Advertisement

Journal of General Internal Medicine

, Volume 34, Issue 8, pp 1452–1458 | Cite as

Use of PROMIS-29® in US Veterans: Diagnostic Concordance and Domain Comparisons with the General Population

  • Sherri L. LaVelaEmail author
  • Bella Etingen
  • Scott Miskevics
  • David Cella
Original Research

Abstract

Background

PROMIS® items have not been widely or systematically used within the Veterans Health Administration (VA).

Objective

To examine the concordance of PROMIS-29® scores and medical record diagnosis in US Veterans and to compare Veteran scores relative to US population norms.

Design/Participants

Cross-sectional multi-site survey of Veterans (n = 3221) provided sociodemographic and PROMIS-29® domain data. Electronic medical records provided health condition (depression, anxiety, sleep disorders, pain disorders) diagnosis data.

Main Measures

For each domain, we calculated PROMIS® standardized T scores and used t tests to compare PROMIS® scores for Veterans diagnosed with each targeted health condition vs. those without that documented clinical diagnosis and compare mean Veterans’ PROMIS-29® with US adult population norms.

Key Results

Veterans with (vs. without) a depression diagnosis reported significantly higher PROMIS® depression scores (60.3 vs. 49.6, p < .0001); those with an anxiety diagnosis (vs. without) reported higher average PROMIS® anxiety scores (62.7 vs. 50.9, p < .0001). Veterans with (vs. without) a pain disorder reported higher pain interference (65.3 vs. 57.7, p < .0001) and pain intensity (6.4 vs. 4.4, p < .0001). Veterans with (vs. without) a sleep disorder reported higher sleep disturbance (55.8 vs. 51.2, p < .0001) and fatigue (57.5 vs. 51.8, p < .0001) PROMIS® scores. Compared with the general population norms, Veterans scored worse across all PROMIS-29® domains.

Conclusions

We found that PROMIS-29® domains are selectively sensitive to expected differences between clinically-defined groups, suggesting their appropriateness as indicators of condition symptomology among Veterans. Notably, Veterans scored worse across all PROMIS-29(R) domains compared with population norms. Taken collectively, our findings suggest that PROMIS-29® may be a useful tool for VA providers to assess patient’s physical and mental health, and because PROMIS® items are normed to the general population, this offers a way to compare the health of Veterans with the adult population at large and identify disparate areas for intervention.

KEY WORDS

patient-reported outcomes Veterans health-related quality of life physical health mental health social role PROMIS 

Notes

Acknowledgements

This material is based on work supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development, Quality Enhancement Research Initiative, and Office of Patient-Centered Care and Cultural Transformation.

Compliance with Ethical Standards

Conflict of Interest

Dr. Cella has NIH grant funding at Northwestern University for PROMIS. All remaining authors declare that they do not have a conflict of interest.

Disclaimer

The views expressed in this presentation are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

