Improved Outcomes Assessment in Arthritis and Aging(RMI)

描述（由申请人提供）：患者报告的转归（pro）越来越被认为是重要的转归。我们寻求通过使用项目反应理论（IRT）和计算机化适应性测试（CAT）开发改进的工具，广泛推进关节炎和衰老的结果评估。现有工具的使用受到不切实际（受访者负担）和跨工具比较研究结果的困难的限制。较短的调查问卷已被证明更实用，但“上限”和“下限”效应通常是在每个健康领域内测量有限范围的结果。此外，简短的问卷调查（如SF- 36， HAQ）缺乏必要的准确性，无法可靠地检测个体患者评分的变化。针对这些问题，我们的团队在开发、评估和实施风湿病中最常用的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创新方法应用IRT和CAT方面拥有丰富的经验。

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).