Evaluating the Health of Socioeconomically Disadvantaged Patients with Chronic Neurological Disorder

Beatriz Thames, Beatriz Helena Thames, Anthony Nguyen, Zhihao Zhu

University of Texas Medical Branch

Patient-reported outcome measures (PROMs) are questionnaires used to assess quality of life (QOL) by using the patient’s subjective experiences with disease. Patient-Reported Outcome Measurement Information System (PROMIS) are NIH-supported PROMs for examining patients’ health and QOL. With better understanding of the impact of disease and social forces on patient health, we can design interventions that address these factors and improve outcomes. St. Vincent´s Student-Run Free Clinic (STVSC) serves a low-income population with limited healthcare acccess. Economic burdens, as well as debilitating conditions like chronic headaches and seizures, adversely affect QOL. The PROMIS Global Health is a 10 question PROM designed to survey physical and mental health of this population. 4 questions each account for mental and physical subscores. 2 questions involving general health and satisfaction with social activities are included to capture the patients´social health dimension. We aim to quantitatively measure how finances, disease burden, and social factors correlate to outcomes. In this prospective cross-sectional study, STVSC patients with chronic headaches or seizures are given a PROMIS Global Health, and questions from both the PROMIS item bank and Financial Subscale of the Multidimensional Index of Life Quality (MILQ). The PROMIS Global Health scoring system was used to yield a T-score for global physical and mental health. Items from the PROMIS item banks and MILQ were grouped into “Symptom Control,” “Community Relationships,” and “Financial” domains. A pairwise correction of the Spearman was used to compare the global physical and mental health T-scores with raw scores for the other 3 domains and 2 questions (general health and satisfaction with social activities) from the PROMIS Global Health. A minimum rho coefficient of 0.3 and a minimum alpha of .05 were specified a-priori. 9 patients have completed surveys, allowing for preliminary analysis. 4 comparisons were statistically significant. The global physical score positively correlated with general health, satisfaction with social activities, and community relationships (rho>0.7, p<.05). Meanwhile, the global mental score correlated with satisfaction with social activities (rho>0.8, p<.01). Strong correlations between the global health domains of the PROMIS and social activities indicate that for socioeconomic disadvantaged patients, social connections are more important than financial stability.