COMPUTERIZED OOL ASSESSMENT IN LOW LITERACY PATIENTS

包括美国医学协会、卫生保健政策和研究机构、食品和药物管理局以及国立卫生研究院在内的几个国家组织都强调需要改进卫生保健质量指标。 患者的观点是评价质量结果的核心。 有大量的患者自我报告生活质量（QOL）问卷，可以连续完成，并用于衡量改善或下降的感知健康。 成功获得该QOL数据的主要障碍是超过4000万美国人是功能性文盲，另外5000万人具有边缘识字技能（Kirsch et al，1993）。 利用多媒体技术对生活质量结果进行计算机化评估，可以提供一种简单有效的管理方法，可以很容易地将其纳入忙碌的临床环境中，对工作人员和患者的负担最小。 在计算机屏幕上呈现一个问题，并伴随着同一问题的记录阅读（视听计算机测试;或AVCBT）可以允许有限甚至没有阅读能力的人参与评估。 在所有识字水平采用标准化方法的另一个好处是，可以减少低识字率带来的耻辱感。 它还可以防止引入系统的方法工件，这可能是由于调查表管理模式的混合而存在的。该项目建立在埃文斯顿西北医疗保健和库克县医院（一家主要为贫困的城市少数民族服务的公立医院）的研究人员之间成功的过去和当前合作的基础上。 具体而言，我们建议：1）开发和评估健康状况的AVCBT和基于偏好的QOL结果为低识字，讲英语的癌症患者;和2）测试QOL评估的等效性在低和高识字水平。 我们将首先开发AVCBT平台。 然后，我们将比较200名癌症患者的一次性AVCBT QOL评估测试低于七年级阅读水平（“低识字组”）和200名癌症患者的测试在七年级阅读水平或以上（“高识字组”）。 Rasch测量将用于检验健康状况测量的等效性。 我们假设，健康状况项目在不同文化水平下的表现相似，并且在控制了表现状况、疾病分期、年龄、性别、种族和社会经济地位的组间差异后，低文化水平与高文化水平患者在AVCBT测量的QOL（基于健康状况和偏好）方面没有显著差异。

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).