Functional Health CAT in Chronic Kidney Disease

描述(由申请人提供)：我们寻求广泛推进使用项目反应理论(IRT)和计算机化适应性测试(CAT)方法测量慢性肾脏疾病(CKD)健康相关生活质量(HRQOL)的技术。HRQOL是临床研究中公认的一个重要结果，是慢性肾脏病有价值的预测指标。临床医生对HRQOL的直观评估和监测影响CKD的治疗选择，从而加强透析护理中患者与护理者的沟通。应答者的负担使得HRQOL测量在CKD中广泛使用是不切实际的。事实证明，短表格更实用，更容易被患者接受；然而，“天花板”和“地板”效应是在每个健康领域内测量有限范围后产生的。缺乏必要的精确度来解释单个患者的分数是像SF-36这样的简短表格的另一个主要弱点。为了解决这些不足，第一阶段的活动将：(1)应用IRT来校准NIDDK血液透析研究(HEMO)中基线管理的项目；(2)编程CAT以模拟将问题与每个患者的功能水平相匹配的动态评估(CKD.CAT)；(3)使用CKD-CAT来估计与现有数据的HEMO调查相比，使用CKD-CAT在受访者负担、测量水平范围和评分准确性方面的减少；以及(4)评估透析室中相对于原始HEMO调查对实际CAT管理的接受程度。第一阶段的产品将是一个原型CKD-CAT，具有关于可行性、可接受性和性能的初步证据。在第二阶段，护理终末期肾脏疾病仪器的血液和选择中的健康结果条目将根据每个HRQOL领域的公共指标进行校准，以具体解决腹膜透析问题。将对CKD-CAT进行评估(可靠性、有效性和精确度)，以创建一个完全可操作的系统，促进临床研究并改进CKD临床实践中的测量。通过极大地降低数据收集成本，减轻受访者负担，消除“天花板”和“地板”效应，并提高单个患者评分的精确度，HRQOL常规监测可能成为CKD的一种临床工具，导致接受CAT治疗其他慢性病。

DESCRIPTION (provided by applicant): We seek to extensively advance the technology for measuring health-related quality of life (HRQOL) in chronic kidney disease (CKD) using item response theory (IRT) and computerized adaptive testing (CAT) methods. HRQOL, accepted in clinical research as an important outcome, is a valuable predictor in CKD. Clinicians' intuitive assessment and monitoring of HRQOL influences treatment choices in CKD that enhance patient-caregiver communication in dialysis care. Respondent burden renders HRQOL measures impractical for widespread use in CKD. Short-forms have proven more practical and acceptable to patients; however, "ceiling" and "floor" effects result from measuring a limited range within each health domain. Lack of precision necessary to interpret individual patient scores is another major weakness of short forms like the SF-36. To address these deficiencies, Phase I activities will: (1) apply IRT to calibrate items administered at baseline in the NIDDK Hemodialysis Study (HEMO); (2) program CAT to simulate dynamic assessments that match questions to each patient's functional level (CKD.CAT); (3) estimate reductions in respondent burden, range of levels measured and score accuracy using CKD-CAT in comparison with the HEMO survey from existing data; and (4) evaluate the acceptance of actual CAT administrations relative to the original HEMO survey in a dialysis unit. The product of Phase I will be a prototype CKD-CAT with preliminary evidence regarding feasibility, acceptability and performance. In Phase II, items from the HEMO and Choices for Healthy Outcomes in Caring for End-Stage Renal Disease instruments will be calibrated on a common metric for each HRQOL domain to specifically address peritoneal dialysis. CKD-CAT will be evaluated (reliability, validity and precision) to create a fully operational system that facilitates clinical research and improves measurement in CKD clinical practice. By greatly lowering data collection costs, reducing respondent burden, eliminating "ceiling" and "floor" effects and increasing the precision of individual patient scores, routine monitoring of HRQOL may become feasible as a clinical tool in CKD, leading to acceptance of CAT for other chronic illnesses.