Dynamic Assessment of Pediatric Health and Functioning

描述(由申请人提供)： 背景：迫切需要开发一种实用而精确的系统，以衡量患有慢性健康状况的儿童在一系列医疗保健环境和服务中的健康状况。这笔规划赠款将用于解决概念、抽样和数据收集问题，以便开发一种通用的、基于规范的计算机适应测试(CAT)系统，用于衡量儿童和青少年的健康和功能。这笔规划赠款的具体目的是：(1)为广泛的健康概念制定一个共识的概念框架，构建定义和具体的项目内容，其中包括身体功能、心理健康以及社会和角色参与(这里用“健康状况”表示)等多个领域；(2)展示在互联网上收集照顾者和儿童的项目库数据的能力；(3)建立一个基于网络的儿童健康状况CAT原型；以及(4)评估一个基于网络的原型儿科健康状况CAT的可行性、效率和准确性。 研究设计和方法：调查团队包括CAT技术、临床儿科学和仪器开发方面的专家，将指导内容专家团队通过一系列家长和儿童焦点小组、审查现有的儿童健康措施、对来自三个来源的儿童健康数据的二次分析--儿童残疾评估清单(PEDI)、儿童健康问卷(CHQ)和兰德健康保险实验(HIE)数据库--制定共识定义；以及专家小组共识会议。在第二年，私人投资主任将探讨策略，透过网上数据收集网站，从具代表性的照顾者和儿童样本中收集项目池数据，并找出抽样偏差对项目池结构的任何影响。将使用项目反应理论和其他统计方法来评估题库的结构，建立项目校准，并为原型CAT系统创建初步算法。将使用计算机模拟来测试基于CAT的分数估计和减少应答者负担的准确性和精确度。在第三年，将招募100名照顾者/儿童进行实地研究，以评估儿童猫原型的可行性、效率和准确性。 意义：为了建立一个基于常模的儿童CAT，需要找到一种廉价的手段来连接内容和跨工具交叉校准分数，并在有和没有慢性健康状况的儿童的大样本中对项目进行标准化。通过展示因特网在建立和管理基于网络的计算机辅助测试系统方面的效用，人们可以利用它提供的效率，在今后的工作中建立一个充分发展的、基于规范的计算机辅助测试系统。用于评估儿科健康和功能的基于网络的CAT可能会消除目前广泛使用的跨年龄和诊断群体的通用仪器的碎片化，并在测量广度和实用性方面实现实质性改进，这是在医学研究和实践中常规使用健康状况工具所需的。

DESCRIPTION (provided by the applicant): Background: There is an urgent need to develop a practical yet precise system to measure health status for children with chronic health conditions across a continuum of medical care settings and services. This planning grant will be used to resolve conceptual, sampling, and data collection issues in order to develop a generic, norm-based computer adapted testing (CAT) system for measuring health and functioning for children and youth. The specific aims of this planning grant are to: (1) develop a consensus conceptual framework, construct definitions, and specific item content for a broad conceptualization of health that includes multiple domains of physical functioning, psychological well-being and social and role participation (represented here by "health status"); (2) demonstrate the ability to collect item pool data on the Internet from both caregivers and children; (3) build a prototype web-based Pediatric Health Status CAT; and (4) evaluate the feasibility, efficiency and accuracy of a prototype web-based Pediatric Health Status CAT. Research Design and Methods: The investigative team, which includes experts in CAT technology, clinical pediatrics, and instrument development, will guide a team of content specialists in developing consensus definitions of concepts through a series of parent and child focus groups, review of existing child health measures, secondary analyses of child health data from three sources - the Pediatric Evaluation of Disability Inventory (PEDI), Child Health Questionnaire (CHQ), and RAND Health Insurance Experiment (HIE) databases; and expert panel consensus meetings. In year 2, the PIs will explore strategies to collect item pool data from a representative sample of caregivers and children via a web based data collection portal and identify any effects of sampling bias on the structure of the item pool. Item response theory and other statistical methods will be used to evaluate the structure of item pools, establish item calibrations, and create preliminary algorithms for a prototype CAT system. The accuracy and precision of CAT-based score estimates and reductions in respondent burden will be tested using computer simulations. In year 3, 100 caregivers/children will be recruited for a field study to evaluate the feasibility, efficiency and accuracy of a prototype Pediatric CAT. Significance: In order to build a norm-based CAT for children, one needs to find an inexpensive means to link content and cross-calibrate scores across instruments and to norm items in large samples of children with and without chronic health conditions. By demonstrating the utility of the Internet to build and administer a web-based CAT system, one can take advantage of the efficiencies it offers to construct a fully developed norm-based CAT system in future work. A web based CAT used to assess pediatric health and functioning may eliminate the current fragmentation of widely-used generic instruments used across age and diagnostic groups and achieve a substantial improvement in measurement breadth and practicality as required for routine use of health status tools in medical research and practice.