Conclusion Our findings suggest that people with low literacy skills or learning disabilities are left out of the development of PROMs .
Background  Patient-reported outcome measures ( PROMs ) are intended to reflect outcomes relevant to patients .
They are increasingly used for healthcare quality improvement .
To produce valid measures , patients should be involved in the development process but it is unclear whether this usually includes people with low literacy skills or learning disabilities .
Physiologic Variables and Functional Status Independently Predict COPD Hospitalizations and Emergency Department Visits in Patients with Severe COPD
Using clinical and cl aims records from the National Emphysema Treatment Trial , we sought to identify factors that accurately predicted COPD exacerbations . This prospect i ve cohort study consisted of subjects with severe emphysema r and omized to medical therapy .  Exacerbations were defined as a hospitalization or emergency department visit for COPD . Patient characteristics obtained before r and omization were entered as independent variables in multivariable logistic regression models to estimate the risk of exacerbation . Discrimination was determined using the area under the receiver operator characteristic curve ( AUC ) . Baseline measures included demographics , body mass index , pulmonary function , arterial blood gases , radiology studies , dyspnea ( Shortness of Breath Question naire — SOBQ ) , health-related quality of life ( St. George 's Respiratory Question naire — SGRQ ) , 6-minute walk , exercise capacity , medication use , prior exacerbations and co-morbidity . In 610 participants , 26.6 % had a COPD exacerbation over 1-year follow-up . In a model incorporating spirometry , PaO2 , dyspnea , prior exacerbations and co-morbidity , a 5-point decrement in percent predicted FEV1 ( OR 1.16 , 95 % CI 1.00–1.34 ) and a 5-point worsening in SOBQ ( OR 1.08 , 1.02–1.14 ) independently predicted exacerbations ( AUC for full model 0.68 ) . Combining physiologic variables , dyspnea , prior exacerbations and co-morbidity may be useful in identifying patients at high risk for COPD exacerbations
Conclusion Our findings suggest that people with low literacy skills or learning disabilities are left out of the development of PROMs .
Background  Patient-reported outcome measures ( PROMs ) are intended to reflect outcomes relevant to patients .
They are increasingly used for healthcare quality improvement .
To produce valid measures , patients should be involved in the development process but it is unclear whether this usually includes people with low literacy skills or learning disabilities .