Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
Center for Program Design and Evaluation at Dartmouth, Geisel School of Medicine at Dartmouth, 21 Lafayette Street, #373, Lebanon, NH, 03766, USA.
Qual Life Res. 2018 Feb;27(2):367-378. doi: 10.1007/s11136-017-1675-5. Epub 2017 Aug 9.
Patient-reported outcome measures (PROMs), which are generic or condition-specific, are used for a number of reasons, including clinical care, clinical trials, and in national-level efforts to monitor the quality of health care delivery. Creating PROMs that meet different purposes without overburdening patients, healthcare systems, providers, and data systems is paramount. The objective of this study was to test a generalizable method to incorporate condition-specific issues into generic PROM measures as a first step to producing PROMs that efficiently provide a standardized score. This paper outlines the method and preliminary findings focused on a PROM for osteoarthritis of the knee (OA-K).
We used a mixed-methods approach and PROMIS measures to test development of a combined generic and OA-K-specific PROM. Qualitative methods included patient focus groups and provider interviews to identify impacts of OA-K important to patients. We then conducted a thematic analysis and an item gap analysis: identified areas covered by existing generic PROMIS measures, identified "gap" areas not covered, compared gap areas to legacy instruments to verify relevance, and developed new items to address gaps. We then performed cognitive testing on new items and drafted an OA-K-specific instrument based on findings.
We identified 52 existing PROMIS items and developed 24 new items across 14 domains.
We developed a process for creating condition-specific instruments that bridge gaps in existing generic measures. If successful, the methodology will create instruments that efficiently gather the patient's perspective while allowing health systems, researchers, and other interested parties to monitor and compare outcomes over time, conditions, and populations.
患者报告的结果测量（PROMs），包括通用或特定于疾病的测量，出于多种原因而被使用，包括临床护理、临床试验以及在国家层面上监测医疗保健提供质量的努力。创建满足不同目的而不会给患者、医疗保健系统、提供者和数据系统带来过重负担的 PROM 至关重要。本研究的目的是测试一种可推广的方法，将特定于疾病的问题纳入通用 PROM 测量中，作为首先生成能够高效提供标准化评分的 PROM 的第一步。本文概述了这种方法和初步研究结果，重点是一种针对膝关节骨关节炎（OA-K）的 PROM。
我们使用混合方法和 PROMIS 测量来测试开发一种通用和 OA-K 特定的联合 PROM。定性方法包括患者焦点小组和提供者访谈，以确定对患者重要的 OA-K 影响。然后，我们进行了主题分析和项目差距分析：确定现有通用 PROMIS 测量涵盖的领域，确定未涵盖的“差距”领域，将差距领域与传统仪器进行比较以验证相关性，并开发新的项目来解决差距。然后，我们对新项目进行认知测试，并根据研究结果起草了一份 OA-K 特定的仪器。
我们确定了 52 项现有 PROMIS 项目，并在 14 个领域开发了 24 项新项目。
我们开发了一种创建特定于疾病的仪器的过程，该仪器弥补了现有通用测量中的差距。如果成功，该方法将创建能够高效收集患者观点的仪器，同时允许医疗系统、研究人员和其他感兴趣的各方随着时间、疾病和人群的变化来监测和比较结果。
