Improved Outcomes Assessment in Arthritis and Aging(RMI)

描述（由申请人提供）：患者报告的结果（PRO）越来越被认为是重要的结果。我们寻求通过使用项目反应理论（IRT）和计算机自适应测试（CAT）开发改进的仪器来广泛推进关节炎和衰老的结果评估。现有工具的使用因不切实际（受访者负担）和比较不同工具的研究结果的困难而受到限制。事实证明，较短的问卷更实用，但“上限”和“下限”效应通常是由于测量每个健康领域内的有限范围而产生的。此外，简短的问卷（例如 SF-36、HAQ）缺乏可靠检测个体患者评分变化所需的精确度。针对这些问题，我们组建了一支在开发、评估和实施风湿病领域最常用的 PRO 评估工具、肌肉骨骼疾病和衰老方面的大型纵向患者数据集以及应用 IRT 和 CAT 创新方法方面拥有丰富经验的团队。 我们建议实现与项目库开发、心理测量测试和 CAT 开发相关的八个具体目标，目标是提供心理测量良好的工具来促进 NIH 临床研究。该项目将建立在关节炎、风湿病和老龄化医疗信息系统 (ARAMIS) 纵向数据库的基础设施之上，用于项目开发、IRT 测试以及 CAT 模拟和开发。最终将进行一项为期四年的随机试验，比较增强的传统静态和动态工具对变化的相对敏感性。第一个网络项目研究了 PROMIS 域的概念层次结构以及寻求共识的域聚合的效用，结合了通用属性和疾病特定属性，并设想了跨不同慢性病的单一通用/特定 CAT 应用。第二个网络项目研究了调查模式对 PRO 的影响，并试图了解哪些界面选项（例如，电话访谈、电话交互式语音应答、基于网络的台式电脑和手持电脑）在不同类型的损伤和其他分层变量中最容易访问。拟议的迭代随机试验旨在阐明给药模式如何影响动态 PRO。 肌肉骨骼疾病、衰老和其他疾病的项目库以及反应性、可靠性和有效性的提高将更好地代表患者的观点，并实现更具成本效益的临床研究。关键词：风湿病、肌肉骨骼、衰老、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).