Using Computer Adaptive Testing to Improve Measurement of Clinical Outcomes

使用计算机自适应测试改进临床结果的测量

• 批准号: 7333097
• 负责人: Christine M McDonough
• 金额: $ 4.75万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-01-02 至 2010-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7333097
• 关键词: Accounting; Affect; Age; Biological Models; Boston; Caring; Categories; Characteristics; Clinical; Clinical Research; Collaborations; Collection; Computers; Cross-Sectional Studies; Decision Making; Development; Dimensions; Effectiveness; Equilibrium; Factor Analysis; Fellowship; Funding; Future; Generic Drugs; Health; Healthcare Systems; Incidence; Injury; Institutes; Institution; International; Intervention; Life; Life Expectancy; Marital Status; Measurement; Measures; Medical center; Medicine; Methods; Monitor; New England; Numbers; Occupational Status; Outcome; Outcomes Research; Patients; Performance; Persons; Pilot Projects; Policies; Population; Productivity; Property; Quality of Care; Quality of life; Questionnaires; Range; Rehabilitation Research; Rehabilitation therapy; Research; Research Design; Research Institute; Research Project Grants; Research Training; Resources; Sampling; Severities; Societies; Spinal Cord; Spinal cord injury; Spinal cord injury patients; Technology; Testing; Universities; Variant; Wages; base; caregiving; design; design and construction; disability; health related quality of life; improved; injured; instrument; life time cost; novel; outcome forecast; programs; prototype; response; social; software development; theories; tool; treatment center; treatment effect; validation studies

DESCRIPTION (provided by applicant): The National Institute on Disability and Rehabilitation Research estimates 253,000 persons presently live with spinal cord injury (SCI) in the U. S. Incidence is approximately 40 per million, or 11,000 new cases per year. SCI affects life expectancy, occupational status, marital status and likelihood, and health-related quality of life. Lifetime costs range from approximately $500,000 for incomplete injury at age 50 to $3 million for high-level injury at age 25, without taking into account lost wages, productivity or informal care giving. Increasing life expectancy for persons with SCI makes improved characterization of health-related quality of life crucial to a full understanding of SCI impact on injured persons, their social circle, the health care system, and society. Judging the effectiveness of rehabilitation to improve independence and quality of life for those with SCI depends on measuring the full range of functional levels across all health aspects targeted by treatment. Current instruments are limited in conceptual clarity, and traditional methods limit their ability to balance measurement precision and acceptability. Therefore, instruments with necessary measurement properties are either too extensive for clinical use or serve a limited patient population. Instruments with a reasonable burden on patients and resources lack the precision required to detect treatment effects, monitor health, judge care quality, provide prognoses, or aid decision-making across the range of patient characteristics. The long-term objective of this project is to develop a superior outcome measurement instrument for SCI than is presently available using contemporary item response theory (IRT) and computer adaptive testing (CAT) methods. The specific aims of are to: 1) field test the "item pool", or collection of existing, revised, and newly designed questions to capture SCI status, 2) build the prototype "SCI-CAT" instrument, and 3) conduct a pilot study of the SCI-CAT in SCI patients with various levels of injury severity. Upon completion, the SCI-CAT and related methods will be available for future clinical and research use. The SCI-CAT will enhance clinical, research, and policy decision-making by providing comprehensive information across the range of limitations affected by SCI while minimizing response burden and resource use.

描述（由申请人提供）：美国国家残疾与康复研究所估计，目前美国有 253,000 人患有脊髓损伤 (SCI)。发病率约为百万分之 40，即每年新增病例 11,000 例。 SCI 影响预期寿命、职业状况、婚姻状况和可能性以及与健康相关的生活质量。终身费用范围从 50 岁时不完全损伤的约 50 万美元到 25 岁时重度损伤的 300 万美元，不考虑工资、生产力或非正式护理的损失。 SCI 患者预期寿命的延长使得改善与健康相关的生活质量特征对于充分了解 SCI 对受伤者、他们的社交圈、医疗保健系统和社会的影响至关重要。判断康复对于改善 SCI 患者的独立性和生活质量的有效性取决于测量治疗所针对的所有健康方面的全方位功能水平。当前的仪器在概念清晰度方面有限，传统方法限制了它们平衡测量精度和可接受性的能力。因此，具有必要测量特性的仪器要么过于广泛而无法用于临床，要么只服务于有限的患者群体。对患者和资源造成合理负担的仪器缺乏检测治疗效果、监测健康状况、判断护理质量、提供预后或根据患者特征辅助决策所需的精度。该项目的长期目标是开发一种比目前使用当代项目反应理论 (IRT) 和计算机自适应测试 (CAT) 方法更优越的 SCI 结果测量工具。具体目标是：1) 现场测试“项目库”，或收集现有的、修订的和新设计的问题来捕获 SCI 状态，2) 构建原型“SCI-CAT”仪器，以及 3) 在不同损伤严重程度的 SCI 患者中进行 SCI-CAT 试点研究。完成后，SCI-CAT和相关方法将可供未来的临床和研究使用。 SCI-CAT 将通过提供受 SCI 影响的一系列限制的全面信息来加强临床、研究和政策决策，同时最大限度地减少响应负担和资源使用。