References

  1. 1.
    Pearman TP, Beaumont JL, Cella D, Neary MP, Yao J. Health-related quality of life in patients with neuroendocrine tumors: an investigation of treatment type, disease status, and symptom burden. Support Care Cancer 2016;24(9):3695–703.CrossRefGoogle Scholar
  2. 2.
    Yount SE, Beaumont JL, Chen SY, et al. Health-related quality of life in patients with idiopathic pulmonary fibrosis. Lung. 2016;194(2): 227–34.CrossRefGoogle Scholar
  3. 3.
    Lai JS, Beaumont JL, Jensen SE, et al. An evaluation of health-related quality of life in patients with systemic lupus erythematosus using PROMIS and Neuro-QoL. Clin Rheumatol 2017;36(3):555–62.CrossRefGoogle Scholar
  4. 4.
    Katz P, Pedro S, Michaud K. Performance of the PROMIS 29-Item profile in rheumatoid arthritis, osteoarthritis, fibromyalgia, and systemic lupus erythematosus. Arthritis Care Res 2017;69(9):1312–21.CrossRefGoogle Scholar
  5. 5.
    Ho B, Houck JR., Flemister AS, et al. Preoperative PROMIS scores predict postoperative success in foot and ankle patients. Foot Ankle Int 2016;37(9):911–8.CrossRefGoogle Scholar
  6. 6.
    Cella D, Riley W, Stone A, et al. The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005-2008. J Clin Epidemiol 2010;63(11):1179–94.CrossRefGoogle Scholar
  7. 7.
    National Institutes of Health (NIH). PROMIS Short Forms for Open Distribution. Bethesda, MD: NIH; 2012.Google Scholar
  8. 8.
    Craig BM, Reeve BB, Brown PM, et al. US valuation of health outcomes measured using the PROMIS-29. Value Health 2014;17(8):846–53.CrossRefGoogle Scholar
  9. 9.
    Craig BM, Reeve BB, Cella D, Hays RD, Pickard AS, Revicki DA. Demographic differences in health preferences in the United States. Med Care 2014;52(4):307–13.CrossRefGoogle Scholar
  10. 10.
    Thompson CF, Price CP, Huang JH, et al. A pilot study of symptom profiles from a polyp vs an eosinophilic-based classification of chronic rhinosinusitis. Int Forum Allergy Rhinol 2016;6(5):500–7.CrossRefGoogle Scholar
  11. 11.
    Hinchcliff ME, Beaumont JL, Carns MA, et al. Longitudinal evaluation of PROMIS-29 and FACIT-dyspnea short forms in systemic sclerosis. J Rheumatol 2015;42(1):64–72.CrossRefGoogle Scholar
  12. 12.
    Alcantara J, Ohm J, Alcantara J. The use of PROMIS and the RAND VSQ9 in chiropractic patients receiving care with the Webster Technique. Complement Ther Clin Pract 2016;23:110–6.CrossRefGoogle Scholar
  13. 13.
    Schnall R, Liu J, Cho H, Hirshfield S, Siegel K, Olender S. A health-related quality-of-life measure for use in patients with HIV: a validation study. AIDS Patient Care STDs 2017;31(2):43–8.CrossRefGoogle Scholar
  14. 14.
    Deyo RA, Ramsey K, Buckley DI, et al. Performance of a Patient Reported Outcomes Measurement Information System (PROMIS) short form in older adults with chronic musculoskeletal pain. Pain Med. 2016;17(2):314–24.Google Scholar
  15. 15.
    Department of Veterans Affairs. Defining Excellence, VHA Strategic Plan 2013-2018. Available at: https://www.va.gov/health/docs/VHA_STRATEGIC_PLAN_FY2013-2018.pdf. Accessed 23 January 2019.
  16. 16.
    LaVela SL, Hill JM. Staff perceptions of implementation of a team-based model of patient-centered primary care. Int J Person-Centered Med 2014;4(4):244–55.Google Scholar
  17. 17.
    Schalet BD, Rothrock NE, Hays RD, et al. Linking physical and mental health summary scores from the Veterans RAND 12-Item Health Survey (VR-12) to the PROMIS(®) Global Health Scale. J Gen Intern Med 2015;30(10):1524–30.CrossRefGoogle Scholar
  18. 18.
    Littman AJ, Boyko EJ, Thompson ML, Haselkorn JK, Sangeorzan BJ, Arterburn DE. Physical activity barriers and enablers in older Veterans with lower-limb amputation. J Rehabil Res Dev 2014;51(6):895–906.CrossRefGoogle Scholar
  19. 19.
    Moye J, June A, Martin LA, Gosian J, Herman LI, Naik AD. Pain is prevalent and persisting in cancer survivors: differential factors across age groups. J Geriatr Oncol 2014;5(2):190–6.CrossRefGoogle Scholar
  20. 20.
    Zullig LL, Jackson GL, Provenzale D, Griffin JM, Phelan S, van Ryn M. Transportation: a vehicle or roadblock to cancer care for VA patients with colorectal cancer? Clin Colorectal Cancer 2012;11(1):60–5.CrossRefGoogle Scholar
  21. 21.
    Kean J, Monahan PO, Kroenke K, Wu J, Yu Z, Stump TE, Krebs EE. Comparative responsiveness of the PROMIS Pain Interference Short Forms, Brief Pain Inventory, PEG, and SF-36 Bodily Pain Subscale. Med Care 2016;54(4):414–21.CrossRefGoogle Scholar
  22. 22.
    Davis LL, Kroenke K, Monahan P, Kean J, Stump TE. The SPADE symptom cluster in primary care patients with chronic pain. Clin J Pain 2016;32(5):388–393.CrossRefGoogle Scholar
  23. 23.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing; 2013.CrossRefGoogle Scholar
  24. 24.
    Revicki D, Hays R, Cella D, Sloan J. Recommended methods for determining responsiveness and minimally important differences for patient-reported outcomes. J Clin Epidemiol 2008;61(2):102–9.CrossRefGoogle Scholar
  25. 25.
    Cella D, Lai JS, Jensen SE, et al. PROMIS fatigue item bank had clinical validity across diverse chronic conditions. J Clin Epidemiol 2016;73:128–34.CrossRefGoogle Scholar
  26. 26.
    Schalet BD, Pilkonis PA, Yu L, et al. Clinical validity of PROMIS depression, anxiety, and anger across diverse clinical samples. J Clin Epidemiol 2016;73:119–27.CrossRefGoogle Scholar
  27. 27.
    Zoellner LA, Rothbaum BO, Feeny NC. PTSD not an anxiety disorder? DSM committee proposal turns back the hands of time. Depress Anxiety 2011;28(10):853–6.CrossRefGoogle Scholar
  28. 28.
    Pai A, Suris AM, North CS. Posttraumatic stress disorder in the DSM-5: controversy, change, and conceptual considerations. Behav Sci (Basel) 2017;7(1). E7. Published online. doi:  https://doi.org/10.3390/bs7010007.CrossRefGoogle Scholar

Copyright information

© Society for General Internal Medicine (This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply) 2019

Authors and Affiliations

  • Sherri L. LaVela
    • 1
    • 2
    Email author
  • Bella Etingen
    • 1
  • Scott Miskevics
    • 1
  • David Cella
    • 3
  1. 1.Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Health Services Research & DevelopmentEdward Hines Jr. VA HospitalHinesUSA
  2. 2.Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine Northwestern UniversityChicagoUSA
  3. 3.Department of Medical Social Sciences, Feinberg School of MedicineNorthwestern UniversityChicagoUSA

Personalised recommendations