Eyeworld

26 February 2018 EW NEWS & OPINION by Stefanie Petrou Binder, MD, EyeWorld Contributing Writer Presentation spotlight PROMIS initiative collects patient reported outcome data to be applied for research and healthcare improve- ments. "Integrating the data from different domains was the challenge and the idea behind PROMIS, a funded initiative of the National Institutes of Health, which is based on item banking," Dr. Alonso said. "PROMIS includes 1,400+ questions (items) for adult patients and 89 item banks (domains) of specific domains. The questions are built on legacy instruments, all the previous QoL specific/generic instruments, and domain specific instruments, and have been analyzed by modern test theory and item response the- ory. For children, there are 22 item banks comprised of 460+ questions. Importantly, this item bank can be modified to accommodate particular issues and calibrated again to have comparable measures." PROMIS data is compiled globally from self-reported health data covering physical, mental, and social health aspects. Physical health domains include symptoms and function; mental health domains are affect, behavior, and cognition; and social health includes the domains that relate to relationships and func- tion. Symptoms allotted to these domains are the units of measure of PROMIS. Basic tools for PROMIS assessment include computerized adaptive testing (CAT), global health index (GHI), and health profile (HP). In practical terms, each domain (symptom) is scored and categorized as better, average, or worse. The cli- nician can easily identify worsening or improving symptoms. In terms of the overall score, the higher the score for symptoms, the worse the situation, while conversely, domains like social activity and social role are "capacities" for which higher scores reflect better outcomes. "The PROMIS Assessment Center is a facility for researchers or clinicians to use PROMIS tools," Dr. Alonso said. "It is a web-based research management tool for the distribution of PROMIS instruments and display of item and instrument level statistics. It also allows the Disease specific PROMs have become important in the assessment of patients with particular diseases, however, a problem these question- naires have is their inability to allow for easy comparisons between differ- ent patient types. "Disease specific questionnaires have high accept- ability and clinical relevance, but permit no comparison to the general population, limiting economic eval- uations," he explained. Examples of domain specific instruments include questionnaires such as PHQ-9 and neuro-QoL. They focus on a particular dimension that measures health related problems in a more detailed, precise way, allow- ing for a more exact, less time-con- suming measurement. One of the problems of using domain specific instruments, however, is that using too many domains may make it hard to integrate the results. PROMIS To develop and validate item banks and domain specific input, the na, Spain, discussed the advantages of the Patient Reported Outcomes Measurement Information System (PROMIS) and International Consor- tium for Health Outcomes Measure- ment (ICHOM) data collection on improving healthcare. Patient reported outcome measures Patient reported outcome measures (PROMs) largely highlight quality of life issues, as the improvements that patients experience in their quality of life constitute the greatest moti- vation for treatment. PROMs can be generic, disease specific, or domain specific. Generic instruments of quality of life are broad in terms of what they measure. "Generic instru- ments tend to give a good picture of the overall health status, but they tend to be long and nonspecific and not very useful for clinicians who are more interested in finding a particular correlation between clinical changes and quality of life," Dr. Alonso said. PROMIS and ICHOM allow treatment overviews that can ultimately advance healthcare D octors become inundat- ed with patient data but don't always have a way to meaningfully interpret the facts and figures on a wid- er scale. How can clinicians assess their patients' symptoms and func- tion in a way that can help improve their treatment? Patient reported outcomes measures turn symptoms into numerical scores that the clini- cian can track over time and then implement to improve an individ- ual patient's care as well as that of groups or entire patient populations. In a presentation at the XXXV Congress of the ESCRS, public health researcher Jordi Alonso, MD, head of epidemiology and public health program, Hospital del Mar Medical Research Institute (IMIM-CIBERESP), Pompeu Fabra University, Barcelo- Using patient reported outcomes to improve standards of care The International Consortium for Health Outcomes Measurement (ICHOM) measures patient outcomes to assess the success of treatments for medical conditions such as cataract and macular degeneration. Source: Jordi Alonso, MD

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