Improved Outcomes Assessment in Arthritis and Aging(RMI)

描述（由申请人提供）：患者报告的结局（PRO）越来越被接受为重要结局。我们寻求通过开发使用项目反应理论（IRT）和计算机自适应测试（CAT）的改进工具来广泛推进关节炎和衰老的结局评估。现有工具的使用受到不切实际（答复者负担）和难以比较各种工具的研究结果的限制。较短的调查表已被证明更实用，但“天花板”和“地板”效应通常是由于测量每个卫生领域的有限范围而产生的。此外，简短的问卷调查（例如，SF- 36、HAQ）缺乏可靠地检测个体患者评分变化所必需的精确度。对于这些问题，我们带来了一个团队，该团队在开发，评估和实施风湿性疾病中最常用的PRO评估工具，肌肉骨骼疾病和衰老的大型纵向患者数据集以及IRT和CAT应用的创新方法方面拥有丰富的经验。 我们建议实现八个具体的目标，与题库开发，心理测试，CAT的发展，提供心理测量的声音工具，以促进NIH的临床研究的目标。该项目将建立在关节炎、风湿病和衰老医学信息系统（ARAMIS）纵向数据库的基础上，用于项目开发、IRT测试和CAT模拟和开发。它将在一项四人随机试验中达到高潮，该试验比较了增强的传统静态和动态工具对变化的相对敏感性。第一个网络项目调查PROMIS域的概念层次结构和寻求共识的域聚合的效用，结合通用和疾病特异性属性，并设想一个单一的通用/特定的CAT应用程序在不同的慢性疾病。第二个网络项目审查了调查模式对专业人员的影响，并试图了解哪些接口选项（例如，电话访谈、电话交互式语音应答、基于网络的台式计算机和手持计算机）在不同类型的损伤和其他分层变量中最容易获得。拟议的迭代随机试验旨在阐明给药模式如何影响动态PRO。 针对肌肉骨骼疾病、衰老和其他疾病的项目库，以及响应性、可靠性和有效性的提高，将更好地代表患者的观点，并使更具成本效益的临床研究成为可能。关键词：风湿性，肌肉骨骼，老化，健康结果，计算机自适应测试（CAT），项目反应理论（IRT）。

DESCRIPTION (provided by applicant): Patient-reported outcomes (PROs) are increasingly accepted as important outcomes. We seek to extensively advance outcome assessment in arthritis and aging by developing improved instruments using item response theory (IRT) and computerized adaptive testing (CAT). The use of existing tools has been limited by impracticality (respondent burden) and difficulties comparing study results across tools. Shorter questionnaires have proven more practical, but "ceiling" and "floor" effects typically result from measuring a limited range within each health domain. Further, brief questionnaires (e.g., the SF- 36, the HAQ) lack the precision necessary to reliably detect changes in individual patient scores. To these issues, we bring a team with extensive experience in developing, evaluating, and implementing the most frequently used PRO assessment instruments in rheumatic diseases, large longitudinal patient datasets in musculoskeletal disease and aging, and experience with innovative approaches to the application of IRT and CAT. We propose to realize eight specific aims related to item bank development, psychometric testing, and CAT development, with a goal of delivering psychometrically sound tools to facilitate NIH clinical research. This project will build on the substantial infrastructure of Arthritis, Rheumatism, and Aging Medical Information System (ARAMIS) longitudinal data banks for item development, IRT testing, and CAT simulation and development. It will culminate in a four-ann randomized trial comparing enhanced traditional static and dynamic tools in terms of relative sensitivity to change. The first network project investigates the conceptual hierarchies of PROMIS domains and the utility of aggregations of domains seeking consensus, combining generic and disease-specific attributes, and envisioning a single generic/specific CAT application across diverse chronic conditions. The second network project examines the impact of survey mode on PROs and seeks to understand which interface options (e.g., telephone interview, telephone Interactive Voice Response, web-based desktop computer, and handheld computer) are most accessible across types of impairment and other stratified variables. Proposed iterative randomized trials seek to elucidate how administration mode influences dynamic PROs. Item banks for musculoskeletal diseases, aging, and other conditions, and improvement of responsiveness, reliability and validity will better represent the patient's perspective and enable more cost effective clinical research. Key Words: Rheumatic, Musculoskeletal, Aging, Health Outcomes, Computer Adaptive Testing (CAT), Item Response Theory (IRT).