Computerized Adaptive Assessment of Asthma Impact

哮喘影响的计算机化自适应评估

• 批准号: 7271066
• 负责人: DIANE M TURNER-BOWKER
• 金额: $ 77.9万
• 依托单位: QUALITYMETRIC, INC.
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-07-09 至 2010-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7271066
• 关键词: Adult; Asthma; Caregivers; Caring; Categories; Clinical; Communication; Complement; Data; Data Collection; Decision Making; Development; Disease; Documentation; Educational Materials; Feedback; Floor; Fostering; Generic Drugs; Goals; Guidelines; Individual; Internet; Length; Measurement; Measures; Monitor; Outcome; Outcome Assessment; Outcome Measure; Paper; Patient Outcomes Assessments; Patients; Performance; Phase; Process; Provider; Psychometrics; Purpose; Quality of Care; Questionnaires; Range; Reporting; Respondent; SF-12; SF-36; Sampling; Score; Screening procedure; Self Management; Severities; Solutions; Surveys; System; Tablets; Technology; Telefacsimile; Testing; Time; Today; Validity and Reliability; base; clinically relevant; computerized; cost; field study; health related quality of life; improved; new technology; patient oriented; programs; prospective; prototype; response; simulation; theories; tool; user-friendly

DESCRIPTION (provided by applicant): Several recent initiatives have emphasized the importance of developing and testing new technologies to measure patient-reported outcomes (PRO). PRO measures for asthma can be substantially improved using item response theory (IRT), and competing objectives of more practical and more precise assessments can be achieved over a wide range of severity levels using computerized adaptive testing (CAT), which matches questionnaire items to each patient's level. If more available, such information could complement asthma management plans, enhance patient-caregiver communication, and improve clinical decision-making. Among the limiting factors is the impracticality (respondent burden) of today's HRQOL measures. Short-forms (e.g., SF-36(r), AQLQ) are more practical, however, "ceiling" and "floor" effects limit their ranges and they lack the precision to detect changes in individual patient scores. In Phase I, we developed and piloted a prototype Internet-based assessment (ASTHMA-CAT) that combines asthma impact, asthma control, and generic HRQOL measures in one "seamless" administration, and displays results in tandem in a single user-friendly aggregate (or group-level) report. Results from a pilot test of the ASTHMA-CAT showed that the dynamic assessment achieved almost as precise score estimation with far less respondent burden than the full-length survey, and discriminated well between mild, moderate, and severe asthma. Patients and providers positively evaluated the ASTHMA-CAT assessment and report. The aims for Phase II are to: (1) evaluate items from our current asthma bank for psychometric performance and clinical relevance, and calibrate item enhancements by collecting and analyzing responses from large samples of adults varying in asthma severity; (2) build a completely functional and comprehensive ASTHMA-CAT system with centralized data capture, scoring, and "real time" feedback reports, and evaluate its psychometric performance through data simulation studies; (3) conduct a longitudinal prospective field study of the ASTHMA-CAT to demonstrate its responsiveness, reliability, and construct validity; and to document the comparability of differing modes of administration (e.g., paper and pencil, tablet PC, Internet); (4) evaluate the ASTHMA-CAT's potential for use in remote self- management; and (5) foster the ASTHMA-CAT's integration into clinical practice through comprehensive documentation and development of educational materials. The goal of this effort is an efficient, less burdensome asthma PRO monitoring system with demonstrated evidence of its administrative feasibility, reliability, validity, and responsiveness. If successful, the ASTHMA-CAT system will offer streamlined data capture, processing, and "real time" reporting features; will produce valid and comparable scores across multiple modes of administration; and will provide useful interpretation guidelines to facilitate its routine application in care management. Public Heath Relevance: The ASTHMA-CAT will provide a comprehensive and precise, yet practical, patient-based assessment valid for routine monitoring of asthma impact, asthma control, and generic HRQOL outcomes across a variety of settings. It will yield meaningful and useful results to inform clinical decision-making and improve care management.

描述（由申请人提供）：最近的几项举措强调了开发和测试新技术来衡量患者报告结果（PRO）的重要性。使用项目反应理论 (IRT) 可以大大改善哮喘的 PRO 测量，并且可以使用计算机自适应测试 (CAT) 将问卷项目与每个患者的水平相匹配，在广泛的严重程度级别上实现更实用、更精确的评估的竞争目标。如果有更多信息，这些信息可以补充哮喘管理计划，加强患者与护理人员的沟通，并改善临床决策。限制因素之一是当今 HRQOL 措施的不切实际（受访者负担）。简短形式（例如 SF-36(r)、AQLQ）更实用，但是“上限”和“下限”效应限制了其范围，并且缺乏检测个体患者评分变化的精确度。在第一阶段，我们开发并试行了一种基于互联网的评估原型（ASTHMA-CAT），它将哮喘影响、哮喘控制和通用 HRQOL 测量结合在一个“无缝”管理中，并在单个用户友好的汇总（或组级）报告中同时显示结果。 ASTHMA-CAT 试点测试的结果表明，动态评估几乎实现了与完整调查一样精确的分数估计，且受访者负担远低于完整调查，并且可以很好地区分轻度、中度和重度哮喘。患者和提供者积极评价 ASTHMA-CAT 评估和报告。第二阶段的目标是：（1）评估我们当前哮喘库中的项目的心理测量表现和临床相关性，并通过收集和分析不同哮喘严重程度的成人大样本的反应来校准项目增强； （2）建立功能齐全、综合性的ASTHMA-CAT系统，具有集中式数据采集、评分和“实时”反馈报告，并通过数据模拟研究评估其心理测量性能； (3) 对 ASTHMA-CAT 进行纵向前瞻性现场研究，以证明其反应性、可靠性和结构有效性；并记录不同管理模式（例如纸和笔、平板电脑、互联网）的可比性； (4) 评估 ASTHMA-CAT 在远程自我管理中的应用潜力； (5) 通过全面的记录和教育材料的开发，促进 ASTHMA-CAT 融入临床实践。这项工作的目标是建立一个高效、负担较轻的哮喘 PRO 监测系统，并提供其管理可行性、可靠性、有效性和响应性的证据。如果成功，ASTHMA-CAT 系统将提供简化的数据采集、处理和“实时”报告功能；将在多种管理模式下产生有效且可比较的分数；并将提供有用的解释指南，以促进其在护理管理中的日常应用。公共卫生相关性：ASTHMA-CAT 将提供全面、精确且实用的基于患者的评估，可有效用于各种环境下哮喘影响、哮喘控制和一般 HRQOL 结果的常规监测。它将产生有意义且有用的结果，为临床决策提供信息并改善护理管理。