliminarily, 12 patients have completed surveys. Physical health positively correlated with general health, satisfaction with social activities, and community relationships (rho>0.6, p<.05). Mental health only correlated with satisfaction with social activities (rho>0.6, p<.01). There was no correlation with symptom control or financial questions. Conclusions: In this initial analysis of an ongoing study, there are strong correlations between the global health domains of the PROMIS and other aspects of QOL, particularly regarding social activities. This indicates that social integration is an important component of QOL for these socioeconomically disadvantaged patients. QOL for these patients may be improved by interventions targeting social dimensions.

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