Clinical Validity of the PROMIS Healthcare Engagement 8-Item Short Form

Rachel Kimerling; Donna M Zulman; Eleanor T Lewis; Benjamin D Schalet; Steven P Reise; Gisselle C Tamayo

doi:https://doi.org/10.1007/s11606-022-07992-6

Clinical Validity of the PROMIS Healthcare Engagement 8-Item Short Form

Rachel Kimerling, Donna M Zulman, Eleanor T Lewis, Benjamin D Schalet, Steven P Reise, Gisselle C Tamayo

Epidemiology and Data Science (VUmc)

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: Healthcare engagement is a key measurement target for value-based healthcare, but a reliable and valid patient-reported measure has not yet been widely adopted.

OBJECTIVE: To assess the validity of a newly developed patient-reported measure of healthcare engagement, the 8-item PROMIS Healthcare Engagement (PHE-8a).

DESIGN: Prospective cohort study of the association between healthcare engagement and quality of care over 1 year. We fit mixed effects models of quality indicators as a function of engagement scores, adjusting for age, race/ethnicity, rural residence, and risk scores.

PARTICIPANTS: National stratified random sample of 9552 Veterans receiving Veterans Health Administration care for chronic conditions (hypertension, diabetes) or mental health conditions (depression, post-traumatic stress disorder).

MAIN MEASURES: Patient experience: Consumer Assessment of Health Plans and Systems communication and self-management support composites; no-show rates for primary care and mental health appointments; use of patient portal My HealtheVet; and Healthcare Effectiveness Data and Information Set electronic quality measures: HbA1c poor control, controlling high blood pressure, and hyperlipidemia therapy adherence.

KEY RESULTS: Higher engagement scores were associated with better healthcare quality across all outcomes, with each 5-point increase (1/2 standard deviation) in engagement scores associated with statistically significant and clinically meaningful gains in quality. Across the continuum of low to high engagement scores, we observed a concomitant reduction in primary care no-show rates of 37% and 24% for mental health clinics; an increased likelihood of My HealtheVet use of 15.4%; and a decreased likelihood of poor diabetes control of 44%.

CONCLUSIONS: The PHE-8a is a brief, reliable, and valid patient-reported measure of healthcare engagement. These results confirm previously untested hypotheses that patient engagement can promote healthcare quality.

Original language	English
Pages (from-to)	2021-2029
Number of pages	9
Journal	Journal of General Internal Medicine
Volume	38
Issue number	9
DOIs	https://doi.org/10.1007/s11606-022-07992-6
Publication status	Published - Jul 2023

Keywords

Diabetes Mellitus/epidemiology
Humans
Mental Health
Patient Compliance
Prospective Studies
Veterans/psychology

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https://doi.org/10.1007/s11606-022-07992-6

Cite this

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title = "Clinical Validity of the PROMIS Healthcare Engagement 8-Item Short Form",

abstract = "BACKGROUND: Healthcare engagement is a key measurement target for value-based healthcare, but a reliable and valid patient-reported measure has not yet been widely adopted.OBJECTIVE: To assess the validity of a newly developed patient-reported measure of healthcare engagement, the 8-item PROMIS Healthcare Engagement (PHE-8a).DESIGN: Prospective cohort study of the association between healthcare engagement and quality of care over 1 year. We fit mixed effects models of quality indicators as a function of engagement scores, adjusting for age, race/ethnicity, rural residence, and risk scores.PARTICIPANTS: National stratified random sample of 9552 Veterans receiving Veterans Health Administration care for chronic conditions (hypertension, diabetes) or mental health conditions (depression, post-traumatic stress disorder).MAIN MEASURES: Patient experience: Consumer Assessment of Health Plans and Systems communication and self-management support composites; no-show rates for primary care and mental health appointments; use of patient portal My HealtheVet; and Healthcare Effectiveness Data and Information Set electronic quality measures: HbA1c poor control, controlling high blood pressure, and hyperlipidemia therapy adherence.KEY RESULTS: Higher engagement scores were associated with better healthcare quality across all outcomes, with each 5-point increase (1/2 standard deviation) in engagement scores associated with statistically significant and clinically meaningful gains in quality. Across the continuum of low to high engagement scores, we observed a concomitant reduction in primary care no-show rates of 37% and 24% for mental health clinics; an increased likelihood of My HealtheVet use of 15.4%; and a decreased likelihood of poor diabetes control of 44%.CONCLUSIONS: The PHE-8a is a brief, reliable, and valid patient-reported measure of healthcare engagement. These results confirm previously untested hypotheses that patient engagement can promote healthcare quality.",

keywords = "Diabetes Mellitus/epidemiology, Humans, Mental Health, Patient Compliance, Prospective Studies, Veterans/psychology",

