Assessing Rheumatoid Arthritis Disease Activity With Patient‐Reported Outcomes Measurement Information System Measures Using Digital Technology

Objective Health information technology has enabled efficient measurement of patient‐reported outcomes ( PRO s). The National Institutes of Health Patient‐Reported Outcomes Measurement Information System ( PROMIS ) is becoming more widely adopted for research and routine care, and some PROMIS instruments might be substituted for lengthier, legacy PRO instruments. Methods Four PROMIS computer‐adaptive testing ( CAT ) instruments (pain interference, physical function, sleep disturbance, and fatigue) and the Routine Assessment of Patient Index Data 3 ( RAPID 3), along with pain intensity and patient global assessment score, were administered to participants in the ArthritisPower registry. The RAPID 3 was predicted using different combinations of these variables to create a new score ( CAT ‐ PROMIS RAPID 3). Kappa statistics and Bland‐Altman 95% limits of agreement were used to measure agreement between the observed versus predicted RAPID 3. Results A total of 6,154 eligible patients contributed 11,275 observations. The mean ± SD age was 52.7 ± 10.5 years, and 93% of patients were women. The median assessment times ranged from 29 seconds ( PROMIS sleep disturbance) to 116 seconds ( RAPID 3). As single pairwise comparisons, the PROMIS CAT s examined were modestly correlated (r approximately 0.4–0.7) to one other and RAPID 3. Together with the pain intensity and patient global assessment, the PROMIS instruments explained a high fraction of total variance (R 2 = 0.97) of the RAPID 3 score. In the model with the highest agreement (κ = 0.93) between the observed RAPID 3 and the CAT ‐ PROMIS predicted RAPID 3, Bland‐Altman 95% limits of agreement showed minimal residual differences and no systematic biases. Conclusion There was excellent agreement between the observed RAPID 3 and predicted RAPID 3 scores estimated using several PROMIS instruments. The Multidimensional Health Assessment Questionnaire and patient global assessment components of RAPID 3 may be unnecessary if PROMIS scores are available.