Computerized Adaptive Assessment of Asthma Impact

描述(由申请者提供)：使用项目反应理论(IRT)可以大大提高对哮喘对健康相关生活质量(HRQOL)的功能影响的理解，使用计算机化的适应性测试(CAT)可以在广泛的严重程度上实现更实用和更准确的评估的相互竞争的目标，它将问卷项目与每个患者的水平相匹配。如果有更多可用的信息，这些信息可能有助于加强患者与护理者的沟通。限制因素之一是今天的HRQOL测量方法的不切实际(反应负担)。短表格(如SF-36“，AQLQ)更实用，然而，”天花板“和”地板“效应限制了它们的范围，它们缺乏检测单个患者评分变化的精确度。为了解决这些不足，第一阶段的目标是使用以前开发的IRT校准，对涵盖哮喘影响的主要领域的哮喘特定问卷的项目进行组合，以：(1)将哮喘影响、哮喘控制和一般HRQOL测量作为一种“无缝”评估，并将其结果同时显示在单一的用户友好的汇总报告中；(2)与完整调查相比，获得对项目使用、受访者负担(所需项目数量和管理时间)、测量水平范围(天花板和地板影响)以及评分准确性的初步估计；(3)相对于完整的问卷对禁止酷刑委员会管理部门的接受程度进行初步评估；以及(4)对原型汇总报告的有用性进行初步评估。第一阶段的产品将是一个全面的哮喘CAT原型，具有关于可行性、可接受性和可能的经验性表现的初步证据。在第一阶段，我们将结合新的哮喘专用CAT和通用CAT表格的项目库(基于SF-36和其他广泛使用的HRQOL测量标准)，以创建一个单一的综合系统。我们的方法在第二阶段的一个显著优势是能够利用IRT模型用当前广泛使用的哮喘特异性和通用影响工具的分数来“交叉校准”新的指标，以实现结果的有意义的比较。哮喘-CAT软件被规划为在互联网上完全运行，并在第二阶段与PC兼容，将促进临床研究并改进评估方法，以便在临床实践中使用。将根据分数的可靠性、有效性和精确度对输出进行评估。通过大幅降低数据收集成本，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常规监测可能成为哮喘患者和其他慢性病患者的临床工具。

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.