author = "Rachel Kimerling and Zulman, {Donna M} and Lewis, {Eleanor T} and Schalet, {Benjamin D} and Reise, {Steven P} and Tamayo, {Gisselle C}",

note = "{\textcopyright} 2023. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.",

year = "2023",

month = jul,

doi = "https://doi.org/10.1007/s11606-022-07992-6",

language = "English",

volume = "38",

pages = "2021--2029",

journal = "Journal of General Internal Medicine",

issn = "0884-8734",

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TY - JOUR

T1 - Clinical Validity of the PROMIS Healthcare Engagement 8-Item Short Form

AU - Kimerling, Rachel

AU - Zulman, Donna M

AU - Lewis, Eleanor T

AU - Schalet, Benjamin D

AU - Reise, Steven P

AU - Tamayo, Gisselle C

PY - 2023/7

Y1 - 2023/7

N2 - BACKGROUND: Healthcare engagement is a key measurement target for value-based healthcare, but a reliable and valid patient-reported measure has not yet been widely adopted.OBJECTIVE: To assess the validity of a newly developed patient-reported measure of healthcare engagement, the 8-item PROMIS Healthcare Engagement (PHE-8a).DESIGN: Prospective cohort study of the association between healthcare engagement and quality of care over 1 year. We fit mixed effects models of quality indicators as a function of engagement scores, adjusting for age, race/ethnicity, rural residence, and risk scores.PARTICIPANTS: National stratified random sample of 9552 Veterans receiving Veterans Health Administration care for chronic conditions (hypertension, diabetes) or mental health conditions (depression, post-traumatic stress disorder).MAIN MEASURES: Patient experience: Consumer Assessment of Health Plans and Systems communication and self-management support composites; no-show rates for primary care and mental health appointments; use of patient portal My HealtheVet; and Healthcare Effectiveness Data and Information Set electronic quality measures: HbA1c poor control, controlling high blood pressure, and hyperlipidemia therapy adherence.KEY RESULTS: Higher engagement scores were associated with better healthcare quality across all outcomes, with each 5-point increase (1/2 standard deviation) in engagement scores associated with statistically significant and clinically meaningful gains in quality. Across the continuum of low to high engagement scores, we observed a concomitant reduction in primary care no-show rates of 37% and 24% for mental health clinics; an increased likelihood of My HealtheVet use of 15.4%; and a decreased likelihood of poor diabetes control of 44%.CONCLUSIONS: The PHE-8a is a brief, reliable, and valid patient-reported measure of healthcare engagement. These results confirm previously untested hypotheses that patient engagement can promote healthcare quality.

AB - BACKGROUND: Healthcare engagement is a key measurement target for value-based healthcare, but a reliable and valid patient-reported measure has not yet been widely adopted.OBJECTIVE: To assess the validity of a newly developed patient-reported measure of healthcare engagement, the 8-item PROMIS Healthcare Engagement (PHE-8a).DESIGN: Prospective cohort study of the association between healthcare engagement and quality of care over 1 year. We fit mixed effects models of quality indicators as a function of engagement scores, adjusting for age, race/ethnicity, rural residence, and risk scores.PARTICIPANTS: National stratified random sample of 9552 Veterans receiving Veterans Health Administration care for chronic conditions (hypertension, diabetes) or mental health conditions (depression, post-traumatic stress disorder).MAIN MEASURES: Patient experience: Consumer Assessment of Health Plans and Systems communication and self-management support composites; no-show rates for primary care and mental health appointments; use of patient portal My HealtheVet; and Healthcare Effectiveness Data and Information Set electronic quality measures: HbA1c poor control, controlling high blood pressure, and hyperlipidemia therapy adherence.KEY RESULTS: Higher engagement scores were associated with better healthcare quality across all outcomes, with each 5-point increase (1/2 standard deviation) in engagement scores associated with statistically significant and clinically meaningful gains in quality. Across the continuum of low to high engagement scores, we observed a concomitant reduction in primary care no-show rates of 37% and 24% for mental health clinics; an increased likelihood of My HealtheVet use of 15.4%; and a decreased likelihood of poor diabetes control of 44%.CONCLUSIONS: The PHE-8a is a brief, reliable, and valid patient-reported measure of healthcare engagement. These results confirm previously untested hypotheses that patient engagement can promote healthcare quality.

KW - Diabetes Mellitus/epidemiology

KW - Humans

KW - Mental Health

KW - Patient Compliance

KW - Prospective Studies

KW - Veterans/psychology

U2 - https://doi.org/10.1007/s11606-022-07992-6

DO - https://doi.org/10.1007/s11606-022-07992-6

M3 - Article

C2 - 37118561

SN - 0884-8734

VL - 38

SP - 2021

EP - 2029

JO - Journal of General Internal Medicine

JF - Journal of General Internal Medicine

IS - 9

ER -