Web-based Training & Reliability for Psychiatric Raters

描述（由申请人提供）：在精神病临床试验期间，培训评定者以及建立和保持可靠性的重要任务是一个经常被忽视的主要问题。这个问题在涉及多个地点的许多评分者的试验中尤其令人烦恼。此外，影响标准精神病评定工具评定者期望（偏倚）的因素从未得到充分探讨。第二阶段项目旨在开发一个交互式视频系统，用于培训研究评级人员使用具有共享评级惯例的评级工具，并评估跨研究中心和随时间推移的评级者间可靠性。将编写程序，使该视频系统能够用作（1）交互式“教程”系统，可用于培训评分员使用评分工具，以及（2）“可靠性测试”系统，使用集成数据库记录评分并计算评分员之间的可靠性，该系统在已识别的评分员组内或使用预设评分，即，“黄金标准”。该计划涉及开发一个完整的30种汉密尔顿抑郁评定量表（HDRS）的图书馆，使用四个不同的性别和不同种族的行为者。II期研究将评估变异性和评估者偏倚，作为评估者和“患者”的人口统计学和专业特征与200名新手评估者的相互作用。第一阶段创建了一个原型，用于评估HDRS的评定者间可靠性。使用来自实际患者访谈的脚本，一名男性和一名女性演员各自描绘了三个独立的HDRS访谈，反映了不同严重程度的抑郁症状。在第二阶段的准备工作中，发现该系统的功能非常出色。可行性是通过以下方式建立的：1）让有经验的评分员评估演员和实际患者的HDRS访谈视频，并建立演员描述的有效性，2）计算一组有经验的评分员的评分员间可靠性评分（0.97）和一组新手评分者（0.96）使用系统原型，以及3）召集焦点小组，与有经验的和新的评级人一起评估系统的积极和消极属性。未来的产品开发将利用软件和统计方法与其他评级工具，包括用于评估精神分裂症，焦虑症和痴呆症。

DESCRIPTION (Provided by Applicant): The important task of training raters and establishing and maintaining reliability for the duration of a psychiatric clinical trial is a major problem that is often ignored. This problem is particularly vexing for trials involving many raters at multiple sites. Furthermore, factors effecting rater expectancy (bias) with standard psychiatric rating instruments has never been fully explored. This Phase II project is intended to develop an interactive video system for training research raters to use rating instruments with shared rating conventions and assess interrater reliability across sites and over time. Programs are to be written that will enable this video system to be used as (1) an interactive "tutorial" system that can be used to train raters on the use of the rating instrument, and (2) a "reliability testing" system, that uses an integrated database to record ratings and compute interrater reliability within an identified group of raters or with preset ratings, i.e., a "gold standard". The plan involves developing a complete library of 30 variations of the Hamilton Depression Rating Scale (HDRS) using four different actors of both genders and diverse ethnicity. The Phase II study will assess variability and rater bias as an interaction of demographic and professional characteristics of the raters and "patients" with 200 novice raters. Phase I created a prototype for assessing interrater reliability for the HDRS. Using scripts from actual patient interviews, a male and a female actor each portrayed three separate HDRS interviews reflecting depressive symptoms of various severity. In preparation for Phase II, the functionality of the system was found to be excellent. Feasibility was established by 1) having experienced raters assess videos of the HDRS interviews of both actors and actual patients and establish the validity of the actors' portrayals, 2) calculating interrater reliability scores for a group of experienced raters (0.97) and a group of novice raters (0.96) using the system prototype, and 3) convening focus groups to assess the positive and negative attributes of the system with both experienced and novice raters. Future product development will utilize the software and statistical methodology with other rating instruments, including those used to assess schizophrenia, anxiety disorders, and dementia.