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:10.1007/s11606-022-07992-6

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

J Gen Intern Med. 2023 Jul;38(9):2021-2029. doi: 10.1007/s11606-022-07992-6. Epub 2023 Apr 28.

Authors

Rachel Kimerling^{1

2}, Donna M Zulman^{3

4}, Eleanor T Lewis⁵, Benjamin D Schalet⁶, Steven P Reise⁷, Gisselle C Tamayo^{8

3}

Affiliations

¹ National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Rd, Menlo Park, CA, 94025, USA. rachel.kimerling@va.gov.
² Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA. rachel.kimerling@va.gov.
³ Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA.
⁴ Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA.
⁵ Program Evaluation and Resource Center, Office of Mental Health and Suicide Prevention, Veterans Health Administration, Washington, DC, USA.
⁶ Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
⁷ Department of Psychology, University of California, Los Angeles, CA, USA.
⁸ National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Rd, Menlo Park, CA, 94025, USA.

PMID: 37118561
PMCID: PMC10361929 (available on 2024-07-01)
DOI: 10.1007/s11606-022-07992-6

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: Veterans; consumer engagement; patient-reported outcome measures; quality indicators.

Publication types

Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

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

Grants and funding

I01 HX002317/HX/HSRD VA/United States