Computerized Adaptive Assessment of Disease Impact

描述（由申请人提供）：该项目引入了一种新的方法来标准化与健康有关的生活质量（HRQOL）的疾病特异性评估，以实现两种通用问卷的优势，可以进行比较，具有更高的敏感性和特异性。该方法建立在：(1)一个代表最常测量的疾病影响领域（例如，角色功能，社会功能和心理困扰）的题库，跨疾病标准化；(2)在回答每个问卷项目时评估特定疾病（例如，关节炎，糖尿病）影响的说明。该方法使用项目反应理论（IRT）和计算机化自适应测试（CAT）软件，对广泛的疾病状况和严重程度进行更实用和精确的评估，消除了“上限”和“下限”效应。将对CAT软件进行编程，以选择和管理每位患者最具信息量和最相关的疾病影响问题，并考虑临床应用。对特定疾病影响项目的内容进行标准化，并对不同疾病的这些项目进行校准，从而有可能实现更具响应性的结果衡量，同时实现不同疾病/治疗之间有意义的比较。以前的工作已经使用IRT方法开发了一个跨越五种疾病的等效项目校准的项目库。本项目第一阶段的目的是分析现有数据集，以评估这些项目跨年龄组校准的等效性，并在临床环境中测试疾病影响CAT方法对老年患者的可行性。可行性研究将使用疾病影响CAT原型，从关节炎、抑郁症、慢性阻塞性肺病、糖尿病和骨质疏松症五组100名中老年患者中收集新数据。将为患者和临床医生编写单独的反馈报告。可行性将根据被调查者负担、测量水平范围、项目使用情况和反应一致性，以及临床医生和患者使用原型CAT工具和反馈报告的经验进行评估。第一阶段的产品将是具有可行性和可接受性初步证据的疾病影响CAT原型。第二阶段将开发并进一步评估综合疾病影响CAT评估系统的潜力，该系统将对原发性和共病慢性疾病/病症进行标准化，以心理测量学的表现和在临床研究和实践中的有用性。

DESCRIPTION (provided by applicant): The project introduces a new approach to standardizing disease-specific assessments of Health-Related Quality of Life (HRQOL) to achieve the advantages of both generic questionnaires, which can be compared across which have greater sensitivity and specificity. The approach builds on: (1) an item bank representing the most frequently measured domains of disease impact (e.g., role functioning, social functioning, and psychological distress), standardized across diseases, and (2) instructions to assess the impact of a specific disease (e.g., arthritis, diabetes) in answering each questionnaire item. The approach uses item response theory (IRT) and computerized adaptive testing (CAT) software to yield more practical and precise assessments over a wide range of disease conditions and severity levels - eliminating "ceiling" and "floor" effects. CAT software will be programmed to select and administer the most informative and relevant disease impact questions for each patient, with consideration of the clinical application. Standardization of the content of disease-specific impact items and calibration of these items across diseases makes it possible to achieve more responsive outcomes measures, while enabling meaningful comparisons across diseases/-treatments. Previous work has used IRT methodology to develop a bank of items with equivalent item calibrations across five diseases. The aims of Phase I of this project are to analyze existing data sets to evaluate the equivalence of these item calibrations across age groups and to test the feasibility of the Disease Impact CAT approach for elderly patients in a clinical setting. The feasibility study will use a prototype Disease Impact CAT to collect new data from 100 middle aged and elderly patients within five groups: arthritis, depression, chronic obstructive pulmonary disease, diabetes, and osteoporosis. Separate feedback reports will be developed for the patients and the clinicians. Feasibility will be evaluated in terms of respondent burden, range of levels measured, item usage, and response consistency, as well as the clinicians' and patients' experience using the prototype CAT tool and the feedback reports. The product of Phase I will be a prototype Disease Impact CAT with preliminary evidence regarding feasibility and acceptance. Phase II will develop and further evaluate the potential of a comprehensive Disease Impact CAT Assessment System, standardized across primary and comorbid chronic diseases/conditions, in terms of psychometric performance and usefulness in clinical research and practice.