Computerized Adaptive Assessment of Disease Impact

描述(由申请人提供)：这个SBIR第二阶段项目将开发和评估一种更实用和更全面的方法，以标准化对日益增长的患有并存慢性病的老年(45岁)成年人的疾病特定健康相关生活质量(HRQOL)的自我评估。具体地说，我们建议通过采用以消费者为中心的智能测量系统来简化疾病影响筛查(用于预防和预警)和对HRQOL结果的监测，该系统使用项目反应理论(IRT)开发以改进结果测量，利用计算机化的自适应测试(CAT)软件来改进数据捕获和得分估计，并通过互联网提供内容。第一阶段论证了行政管理的可行性，并支持将针对疾病的影响项目的内容标准化并对其进行跨疾病校准的假设，以实现对结果更敏感的措施，并在不同疾病之间进行有意义的可比性。其他免费赠送的SBIR项目侧重于单一疾病，表明有可能对广泛的严重程度进行更实际和准确的评估--以及消除“天花板”和“底线”影响的可能性。在第二阶段，我们将结合这些努力，通过实施新的标准化疾病特定题库中的项目以及先前验证的疾病特定和通用HRQOL措施，在患有多种并存疾病的老年成年人的更大样本中扩大对标准化疾病特定和通用测量模型的测试，以满足以下目标：(1)使用(A)定性方法和专家/消费者评估，(B)对最普遍和最繁重的慢性病(例如哮喘、CHF、CKD、抑郁症、糖尿病、头痛、肥胖症、骨关节炎)的大样本进行定量研究，以改进工具和项目库，以及(C)更有效的静态和动态短表格与“遗留”(先前经过验证的)工具之间的正面比较；(2)开发和评估针对特定疾病和通用反馈的汇总报告(S)，适用于消费者(目前是或不是“患者”)及其临床医生，提供用户友好的规范/基准解释信息；(3)在纵向前瞻性小组研究中评估自我评估系统，以重复心理测量学特性、测试预测有效性(医疗支出、角色/社会参与、死亡率)和反应性的测试，并解决数据质量、背景和模式影响、互联网可访问性、以及受访者特征的影响；(4)通过对患有和不患有慢性病的代表性美国人口样本实施通用和疾病特定措施来收集规范。第二阶段的产品将是一个全面运作的自我评估系统，用于筛查和监测患有多种并存疾病的老龄化人口的疾病影响，包括：改进的用于评估疾病影响和一般健康结果的“静态”和动态(CAT)简短表格、用户友好的反馈报告和文件。公共卫生相关性：疾病影响评估工具将衡量身体功能和精神健康范围内多种并存疾病的影响。它将简化疾病负担筛查，并提供更多可操作的信息，用于早期预警和卫生保健分层，并使健康结果能够更实际地监测，供提供者、付款人、政府、研究人员以及最重要的消费者使用，鼓励自我管理和以患者为中心的护理提供。

DESCRIPTION (provided by applicant): This SBIR Phase II project will develop and evaluate a more practical and comprehensive approach to standardizing the self-assessment of disease-specific Health-Related Quality of Life (HRQOL) in the growing population of aging (45+ years) adults with, and at-risk of, co-morbid chronic conditions. Specifically, we propose to simplify disease impact screening (for prevention and early warning), and monitoring of HRQOL outcomes by adapting a consumer-focused Smart Measurement" system, developed using item response theory (IRT) to improve outcomes measures, utilizing computerized adaptive testing (CAT) software to improve data capture and score estimation, and deliver content via the Internet. Phase I demonstrated administrative feasibility and supported the assumptions underlying the standardization of the content of disease-specific impact items and their calibration across diseases to achieve measures that are more responsive to outcomes as well as meaningfully comparable across diseases. Other complimentary SBIR projects focusing on single diseases have demonstrated the potential for more practical and precise assessments over a wide range of severity levels - and the possibility of eliminating "ceiling" and "floor" effects. In Phase II we will combine these efforts and expand our tests of standardized disease-specific and generic measurement models among larger samples of aging adults with multiple co-morbid conditions by administering items from new standardized disease specific item banks as well as previously-validated disease-specific and generic HRQOL measures to address the following aims: (1) Improve the instrument and item pools using (a) qualitative methods and expert/consumer evaluation, (b) quantitative studies among large samples of the most prevalent and burdensome chronic conditions (e.g., asthma, CHF, CKD, depression, diabetes, headache, obesity, osteoarthritis), and (c) head-to-head comparisons between more efficient static and dynamic short forms versus "legacy" (previously-validated) tools; (2) Develop and evaluate aggregated disease-specific and generic feedback report(s), suitable for consumers (who are and are not currently "patients") and their clinicians, with user-friendly normative/benchmark interpretive information; (3) Evaluate the self-assessment system in a longitudinal prospective panel study to replicate tests of psychometric properties, test predictive validity (medical expenditures, role/social participation, mortality) and responsiveness, and address data quality, context and mode effects, accessibility of the Internet, and effects of respondent characteristics; (4) Gather norms by administering generic and disease specific measures to representative US population samples with and without chronic conditions. The Phase II product will be a fully operational self-assessment system for screening and monitoring disease impact for the aging population with multiple co-morbid conditions, including: improved "static" and dynamic (CAT) short forms for assessing disease impact and generic health outcomes, user-friendly feedback reports and documentation. PUBLIC HEALTH RELEVANCE: The Disease Impact Assessment Tool will measure the impact of multiple co-morbidities across the spectrum of physical functioning and mental well-being. It will simplify disease burden screening and provide more actionable information for use in early warning and health care stratification, and enable more practical monitoring of health outcomes for use by providers, payors, governments, researchers and most importantly, consumers that encourage self-management and patient-centered care delivery.