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Measuring Value in Spine Care Using the PROMIS-Preference Scoring System.

Richard L Skolasky1, Amy M Cizik2,3, Amit Jain1

  • 1Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.

The Journal of Bone and Joint Surgery. American Volume
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Summary

The Patient-Reported Outcomes Measurement Information System-Preference (PROPr) score effectively measures health utility in spine surgery patients. This validated tool shows responsiveness to surgical outcomes and patient-reported changes in health status.

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Area of Science:

  • Orthopedics
  • Health Economics
  • Psychometrics

Background:

  • Value-based care necessitates understanding intervention costs and impacts on patient health utility.
  • Patient-Reported Outcomes Measurement Information System (PROMIS) is widely used for health domain assessment.
  • The PROMIS-Preference (PROPr) score offers a single, societal preference-based estimate of health utility.

Purpose of the Study:

  • To determine the psychometric properties (validity and responsiveness) of the PROPr score in spine surgery patients.
  • To hypothesize PROPr score correlations with comorbidities, socioeconomic status, and pain-related disability.
  • To assess PROPr score responsiveness to health status changes post-spine surgery.

Main Methods:

  • Prospective cohort study of 904 adults undergoing spine surgery (August 2019-January 2022).
  • Concurrent validity assessed via correlation with Neck Disability Index/Oswestry Disability Index.
  • Known-groups validity evaluated through regression analysis with demographic and clinical factors.
  • Responsiveness determined using an anchor-based approach comparing pre- and post-operative scores at 6 and 12 months.

Main Results:

  • Median preoperative PROPr score was 0.20; associated with higher education, income, and more comorbidities.
  • PROPr scores significantly decreased with increased disability (NDI/ODI, p < 0.001).
  • PROPr score changes were significantly different for patients reporting improved, unchanged, or worse postoperative health at 6 and 12 months (p < 0.001).

Conclusions:

  • The PROPr score is a valid and responsive measure of health utility for spine surgery patients.
  • PROPr scores can be derived from existing PROMIS outcome data.
  • This tool supports value-based care assessments in spine surgery.