Multidimensional adaptive testing for mental health problems in primary care
Multidimensional adaptive testing for mental health problems in primary care
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DOI：
10.1097/00005650-200209000-00010
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发表时间：
2002-09-01
期刊：
影响因子：
3
通讯作者：
Pajer, KA
中科院分区：
文献类型：
--
作者：
Gardner, W;Kelleher, KJ;Pajer, KA
目标。在临床实践和研究中，评估儿童精神病理学的有效和准确的工具越来越重要。例如，在初级保健环境中进行筛查可以确定患有疾病的儿童和青少年，否则这些疾病可能无法被发现。然而，初级保健办公室以就诊时间短而臭名昭著，筛查不能用长时间的问卷给患者或工作人员带来负担。一种解决方案是缩短评估工具，但放弃问题通常会降低工具的准确性。另一种选择是适应性测试，在这种测试中，计算机根据患者以前的反应来选择要询问患者的项目。本研究采用模拟的方法对基于该技术的儿童心理健康筛查进行了测试。研究设计。利用一半的大样本数据，开发了儿科症状检查表(PSC)的计算机版本，这是一种父母报告的心理社会问题筛查。结果：通过因子分析确定了四个潜在的心理社会问题维度：内化问题、外化问题、注意力问题和学校问题。一项衡量这些特征的模拟适应性测试平均向每个患者提出了11.6个问题，49%的样本提出了5个或更少的问题。适应性测验和完整的(35个条目)PSC之间有很高的一致性：只有1.3%的筛查决定是不一致的(K=0.93)。这一一致性高于使用相同长度(12个条目)的PSC获得的结果(3.2%的决策不一致；K=0.84)。结论：多维适应性测试可能是一种在初级保健环境中筛查精神健康问题的准确和有效的技术。
OBJECTIVES. Efficient and accurate instruments for assessing child psychopathology are increasingly important in clinical practice and research. For example, screening in primary care settings can identify children and adolescents with disorders that may otherwise go undetected. However, primary care offices are notorious for the brevity of visits and screening must not burden patients or staff with long questionnaires. One solution is to shorten assessment instruments, but dropping questions typically makes an instrument less accurate. An alternative is adaptive testing, in which a computer selects the items to be asked of a patient based on the patient's previous responses. This research used a simulation to test a child mental health screen based on this technology.RESEARCH DESIGN. Using half of a large sample of data, a computerized version was developed of the Pediatric Symptom Checklist (PSC), a parental-report psychosocial problem screen. With the unused data, a simulation was conducted to determine whether the Adaptive PSC can reproduce the results of the full PSC with greater efficiency.SUBJECTS. PSCs were completed by parents on 21,150 children seen in a national sample of primary care practices.RESULTS. Four latent psychosocial problem dimensions were identified through factor analysis: internalizing problems, externalizing problems, attention problems, and school problems. A simulated adaptive test measuring these traits asked an average of 11.6 questions per patient, and asked five or fewer questions for 49% of the sample. There was high agreement between the adaptive test and the full (35-item) PSC: only 1.3% of screening decisions were discordant (K = 0.93). This agreement was higher than that obtained using a comparable length (12-item) short-form PSC (3.2% of decisions discordant; K = 0.84).CONCLUSIONS. Multidimensional adaptive testing may be an accurate and efficient technology for screening for mental health problems in primary care settings.