Lapin Brittany, Katzan Irene L
Center for Outcomes Research & Evaluation, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, JJ3-603, USA.
Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
Qual Life Res. 2023 Jan;32(1):105-113. doi: 10.1007/s11136-022-03206-y. Epub 2022 Aug 10.
Patient-reported outcome measures (PROMs), including global health and construct-specific measures, are collected across healthcare systems. Efforts should be made to reduce data collection burden and individualize survey administration to patient needs. Our study evaluated the ability of utilizing items on a global health measure to identify patients who may require additional screening.
A cross-sectional study was conducted of patients who completed PROMIS Global Health (GH) as part of routine care, as well as additional construct-specific surveys, in a large healthcare system from 1/1/2016 to 12/31/2018. Receiver operating characteristic (ROC) analysis identified optimal thresholds for PROMIS GH items identifying clinically meaningful thresholds on construct-specific PROMs: PHQ-9 score ≥10, Neuro-QoL Cognitive Function, PROMIS Physical Function, and Satisfaction with Social Roles and Activities T-score ≤40, PROMIS Anxiety, Fatigue, Sleep Disturbance, and Pain Interference T-score ≥60.
There were 206,685 patients who completed PROMIS GH and additional construct-specific surveys. Scores ≤3 on PROMIS GH item 10 (emotional problems) had 90.0% sensitivity (area under the curve (AUC) = 0.821) for identifying patients with moderate-severe depressive symptoms on PHQ-9. Similarly high sensitivities and AUCs were demonstrated for PROMIS GH items assessing mental and physical health, fatigue, and pain to identify poor scores on their corresponding construct-specific PROMs.
Our study provides preliminary support for the ability of utilizing PROMIS GH items as screening tools to identify patients with poor scores on additional construct-specific PROMs. Through directing construct-specific PROMs to patients for whom they are most applicable, survey burden could be reduced for many patients, allowing a more efficient and targeted use of PROMs in healthcare decision-making.
患者报告结局测量指标（PROMs），包括总体健康状况和特定结构测量指标，在各个医疗保健系统中均有收集。应努力减轻数据收集负担，并根据患者需求对调查管理进行个性化设置。我们的研究评估了利用总体健康测量指标中的条目来识别可能需要额外筛查的患者的能力。
对2016年1月1日至2018年12月31日期间在一个大型医疗保健系统中作为常规护理一部分完成PROMIS总体健康（GH）以及其他特定结构调查的患者进行了一项横断面研究。受试者操作特征（ROC）分析确定了PROMIS GH条目的最佳阈值，这些条目可识别特定结构PROMs上具有临床意义的阈值：PHQ-9评分≥10、神经生活质量认知功能、PROMIS身体功能以及社会角色和活动满意度T评分≤40、PROMIS焦虑、疲劳、睡眠障碍和疼痛干扰T评分≥60。
共有206,685名患者完成了PROMIS GH和其他特定结构调查。PROMIS GH条目10（情绪问题）得分≤3对于识别PHQ-9上有中度至重度抑郁症状的患者具有90.0%的灵敏度（曲线下面积（AUC）=0.821）。对于评估心理和身体健康、疲劳和疼痛的PROMIS GH条目，在识别其相应特定结构PROMs上的低分方面也显示出同样高的灵敏度和AUC。
我们的研究为利用PROMIS GH条目作为筛查工具来识别在其他特定结构PROMs上得分较低的患者的能力提供了初步支持。通过将特定结构的PROMs指向最适用的患者，许多患者的调查负担可以减轻，从而在医疗决策中更高效、有针对性地使用PROMs。
