Development of a Functional Health CAT for Managing Obesity

摘要近几十年来，肥胖在美国的患病率急剧上升，给个人和社会造成了巨大的负担。尽管行为因素是导致肥胖的最主要原因之一，目前也有许多体重管理项目被提供，但目前很少有实用的工具可以用来衡量肥胖成年人的功能健康和其他特征，而这些特征决定和定义了体重管理项目的成功。我们建议使用项目反应理论（IRT）和计算机化自适应测试（CAT）技术建立一个精确和简短的患者报告结果（PRO）工具（OBESITY-CAT）来测量肥胖对健康相关生活质量（HRQOL）和自我效能预期的影响。CATs针对每个应答者量身定制问题，从而在不增加应答者负担的情况下提高了测量的精度和范围。在第一阶段，我们建议：(1)构建两个题库来衡量肥胖对HRQOL和控制体重的自我效能期望的影响；(2)开发一个全面灵活的obesi - cat软件解决方案，包括即时反馈报告；(3)与传统的全长静态问卷相比，对新工具进行试点测试。为了实现这些目标，我们与麦哲伦医疗服务公司合作，麦哲伦医疗服务公司是美国最大的管理式医疗机构之一，为4000万人提供服务。我们将共同开发专门为CAT过程量身定制的肥胖特定项目，在1000名员工（约75%超重或肥胖）的样本中分析项目参数，最后在100名参与者中测试将OBESITY-CAT纳入麦哲伦全国体重管理计划的可行性和接受度。第一阶段的产品将是一个具有可行性、可接受性和经验性的初步证据的原型型综合OBESITY-CAT。在第二阶段，该工具将在有效性、可靠性和响应性方面进行改进和进一步评估，以及其在预测和监测治疗成功方面的潜力，并将对该工具进行评估和编程，以便在不同的平台上全面运行，包括pda和交互式语音识别（IVR）。通过大大降低数据收集成本，减轻反应负担，消除“上限”和“下限”效应，提高个体评分的准确性，HRQOL的常规监测可能成为肥胖成人的临床工具。肥胖- cat将能够监测体重管理计划的成功，以提高超重和肥胖成年人的健康相关生活质量。此外，它将支持根据个人量身定制体重管理计划，并识别出那些退出计划的风险更高、需要特别关注的人。与现有仪器相比，它将大大降低数据收集成本，减轻反应负担，提高个体评分的准确性，从而使HRQOL的常规监测成为肥胖成人的临床工具。

DESCRIPTION (provided by applicant): Development of a Functional Health CAT for Managing Obesity Abstract In recent decades the prevalence of obesity has increased dramatically in the United States, causing a great burden for the individual and society. Although behavioral factors are among the most prominent causes of obesity and numerous weight management programs are currently offered, few practical instruments are available today to measure the functional health and other characteristics of obese adults that determine and define the success of weight management programs. We propose to use Item Response Theory (IRT) and Computerized Adaptive Testing (CAT) techniques to build a precise and short Patient-Reported Outcomes (PRO) instrument (OBESITY-CAT) to measure the impact of being obese on health-related quality of life (HRQOL) and self-efficacy expectations. CATs tailor the questions administered to each individual respondent, thereby increasing the precision and range of measurement without increasing respondent burden. In Phase I we propose to: (1) construct two item banks to measure the impact of obesity on HRQOL and the self-efficacy expectation to control weight, (2) develop a comprehensive and flexible OBESITY-CAT software solution, including immediate feedback reporting, and (3) pilot test the new tool in comparison with traditional full-length static questionnaires. To achieve these aims, we have partnered with Magellan Health Services, one of the nations' largest managed care organizations, serving 40 million individuals. Together we will develop obesity-specific items tailored particularly for the CAT process, analyze the item parameters in a sample of 1,000 of their employees (~ 75% being overweight or obese), and finally test the feasibility and acceptance of the OBESITY-CAT integrated into Magellan's nationwide weight management program in 100 participants. The product of Phase I will be a prototype comprehensive OBESITY-CAT with preliminary evidence regarding feasibility, acceptability, and empirical performance. In Phase II, the tool will be improved and further evaluated in terms of validity, reliability, and responsiveness, and its potential for use in predicting and monitoring treatment success, and the tool will be evaluated and programmed to be fully operational on different platforms, including PDAs and Interactive Voice Recognition (IVR). By greatly lowering data collection costs, reducing response burden, eliminating "ceiling" and "floor" effects and increasing the precision of individual scores, routine monitoring of HRQOL may become feasible as a clinical tool among obese adults. The Obesity-CAT will be able to monitor the success of weight management programs to increase the health related quality of life of overweight and obese adults. In addition, it will support tailoring weight management programs to the individual, and identify those which are at higher risk to drop-out of the program and need special attention. Compared to existing instruments, it will greatly lower data collection costs, reduce response burden, and increase the precision of individual scores, so that routine monitoring of HRQOL may become feasible as a clinical tool among obese adults.