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

基本信息

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
项目类别：
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&apos s Disease Alzheimer&apos 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

项目摘要

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.

项目概要美国国立卫生研究院 (NIH) 患者报告结果测量信息系统 (PROMIS®) 测量的开发是为了提供高度精确和有效的患者报告测量结果，建立针对慢性健康状况的通用指标，并实现计算机化自适应 PROMIS 工具尚未在老年人群中进行广泛测试，尤其是 80 岁的老年人群。及老年人或患有轻度认知障碍 (MCI) 和阿尔茨海默病及相关痴呆症的人 (ADRD) 具有 MCI 或 ADRD 的人员针对 PROMIS 措施提供的答复的可靠性和有效性。是未知的，认知测量的阈值也是未知的，其中自我报告的 PROMIS 数据不再是代表潜在的健康状况。该项目的具体目标是验证 PROMIS 概况老年人的测量，并确定认知障碍使这些测量无效的阈值。我们将测试 PROMIS Profile 测量（29、43 和 57 项版本）在老年人中的实用性具有不同程度的认知障碍，以找到患者报告的数据无法识别的阈值（切点）不再可靠或有效地达到认知水平将通过蒙特利尔认知评估进行评估。 (MoCA) 和简易精神状态检查 (MMSE) 总共将从门诊招募 448 名受试者。确保年龄 65-79 岁和 80 岁以上的受试者数量以及认知范围相同对 48 名老年人的定性认知访谈将检查从正常认知到 MCI 到 ADRD 的功能。认知访谈将考验患者对个别项目的理解和提供有效信息的能力。用于根据项目相对于认知的认知复杂性来阐明反应模式对 PROMIS 概况的认知阈值进行定量调查。将在 400 名老年人的额外样本中进行测量（29、43 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。将通过三种方式评估功能： i) 调查 PROMIS 配置文件上的差异项目功能对于 MoCA 和 MMSE 阈值，患者报告内部一致性较差（使用 Item- ii) PROMIS 配置文件的半可靠性，以确定内部一致性低于 alpha=0.8；以及 iii)，将检查目标 1 中阐明的响应模式以确定阈值当受试者使用令人满意的策略时，将通过检查的一致性来评估有效性。 PROMIS 概况与其他变量之间的关系（例如，抵押代理报告、自我报告）类似的措施）横向和纵向（例如住院、跌倒）的同时有效性，以该研究将产生可立即转化为研究和临床的实用数据。练习对具有不同程度认知障碍的老年人提供准确信息的能力进行练习对 PROMIS 残疾和心理困扰措施的回应。