PROMIS Profile Measures in Older Adults - Identifying Cognitive Thresholds for Reliable and Valid Responses

老年人的 PROMIS 概况测量 - 确定可靠和有效反应的认知阈值

• 批准号: 10425407
• 负责人: ANN L GRUBER-BALDINI
• 金额: $ 61.88万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10425407
• 关键词: Adopted; Age; Alzheimer' s Disease; Alzheimer' s disease related dementia; Anxiety; Awareness; Chronic; Cognition; Cognitive; Complex; Data; Data Reporting; Dementia; Elderly; Electronic Health Record; Enrollment; Ensure; Fatigue; Health; Health Status; Hospitalization; Impaired cognition; Individual; Information Systems; Investigation; Measurement; Measures; Mental Depression; Methods; Modeling; Outcome Assessment; Outcome Measure; Outpatients; Pain; Participant; Patient Outcomes Assessments; Patient Self-Report; Patient-Focused Outcomes; Patients; Pattern; Persons; Phase; Physical Function; Population; Proxy; Quality of Care; Race; Reporting; Research; Research Personnel; Respondent; Role; Sampling; Sleep; Social Desirability; Subgroup; Surveys; Testing; Translations; United States National Institutes of Health; Validation; Validity and Reliability; Voice; aged; base; clinical practice; cognitive capacity; cognitive function; cognitive interview; cognitive testing; computerized; design; disability; falls; improved; instrument; mental state; mild cognitive impairment; multiple chronic conditions; psychological distress; response; theories; tool

Project Summary The National Institutes of Health (NIH) Patient-Reported Outcomes Measurement Information System (PROMIS®) measures were developed to provide highly precise and valid measures of patient-reported outcomes, establish a common metric across chronic health conditions, and enable computerized adaptive testing. The PROMIS tools have not been widely tested in the older adult population, especially those aged 80 and older nor among those with Mild Cognitive Impairment (MCI) and Alzheimer's and Related Dementias (ADRD). The reliability and validity of responses provided by those with MCI or ADRD on PROMIS measures is unknown, as are the threshold on cognitive measures where self-reported PROMIS data are no longer representative of underlying health status.The Specific Aim of this project is to validate the PROMIS Profile measures in older adults and to identify the threshold where cognitive impairment invalidates these measures. We will test the utility of the PROMIS Profile measures (29-, 43-, and 57-item versions) among older adults with varying levels of cognitive impairment to find thresholds (cut points) where patient-reported data can no longer be reliably or validly attained. Cognitive levels will be assessed with the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE). A total of 448 subjects will be enrolled from outpatient practices ensuring equal numbers of subjects, ages 65-79 and 80+ years as well as a spectrum of cognitive function from normal cognition to MCI to ADRD. Qualitative cognitive interviews in 48 older adults will examine patient understanding of individual items and capacity to provide valid information. The cognitive interviews will be used to elucidate patterns of response based on cognitive complexity of the items relative to the cognitive capacity of the participants. Quantitative investigation of the thresholds of cognition on the PROMIS profile measures (29-, 43-, and 57-item versions) will be done in an additional sample of 400 older adults to identify the cognitive threshold where responses become inconsistent (unreliable) and invalid. Scale reliability and item functioning will be assessed in three ways: i) investigating differential item functioning on the PROMIS Profiles for the MoCA and MMSE threshold where patient reports become less internally consistent (using Item- Response Theory modeling); ii) split-half reliability of PROMIS Profiles to identify where internal consistency falls below alpha=0.8; and iii), patterns of responses elucidated in Aim 1 will be examined to identify thresholds where subjects use satisficing strategies. Validity will be assessed by examining the consistency of relationships between PROMIS Profiles and other variables (e.g., collateral proxy reports, self-reports on similar measures) cross-sectionally for concurrent validity and longitudinally (e.g., hospitalizations, falls), to show predictive validity. The study will result in practical data for immediate translation in research and clinical practice on the capacity of older adults with varying levels of cognitive impairment to provide accurate responses on PROMIS measures of disability and psychological distress.

项目摘要 美国国立卫生研究院（NIH）患者报告结局测量信息系统 （PROMIS®）的措施，以提供高度精确和有效的措施，病人报告 结果，建立慢性健康状况的共同指标，并使计算机化的自适应 试验. PROMIS工具尚未在老年人群体，特别是80岁的老年人群体中进行广泛测试 而老年人也没有轻度认知障碍（MCI）和阿尔茨海默氏症及相关痴呆症 （ADRD）. MCI或ADRD患者对PROMIS测量结果的信度和效度 是未知的，因为自我报告的PROMIS数据不再是 该项目的具体目标是验证PROMIS概况 在老年人的措施，并确定阈值，认知障碍使这些措施无效。 我们将在老年人中测试PROMIS个人资料测量（29项、43项和57项版本）的效用 具有不同程度的认知障碍，以找到患者报告数据无法识别的阈值（临界点） 不再可靠或有效地实现。认知水平将通过蒙特利尔认知评估进行评估 简易精神状态检查（MMSE）。共448例受试者将从门诊入组 实践确保受试者数量相等，年龄为65-79岁和80岁以上，以及认知能力范围 从正常认知到MCI再到ADRD。48名老年人的定性认知访谈将研究 耐心地理解个别项目，并有能力提供有效的信息。认知访谈将 用于阐明基于项目的认知复杂性的反应模式， 参与者的能力。PROMIS量表认知阈值的定量研究 将在另外400名老年人的样本中进行测量（29项、43项和57项版本），以确定 反应变得不一致（不可靠）和无效的认知阈值。量表信度和项目 功能将通过三种方式进行评估：i）调查PROMIS配置文件上的差异项目功能 对于莫卡和MMSE阈值，其中患者报告变得不太内部一致（使用项目- 响应理论建模）; ii）PROMIS配置文件的分半可靠性，以确定内部一致性 福尔斯低于α =0.8;以及iii）将检查目标1中阐明的反应模式，以确定阈值 受试者使用满足策略的情况。将通过检查以下内容的一致性来评估有效性： PROMIS配置文件和其他变量之间的关系（例如，附属代理报告，自我报告 类似的测量）横向地用于并行有效性和纵向地（例如，住院、福尔斯）， 显示预测有效性。该研究将产生实用数据，可立即用于研究和临床 实践对老年人的能力与不同程度的认知障碍，提供准确的 残疾和心理困扰PROMIS措施的反应。