Computerized Adaptive Assessment of Asthma Impact

哮喘影响的计算机化自适应评估

• 批准号: 7672227
• 负责人: DIANE M TURNER-BOWKER
• 金额: $ 5.64万
• 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 2009-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7672227
• 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; Quality of Care; Questionnaires; Reporting; Respondent; SF-12; SF-36; Sampling; Screening procedure; Self Management; Severities; Solutions; Surveys; System; Tablets; Technology; Telefacsimile; Testing; Time; Validity and Reliability; base; clinical practice; 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以测量患者报告结局（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，并且使用计算机自适应测试（CAT）可以在广泛的严重程度水平上实现更实用和更精确评估的竞争目标，该测试将问卷项目与每个患者的水平相匹配。如果更多的可用性，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。其中的限制因素是不切实际的（受访者负担），今天的HRQOL措施。短格式（例如，SF-36（r）、AQLQ）更实用，然而，“天花板”和“地板”效应限制了它们的范围，并且它们缺乏检测个体患者评分变化的精度。在第一阶段，我们开发并试行了一种基于互联网的原型评估（ASTHMA-CAT），该评估将哮喘影响、哮喘控制和一般HRQOL指标结合在一个“无缝”管理中，并在一个用户友好的汇总（或组级）报告中显示结果。ASTHMA-CAT的初步测试结果表明，动态评估实现了几乎一样精确的评分估计，远低于全长调查的受访者负担，并区分轻度，中度和重度哮喘。患者和供应商积极评价ASTHMA-CAT评估和报告。第二阶段的目标是：（1）从我们现有的哮喘库中评估项目的心理测量性能和临床相关性，并通过收集和分析来自不同哮喘严重程度的成人的大样本的响应来校准项目增强;（2）建立一个功能齐全、全面的ASTHMA-CAT系统，具有集中的数据采集、评分和“真实的时间”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进行纵向前瞻性实地研究，以证明其反应性、可靠性和结构效度;并记录不同给药模式的可比性（例如，纸和笔，平板电脑，互联网）;（4）评估ASTHMA-CAT用于远程自我管理的潜力;和（5）通过全面的文档和教育材料的开发，促进ASTHMA-CAT与临床实践的整合。这项工作的目标是一个有效的，负担较轻的哮喘PRO监测系统，其管理的可行性，可靠性，有效性和反应性的证据证明。如果成功，ASTHMA-CAT系统将提供简化的数据采集、处理和“真实的时间”报告功能;将在多种管理模式下产生有效和可比的分数;并将提供有用的解释指南，以促进其在护理管理中的常规应用。公共卫生相关性：ASTHMA-CAT将提供一种全面、准确、实用、基于患者的评估，可用于常规监测各种环境下的哮喘影响、哮喘控制和一般HRQOL结局。它将产生有意义和有用的结果，为临床决策提供信息，并改善护理管理。