Using Computer Adaptive Testing to Improve Measurement of Clinical Outcomes

描述（由申请人提供）：国家残疾和康复研究所估计，目前在美国有253,000人患有脊髓损伤（SCI）。S.发病率约为百万分之40，或每年11，000例新病例。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。终身成本从50岁时的不完全损伤约50万美元到25岁时的高度损伤300万美元不等，其中不包括工资损失、生产力损失或非正式护理。随着SCI患者预期寿命的延长，改善与健康相关的生活质量特征对于充分了解SCI对受伤人员、其社交圈、医疗保健系统和社会的影响至关重要。判断康复对改善SCI患者独立性和生活质量的有效性取决于测量治疗目标所有健康方面的全方位功能水平。目前的仪器在概念清晰度方面受到限制，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对于临床使用来说过于广泛，或者服务于有限的患者群体。对患者和资源有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、提供诊断或帮助患者特征范围内的决策所需的精度。这个项目的长期目标是开发一个上级的结果测量工具，SCI比目前使用当代项目反应理论（IRT）和计算机自适应测试（CAT）的方法。的具体目标是：1）现场测试的“项目池”，或收集现有的，修订的，和新设计的问题，以捕捉SCI的状态，2）建立原型“SCI-CAT”仪器，和3）进行试点研究的SCI-CAT在SCI患者与不同程度的损伤严重程度。完成后，SCI-CAT和相关方法将可用于未来的临床和研究。SCI-CAT将通过提供受SCI影响的各种限制的全面信息，同时最大限度地减少响应负担和资源使用，从而加强临床，研究和政策决策。

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.