COMPUTERIZED QOL ASSESSMENT IN LOW LITERACY PATIENTS

文化程度低的患者的计算机化生活质量评估

• 批准号: 6053791
• 负责人: ELIZABETH A HAHN
• 金额: $ 33.21万
• 依托单位: EVANSTON NORTHWESTERN HEALTHCARE RES INS
• 依托单位国家: 美国
• 财政年份: 1999
• 资助国家: 美国
• 起止时间: 1999-09-30 至 2001-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6053791
• 关键词: clinical research; computer assisted patient care; educationally disadvantaged; health care quality; health science research analysis /evaluation; health services research tag; human subject; quality of life; questionnaires

Several national organizations, including the American Medical Association, the Agency for Health Care Policy and Research, the Food and Drug Administration, and the National Institutes of Health, have stressed the need for improved health care quality indicators. The patients perspective is central to the evaluation of quality outcomes. There is an abundance of patient self-report quality of life (QOL) questionnaires that can be completed serially and used to measure improving or declining perceived health. A major barrier to success in obtaining this QOL data is the fact that over 40 million Americans are functionally illiterate, and another 50 million have marginal literacy skills (Kirsch et al, 1993). Computerized assessment of QOL outcomes, utilizing multimedia technology, may provide a simple and efficient administration method that can be easily incorporated into a busy clinical setting, with minimal burden on staff and patients. Presentation of a question on a computer screen, accompanied by a recorded reading of the same question (Audiovisual Computer-based Testing; or AVCBT) can allow people with limited or even no reading ability to participate in the assessment. A standardized approach across all levels of literacy has the added advantage of reducing the stigma of low literacy. It can also prevent the introduction of systematic method artifacts which might be present due to the mixing of modes of questionnaire administration. This project builds upon successful past and current collaborations between researchers from Evanston Northwestern Healthcare and Cook County Hospital, a public hospital serving primarily indigent, urban ethnic minorities. Specifically, we propose to: 1) Develop and evaluate AVCBT of health status and preference-based QOL outcomes for low literate, English-speaking cancer patients; and 2) Test the equivalence of QOL assessment across low and high levels of literacy. We will first develop the AVCBT platform. Then we will compare one-time AVCBT QOL assessments of 200 cancer patients who test below the seventh-grade reading level ("low literacy group") to those of 200 cancer patients who test at or above the seventh grade reading level ("high literacy group"). Rasch measurement will be used to test the equivalence of health status measurement. We hypothesize that health status items will perform similarly across literacy levels, and that after controlling for group differences in performance status, disease stage, age, gender, ethnicity and socioeconomic status, there will be no significant difference between low versus high literacy patients in AVCBT- measured QOL (both health status and preference-based).

包括美国医学会、卫生保健政策和研究机构、食品和药物管理局以及国家卫生研究院在内的几个国家组织强调需要改进卫生保健质量指标。患者的观点是评估高质量结果的核心。有大量的患者自我报告的生活质量(QOL)问卷，可以连续完成，用于衡量自我感觉健康的改善或下降。成功获得这些生活质量数据的一个主要障碍是，超过4000万美国人是功能性文盲，另有5000万人具有边缘识字技能(Kirsch等人，1993)。利用多媒体技术对生活质量结果进行计算机化评估，可以提供一种简单而有效的管理方法，可以很容易地整合到繁忙的临床环境中，而对工作人员和患者的负担最小。在电脑屏幕上展示问题，并伴随着同一问题的录音阅读(基于视听的计算机测试；或AVCBT)可以让阅读能力有限甚至没有阅读能力的人参与评估。所有识字水平的标准化方法还有一个额外的好处，那就是减少了识字率低的污名。它还可以防止引入由于混合了问卷管理模式而可能出现的系统性方法缺陷。这个项目建立在埃文斯顿西北医疗保健和库克县医院研究人员过去和现在成功合作的基础上，库克县医院是一家公立医院，主要服务于贫困的城市少数民族。具体地说，我们建议：1)开发和评估低识字、讲英语的癌症患者的健康状况和基于偏好的生活质量结果的AVCBT；以及2)测试低识字和高识字水平的生活质量评估的等价性。我们将首先开发AVCBT平台。然后，我们将比较200名七年级阅读水平以下的癌症患者(低识字组)和200名七年级阅读水平或以上的癌症患者(高识字组)的一次性AVCBT生活质量评估。Rasch测量将用于测试健康状况测量的等价性。我们假设，健康状况项目在不同识字水平上的表现相似，在控制了表现状况、疾病阶段、年龄、性别、种族和社会经济地位的群体差异后，低识字和高识字患者在AVCBT测量的生活质量(包括健康状况和基于偏好的)方面没有显著差异。