Patient-Reported Outcomes Measurement System (PROMIS®) for Patients with Urolithiasis: Initial Report

Purpose: Health related quality of life is increasingly important in quality improvement efforts for medical conditions. However, it has proved challenging to measure health related quality of life for urolithiasis, given the distinct chronic and acute phases of this disease. We evaluated the use of PROMIS (R) (Patient-Reported Outcomes Measurement System) to assess the patient experience through acute stone episode stages. Materials and Methods: PROMIS pain measures (intensity and interference) were obtained from patients at a subspecialty kidney stone clinic. Four types of clinical encounters were considered, including emergency department followup, trial of passage, stent removal and 1-month postoperative findings. Raw scores were translated into population normed T-scores with a T-score of 50 considered the reference population mean and a score of 60 considered 1 SD above the mean. T-scores were compared across encounter types on univariate and multivariate analysis. Results: A total of 2,018 complete surveys were available from 1,162 patients. Mean pain intensity and pain interference T-scores differed significantly by encounter type (p < 0.001). On multivariate analysis the OR of T-scores greater than 60 was higher for pain intensity and interference for all encounter types relative to postoperative findings, including emergency department followup 37.9 vs 124.9, passage trial 5.4 vs 10.5 and stent removal 9.4 vs 30.2 (p < 0.001). Additionally, female gender and younger age were independent risk factors for T-scores greater than 60. Conclusions: PROMIS pain measures are responsive to the phase of care during symptomatic stone events. Further application of this instrument holds great potential as a valuable tool to improve the quality of urolithiasis care.