Selection of key health domains from PROMISA® for a generic preference-based scoring system

We sought to select a parsimonious subset of domains from the patient-reported outcomes measurement information system (PROMISA (R)) that could be used for preference-based valuation. Domain selection criteria included face validity, comprehensiveness, and structural independence. First, 9 health outcomes measurement experts selected domains appropriate for a general health measure using a modified Delphi procedure. Second, 50 adult community members assessed structural independence of domain pairs. For each pair, the participant was asked if it were possible to have simultaneously good functioning in domain 1 but poor functioning in domain 2, and vice versa. The community members also rated the relative importance of the domains. Finally, the experts selected domains, guided by community members' judgments of structural independence and importance. After 3 rounds of surveys, the experts agreed on 10 potential domains. The percent of pairs deemed structurally independent by community members ranged from 50 to 95 (mean = 78). Physical Function, Pain Interference, and Depression were retained because of their inclusion in existing preference-based measures and their importance to community members. Four other domains were added because they were important to community members and judged to be independent by at least 67% of respondents: Cognitive Function-Abilities; Fatigue; Ability to Participate in Social Roles and Activities; and Sleep Disturbance. With input from measurement experts and community members, we selected 7 PROMIS domains that can be used to create a preference-based score.