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Complete results of analyses for differential item functioning

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Research Questions

  1. Is the PROMIS-29 valid in a geriatric population?
  2. What might be the practical use of PRO-based PMs in a geriatric population?

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 Findings

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.

Table of Contents

  • Chapter One

    Background

  • Chapter Two

    Data Collection Methods

  • Chapter Three

    Analytic Methods and Results: Validation of Items

  • Chapter Four

    Analytic Methods and Results: Utility of Items as Performance Measures

  • Chapter Five

    Discussion and Policy Implications

  • Appendix A

    International Classification of Diseases, Tenth Revision, Codes for Chronic Conditions

  • Appendix B

    Mail Version of the Survey Instrument

  • Appendix C

    Complete Results of Analyses for Differential Item Functioning

  • Appendix D

    Intraclass Correlation Coefficients, Reliability, and Number Needed for Alternative Performance Measures Based on the Original Eight Patient-Reported Outcomes Measurement Information System 29-Item Survey Scores

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