Development And Evaluation Of Patient Reported Outcomes For Elderly Hypertension Patients

BackgroundHypertension is known as a common cardiovascular disease, it is the most important risk factor for atherosclerosis. Hypertensive crisis, stroke, heart failure and myocardial infarction are all its complication. With the rapid socio-economic development, people’s living standards have continued to increase, however, our living environment and lifestyle also has a subtle change, which makes the number of patients with cardiovascular disease continues to increase, causing serious socio-economic burden.On the other hand, with the acceleration of the aging population, the changing demographics aggravated the harm, which were lead by hypertension. As a special group, the elderly themselves are susceptible to a variety of chronic diseases. Hypertension, as one of the most common chronic disease of older persons, has caused the elderly serious health burden. At present, China’s elderly hypertensive patients has more than eighty million, the prevalence of hypertension in the elderly has been over 40%. Previous studies in elderly hypertensive believe that it is a natural physiological phenomenon, and conservative treatment is a common strategy for the elderly hypertension. With the deepening of medical research, a new idea has emerged for prevention and treatment of hypertension in the elderly people.As a typical physical and mental illness, psychological factors always has an important role in the occurrence and development of elderly hypertensive. Anxiety, depression can lead to high blood pressure, while the prevalence of hypertension will promote anxiety and worsen depression. Many studies have shown that high blood pressure patients often accompanied by depression, anxiety and other psychological problems. Hypertension has become a major public health problem affecting the quality of life of our population, especially for the growing elderly population. Effective prevention and controlling has become urgent. Thus, to conduct a comprehensive understanding and evaluation of the quality of life of elderly patients with hypertension, we need to consider many aspects. To solve this problem, the patient reported outcome is an ideal measurement and evaluation tools.Patient reported outcomes directly come from a patient, for reporting their own health and treatment, usually, it is not under the influence of a physician or other patient to carry out their own measurements of health status or disease clinical outcomes. Although the most common evaluation for the treatment or intervention is the biological indicators, with the recent increase in chronic diseases and more attention on preventive treatment, people have started to notice the limitations of biological indicators such as phosphorous health and chronic diseases. In addition, with the change of medical model, relying solely on biological indicators of efficacy evaluation has become stretched at the moment. Patient’s own feelings and satisfaction is also very important, and often the patient’s own feelings are more sensitivity than clinical biological indicators. At present, people are no longer only concerned with a change in biological indicators, and more focusing on improving the quality of life.ObjectiveThe investigation aimed-at elderly people, in three community health service centres in Jinan. Collect and analyze the data to form the patient reported outcomes for elderly patients with hypertension. It can provide an instrument for epidemiologic study and clinical study.MethodsThe research group was established in the primary position. We then combined two relatively mature scales(hy-pro developed by Shanxi Medical University and qlicd-hy developed by Qunming Medical University) into a new scale(elder hypertension patient-reported outcom) according to the international PRO scale norms. The research was taken place in three administrative district in Jinan. We then respectively choose a community health service centre in each district to hold physical examination. During the examination, all of the people who met the inclusion and exclusion criteria would be required to fill in the scale with the help of our investigator. Six statistical methods were used during the analysis(discrete tendency, factor analysis, Cronbach’s a, t-test, correlation coefficient and distinction degree). According to the result, three scales were formed(items chosen by 3 or more methods, items chosen by 4 or more methods and items chosen by 5 or more methods). Finally, a few indexes (reliability, validity and responsiveness) were used to measure and compare the three scales and two original scales.Results1. Results of selecting itemsThree elderly hypertension PRO scales were formed in the study, which respectively included 80 items,56 items and 34 items. Each of the scale was all consisted of four domains. There were 18 facets in 80-items scale,13 facets in 56-items scale and 7 facets in 34-items scale.2. Reliability analysisThe cronbach’s a of the whole 80-items scales was 0.916, while physiology domain 0.872, psychological domain 0.906, social domain 0.780, treating domain 0.710. However, to the 56-items scale, the cronbach’s a was 0.910 and 0.841 for its physiology domain,0.913 for its psychological domain,0.760 for its social domain, 0.797 for its treating domain. In addition, The cronbach’s a of the whole 34-items scales was 0.893, while physiology domain 0.793, psychological domain 0.895, social domain 0.752, treating domain 0.881.3. Validity analysisIn content validity part, all the items of three scales showed a better correlation in its own domain than in any other domains. In construct validity part, the result of exploratory factor analysis(EFA) showed that 18 factors,13 factors and 7 factors were extracted form the three scales and the explanations of the variance were all greater than 60%. The combination of factors could perfectly explain all the facets of scales. Also, the items in these factors showed obvious logical connection.4. ResponsivenessAs to the responsiveness, all the three scales showed a well reaction on their physiology domain, psychological domain and treating domain(t-test, p value<0.05). However, the social domain did not show a valuable reaction, but all the single items of it distinguished different people well.ConclusionsAll the three elder hypertension PRO scales had passed the preliminary assessment which contains reliability, validity and responsiveness.Suggestions1. All the three scales can be used in epidemiological survey and clinical survey.2.According to the practicability and acceptability, researcher suggest the 56-items scale and 34-items scale should be better, especially for 34-items scale.