RAND analysts tested performance measures of health-related quality of life to validate the Patient-Reported Outcomes Measurement Information System 29-item (PROMIS-29) profile instrument in a geriatric population and to develop a better understanding of the practical use of patient-reported outcome–based performance measures in a geriatric population, especially people with multiple chronic conditions.

Patient-Reported Outcome–Based Performance Measures for Older Adults with Multiple Chronic Conditions

Maria Orlando Edelen, Adam J. Rose, Elizabeth Bayliss, Lesley Baseman, Emily Butcher, Rosa-Elena Garcia, David Tabano, Brian D. Stucky

ResearchPublished Dec 7, 2017

Cover: Patient-Reported Outcome–Based Performance Measures for Older Adults with Multiple Chronic Conditions
Download PDF

Does not include Appendix C

Additional Downloads

Includes Appendix C Spreadsheets

As measures of health care quality have become more sophisticated, the goals of patient care have expanded into helping patients optimize their functional status and well-being. Patient-reported outcome (PRO) based performance measures (PMs) can measure how well these aspects of care are being delivered and compare the performance of health care systems and different provider groups. Most PMs focus on technical quality of care or such outcomes as survival. For older adults, especially those over age 80 with multiple chronic conditions (MCC), it might be equally important or even more important to have a good quality of life. Therefore, policymakers and researchers have been particularly interested in designing PMs that reflect these patients' goals. To date, no PRO-based PMs have been formally developed or validated specifically for use in older adults with MCC.

RAND analysts tested PMs that were based on two prominent instruments for assessing health-related quality of life: the Veterans RAND 36 Item Health Survey (VR-36) and the Patient-Reported Outcomes Measurement Information System 29-item (PROMIS-29) profile instrument. The PROMIS-29 is in widespread use but has undergone limited validation in a geriatric population with MCC. The study had two main aims: first, to validate the PROMIS-29 in this population, and second, to develop a better understanding of the practical use of PRO-based PMs in a geriatric population. To this end, the analysts assessed PM performance based on serial administration of the VR-36 or PROMIS-29, specifically in the MCC population studied.

Key Takeaways

The PROMIS-29 Is Valid for Use in Older Adults with Multiple Chronic Condition

  • Scores on the PROMIS-29 are valid for use in an older population with MCC.
  • Using data collected at baseline and a six-month follow-up, PMs based on the VR-36 or PROMIS-29 would have required infeasible or impossible sample sizes to achieve acceptable reliability for performance measurement.
  • A major limitation of the approach taken here was the small amount of change in health-related quality of life (HRQoL) that can be expected over a six-month interval.
  • It is feasible to collect HRQoL data among older adults with MCC in an integrated health system, but additional work is needed before such data can be used as a basis for performance measurement.

Recommendations

  • PROMIS-29 may be used to collect HRQoL data among the oldest-old (age 80+) and among those with multiple chronic conditions.
  • Efforts to develop PRO-based PMs for general use should continue because achieving reliable measures is such an important goal.
  • Future efforts to develop PRO-based PMs require longer follow-up intervals and larger samples than this study used.

Topics

Document Details

Citation

Chicago Manual of Style

Edelen, Maria Orlando, Adam J. Rose, Elizabeth Bayliss, Lesley Baseman, Emily Butcher, Rosa-Elena Garcia, David Tabano, and Brian D. Stucky, Patient-Reported Outcome–Based Performance Measures for Older Adults with Multiple Chronic Conditions. Santa Monica, CA: RAND Corporation, 2017. https://www.rand.org/pubs/research_reports/RR2176.html.
BibTeX RIS

The research described in this report was prepared for the National Institutes of Health and conducted by RAND Health.

This publication is part of the RAND research report series. Research reports present research findings and objective analysis that address the challenges facing the public and private sectors. All RAND research reports undergo rigorous peer review to ensure high standards for research quality and objectivity.

This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited; linking directly to this product page is encouraged. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial purposes. For information on reprint and reuse permissions, please visit www.rand.org/pubs/permissions.

RAND is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.