New Item Bank for Prescription Pain Medication Developed for PROMIS
- The Patient-Reported Outcomes Measurement Information System (PROMIS®) is an NIH roadmap initiative designed to improve the assessment of self-reported outcomes using state-of-the-art psychometric methods.
There are more than 50 PROMIS item banks measuring a range of physical, mental, and social health constructs in adults and children. Current PROMIS® item banks take a broad approach to substance use disorders, simply referring to “drugs” in general. However, the abuse of prescription pain medications, and the morbidity and mortality associated with such abuse, have become pronounced public health problems over the last decade, resulting in the need for a more specific measure in PROMIS® of severity of abuse of such medications in clinical and community samples.
The project to develop just such an item bank began with a comprehensive literature search, resulting in an initial list of over 5,300 items relevant to substance use and abuse, including abuse of prescription pain medication, from over 80 unique instruments. After qualitative item analysis (focus groups, cognitive interviewing, expert review, and item revision), 25 items were included in field testing.
Items were written in a first-person, past-tense format (“I kept a hidden supply of pain medication,” “I experienced cravings for pain medication,” e.g.), and participants responded using a 5-point scale reflecting frequency or severity for each item as it related to their experiences over the previous 3 months.
The new scale was tested on a calibration sample that included 448 respondents – 367 from the general population and 81 from community treatment programs participating in the NIDA Clinical Trials Network.
A final bank of 22 items was calibrated by the sample using the two-parameter grade response model from item response theory, and a 7-item static short form was also developed. The test information curve showed that the new item bank provided substantial information in a broad range of severity.
Conclusions: The initial psychometric characteristics of the item bank support its use as a computerized adaptive test or short form, with either version providing a brief, precise, and efficient measure relevant to both clinical and community samples. The new item bank adds to the existing body of PROMIS® measures and is responsive to the need for additional instruments to assess the risk associated with prescribing opioid pain medication and to monitor potential misuse during treatment.
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