Computerized Adaptive Assessment of Asthma Impact

描述（由申请人提供）：了解哮喘对健康相关生活质量（HRQOL）的功能影响可以使用项目反应理论（IRT）大大提高，使用计算机化自适应测试（CAT）可以在大范围的严重程度上实现更实用和更精确的评估目标，该测试将问卷项目与每个患者的水平相匹配。如果能获得更多的信息，这些信息将有助于加强患者与护理者之间的沟通。限制因素之一是当今HRQOL测量的不实用性（受访者负担）。短格式（如SF-36”，AQLQ）更实用，然而，“上限”和“下限”效应限制了它们的范围，并且它们缺乏检测个体患者评分变化的精度。为了解决这些缺陷，第一阶段的目标是使用先前开发的IRT校准对哮喘特定问卷中涵盖哮喘影响主要领域的项目进行组合“池”：(1)将哮喘影响、哮喘控制和一般HRQOL措施作为“无缝”评估，并在单个用户友好的汇总报告中串联显示其结果；(2)获得项目使用情况、受访者负担（所需项目数量和管理时间）、测量水平范围（上限和下限影响）的初步估计，以及与全面调查相比的得分准确性；(3)相对于完整的问卷调查，对CAT管理的接受程度进行初步评估；(4)对原型汇总报告的有用性进行初步评价。第一阶段的产品将是一个具有可行性、可接受性和可能的经验表现的初步证据的综合哮喘- cat原型。在第一阶段，我们将把新的哮喘特异性CAT与通用CAT表格（基于SF-36和其他广泛使用的HRQOL测量）的项目池“结合”起来，创建一个单一的综合系统。我们的方法在II期的一个重要优势是能够利用IRT模型与目前广泛使用的哮喘特异性和通用影响工具的分数“交叉校准”新指标，从而实现有意义的结果比较。哮喘- cat软件，编程为在互联网和pc上完全兼容的第二阶段，将促进临床研究和改进临床实践中使用的评估方法。产出将根据分数的信度、效度和精度进行评估。通过大大降低数据收集成本，减轻被调查者负担，消除“天花板”和“地板”效应，提高个体患者评分的准确性，常规HRQOL监测可能成为哮喘患者和其他慢性疾病患者的临床工具。

DESCRIPTION (provided by applicant): Understanding the functional impact of asthma on health-related quality of life (HRQOL) can be substantially improved using item response theory (IRT) and competing objectives of more practical and more precise assessments can be achieved over a wide range of severity levels using computerized adaptive testing (CAT), which matches questionnaire items to each patient's level. If more available, such information could be useful in enhancing patient-caregiver communication. Among the limiting factors is the impracticality (respondent burden) of today's HRQOL measures. Short-forms (e.g., SF-36", AQLQ) are more practical, however, "ceiling" and "floor" effects limit their ranges and they lack the precision to detect changes in individual patient scores. To address these deficiencies, the aims of Phase I are to use previously developed IRT calibrations for a combined "pool" of items from asthma-specific questionnaires covering major domains of asthma impact to: (1) administer asthma impact, asthma control, and generic HRQOL measures as a "seamless" assessment and display their results in tandem in a single user-friendly aggregate report; (2) obtain preliminary estimates of item usage, respondent burden (number of items required and administration times), range of levels measured (ceiling and floor effects), and score accuracy in comparison with a full length survey; (3) conduct preliminary evaluations of the acceptance of CAT administrations relative to full length questionnaire; and (4) conduct preliminary evaluations of the usefulness of the prototype aggregate report. The product of Phase I will be a prototype comprehensive ASTHMA-CAT with preliminary evidence regarding feasibility, acceptability, and likely empirical performance. In Phase I1, we will "marry" the new asthma-specific CAT with item pools for generic CAT forms (based on SF-36 and other widely-used HRQOL measures) to create a single comprehensive system. A substantial advantage of our approach in Phase II is the ability to utilize IRT models to "cross-calibrate" the new metrics with scores from current widely used asthma-specific and generic impact tools to enable meaningful comparisons of results. ASTHMA-CAT software, programmed to be fully operational on the Internet and PC-compatible in Phase II, will facilitate clinical research and improve assessment methods for use in clinical practice. Output will be evaluated in terms of reliability, validity and precision of scores. 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 among asthma sufferers and patients with other chronic illnesses.