Dynamic Assessment of Pediatric Health and Functioning

描述（由申请人提供）： 背景资料：迫切需要开发一个实用而精确的系统，以衡量整个医疗保健环境和服务的连续性慢性健康状况的儿童的健康状况。这项规划赠款将用于解决概念、抽样和数据收集问题，以便开发一个通用的、基于规范的计算机适应性测试系统，用于衡量儿童和青年的健康和功能。这项规划补助金的具体目标是：（1）为广泛的健康概念化制定一个共识概念框架，构建定义和具体项目内容，包括身体功能，心理健康以及社会和角色参与的多个领域（2）展示在互联网上从照顾者和儿童收集项目池数据的能力;（3）建立一个基于网络的儿童健康状况CAT原型;（4）评估一个基于网络的儿童健康状况CAT原型的可行性、效率和准确性。 研究设计和方法：调查小组包括CAT技术、临床儿科学和仪器开发方面的专家，将指导一个内容专家小组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进行二次分析--儿童残疾评估量表（PEDI），儿童健康问卷（CHQ），和兰德健康保险实验（HIE）数据库;以及专家小组共识会议。在第二年，PI将探索策略，通过基于网络的数据收集门户网站从照顾者和儿童的代表性样本中收集项目池数据，并确定抽样偏差对项目池结构的任何影响。项目反应理论和其他统计方法将被用来评估项目池的结构，建立项目校准，并创建一个原型CAT系统的初步算法。将使用计算机模拟测试基于CAT的评分估计值的准确性和精确性以及应答者负担的减少。在第三年，将招募100名照顾者/儿童进行实地研究，以评估原型儿科CAT的可行性，效率和准确性。 重要性：为了建立一个基于规范的儿童CAT，需要找到一种廉价的手段来链接的内容和交叉校准跨仪器的分数，并规范项目在大样本的儿童有和没有慢性健康状况。通过展示互联网的效用，建立和管理一个基于Web的CAT系统，可以利用它提供的效率，在未来的工作中构建一个完全开发的规范为基础的CAT系统。用于评估儿科健康和功能的基于网络的CAT可以消除当前跨年龄和诊断组广泛使用的通用工具的碎片化，并实现在医学研究和实践中常规使用健康状态工具所需的测量广度和实用性的实质性改善。

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.