RAND Corporation, 4570 Fifth Avenue #600, 15213, Pittsburgh, PA, USA.
Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
J Patient Rep Outcomes. 2024 Apr 10;8(1):43. doi: 10.1186/s41687-024-00699-8.
Cognitive assessment is a required component of the Medicare Annual Wellness Visit (AWV). In this prospective study, we evaluated acceptability and usefulness of a patient-reported outcome measure (the PROMIS® Cognitive Function Screener, or PRO-CS) to screen for cognitive impairment during the AWV. We compared two versions of the PRO-CS: Abilities and Concerns.
We developed PRO-CS Abilities and PRO-CS Concerns using items from the PROMIS Cognitive Function item banks. We partnered with a large health system in Pennsylvania to implement an electronic health record (EHR)-integrated version of the 4-item PRO-CS into their AWV workflow. PRO-CS Abilities was implemented in June 2022 and then replaced with PRO-CS Concerns in October 2022. We used EHR data to evaluate scores on Abilities versus Concerns and their association with patient characteristics. We gathered feedback from providers on experiences with the PRO-CS and conducted cognitive interviews with patients to evaluate their preferences for Abilities versus Concerns.
Between June 2022 and January 2023, 3,088 patients completed PRO-CS Abilities and 2,614 patients completed PRO-CS Concerns. Mean T-scores for Abilities (54.8) were slightly higher (indicating better cognition) than for Concerns (52.6). 10% of scores on Abilities and 13% of scores on Concerns indicated concern for cognitive impairment (T-score < 45). Both Abilities and Concerns were associated with clinical characteristics as hypothesized, with lower scores for patients with cognitive impairment diagnoses and those requiring assistance with instrumental activities of daily living. Abilities and Concerns had similar negative correlations with depression (r= -0.31 versus r= -0.33) and anxiety (r= -0.28 for both), while Abilities had a slightly stronger positive correlation with self-rated health (r = 0.34 versus r = 0.28). In interviews, providers commented that the PRO-CS could be useful to facilitate conversations about cognition, though several providers noted potential limitations of patient self-report. Feedback from patients indicated a preference for PRO-CS Concerns.
Our findings suggest potential utility of the PRO-CS for cognitive screening in the Medicare AWV. PRO-CS Abilities and Concerns had similar associations with patient clinical characteristics, but the Concerns version was more acceptable to patients.
认知评估是医疗保险年度健康访视（AWV）的必需组成部分。在这项前瞻性研究中，我们评估了患者报告结局测量（PROMIS®认知功能筛查器，或 PRO-CS）在 AWV 期间筛查认知障碍的可接受性和有用性。我们比较了 PRO-CS 的两种版本：能力和关注点。
我们使用 PROMIS 认知功能项目库中的项目开发了 PRO-CS 能力和 PRO-CS 关注点。我们与宾夕法尼亚州的一家大型医疗系统合作，将四项目 PRO-CS 的电子健康记录（EHR）集成版本纳入他们的 AWV 工作流程。PRO-CS 能力于 2022 年 6 月实施，然后于 2022 年 10 月被 PRO-CS 关注点取代。我们使用 EHR 数据评估能力与关注点的得分及其与患者特征的关联。我们从提供者那里收集了对 PRO-CS 的经验反馈，并对患者进行认知访谈，以评估他们对能力与关注点的偏好。
在 2022 年 6 月至 2023 年 1 月期间，3088 名患者完成了 PRO-CS 能力，2614 名患者完成了 PRO-CS 关注点。能力的平均 T 分数（54.8）略高于关注点（52.6），表明认知功能更好。能力的 10%和关注点的 13%的得分表明对认知障碍的关注（T 分数<45）。能力和关注点都与临床特征相关，认知障碍诊断和需要日常生活活动辅助的患者得分较低。能力和关注点与抑郁（r=-0.31 与 r=-0.33）和焦虑（r=-0.28 均为）呈负相关，而能力与自我评估健康的相关性略强（r=0.34 与 r=0.28）。在访谈中，提供者评论说，PRO-CS 可以有助于促进关于认知的对话，尽管一些提供者指出了患者自我报告的潜在局限性。患者的反馈表明对 PRO-CS 关注点的偏好。
我们的研究结果表明，PRO-CS 有可能用于医疗保险 AWV 中的认知筛查。PRO-CS 能力和关注点与患者的临床特征具有相似的关联，但关注点版本更受患者欢迎。
