As physicians, we do not always have a full understanding on the effects of disease and treatment on our patients’ lives.  Over the past few decades, hundreds of standardized measures have been developed to capture patient-reported outcomes, including symptom status, physical function, mental health, social function, and wellbeing.  Through understanding of the patient experience, we can work to understand disease and develop treatments that better target our ultimate customer – the patient.

PROMIS, which stands for Patient Reported Outcome Measurement Information System, is an initiative funded by the NIH to develop patient-reported outcome measures.  From the website, PROMIS consists of three areas:

  1. PRO Measure Development Standards: PROMIS stands for a particular set of methods used to develop PRO measures. This methodology was developed by leading PRO researchers from across the country and can be used as a model for future PRO development
  2. PRO Measures: PROMIS used this methodology to create a large number of PRO measures of health in multiple languages, for adults and children.
  3. PRO Administration Software: PROMIS developed software, called “Assessment Center” to facilitate using these new PRO measures with patients.

There are many problems with several outcome measures that have previously been developed and are currently in use:  too long (burdensome), too short (limited data), expensive, cannot cross-compare, etc.  PROMIS aims to improve PRO measurement quality and precision, and does this in part through utilizing item response theory (IRT).  IRT is a psychometric method commonly used in educational testing, but more recently adopted by the field of health outcomes. Statistical models based on IRT produce scores associated with answers to questions. These calibrations provide computer software with the information it needs to select the most informative follow-up question to an initial question. This computer software is called Computer Adaptive Testing (CAT) because the content of the assessment, that is the questions that are asked, adapts to the patient based on his or her responses to the previous question.

Therefore, the hoped for end result of PROMIS CAT are outcome measurements that are valid, reliable, precise, and much less burdensome to administer and take.  A patient can simply answer a few questions on a tablet device or computer and provide valuable outcomes data with minimum burden on them or the practice workflow.

The lead article in the June JOT is titled “PROMIS Physical Function Computer Adaptive Test Compared With Other Upper Extremity Outcome Measures in the Evaluation of Proximal Humerus Fractures in Patients Older Than 60 Years.”  As mentioned by the authors, PROMIS has been very successful in developing several outcome measures for research and clinical use.  However, there have been few studies evaluating the use of PROMIS in the orthopaedic trauma population to date.  I believe that kudos should go to the authors of this (and previous/future) studies in this realm.   The authors found that using the PROMIS PF CAT as a sole PF (physical function) outcome measure can yield an assessment of upper extremity function similar to those provided by traditional PF measures, while substantially reducing patient assessment time.

Please share your thoughts /comments on PROMIS and CAT.  Do you have an opinion in regard to the evaluation of PROMIS measures in orthopaedic trauma?  Have you had other experiences with these instruments?  Ideas on overcoming administrative burden?

Hassan R. Mir, MD, MBA, FACS

Editor | OsteoSynthesis – The JOT Online Discussion Forum