Validity evidence for the Patient Reported Outcome Measurement Information System (PROMIS)

Objectives: This study aims to provide evidence on the validity of the Patient Reported Outcome Measurement Information System (PROMIS) Methods: We analyzed data of 19,037 patients aged 65+ who completed the cognitive screener during their Medicare Annual Wellness visit (Once=16,115; Twice= 2922) in a large healthcare system. Bivariate and multivariate ordinary least squares and logistic regression were used to examine key risk factors and their cross-sectional and predictive relationships with PRO-CS scores and cognitive decline. Results: We found cognitive impairment based on PRO-CS scores was associated with having a clinical diagnosis (unadjusted Odds Ratio = -3.22(0.18), p < .001). PRO-CS scores were also found to have cross-sectional relationships with a wide range of known risk factors for cognitive impairment, including age, emotional distress, social needs, frailty, and overall general health (all ps < .001). Group-level analyses indicate that PRO-CS scores were useful for detecting subjective cognitive decline occurring within one year, with declining scores predicted by indicators of frailty and general health (all ps < .001). Conclusion: Our findings support the validity of using the PRO-CS to detect risk for subjective cognitive decline among older adults during Medicare Annual Wellness visits. Specifically, the PRO-CS is useful in detecting potential cases of MCI and subjective cognitive decline who are at higher risk of transitioning into a confirmed diagnosis of MCI or dementia in the future.