Web-based Training & Reliability for Psychiatric Raters

描述（由申请人提供）：在精神病学临床试验期间，培训评分员以及建立和保持可靠性的重要任务是一个经常被忽视的主要问题。这个问题对于涉及多个地点的许多评价员的试验来说尤其令人烦恼。此外，影响标准精神病评定工具的评分者期望（偏差）的因素从未被充分探索过。这个第二阶段项目的目的是开发一个交互式视频系统，用于培训研究评级人员使用具有共同评级惯例的评级工具，并评估跨地点和跨时间的评级人员的可靠性。应编写程序，使该视频系统可用作：(1)可用于培训评级员使用评级工具的交互式“教程”系统，以及(2)“可靠性测试”系统，该系统使用集成数据库记录评级，并在确定的评级员组中计算评级员之间的可靠性或预置评级，即“金标准”。该计划包括建立一个完整的库，其中包括汉密尔顿抑郁评定量表（HDRS）的30种变体，使用四名不同性别和不同种族的演员。II期研究将评估变异性和评分者偏差，作为评分者和“患者”的人口统计学和专业特征的相互作用，有200名新手评分者。第一阶段创建了一个用于评估HDRS互连器可靠性的原型。使用来自实际患者访谈的脚本，一男一女演员分别描绘了三个独立的HDRS访谈，反映了不同严重程度的抑郁症状。在为第二阶段做准备时，发现该系统的功能非常出色。可行性通过以下几个方面来确定：1)由经验丰富的评分员对演员和实际患者的HDRS访谈视频进行评估，并建立演员描述的效度；2)使用系统原型计算经验丰富的评分员（0.97）和新手评分员（0.96）的评分员间信度得分；3)召集焦点小组对经验丰富的评分员和新手评分员对系统的积极和消极属性进行评估。未来的产品开发将利用软件和统计方法与其他评级工具，包括那些用于评估精神分裂症，焦虑症和痴呆症。

DESCRIPTION (Provided by Applicant): The important task of training raters and establishing and maintaining reliability for the duration of a psychiatric clinical trial is a major problem that is often ignored. This problem is particularly vexing for trials involving many raters at multiple sites. Furthermore, factors effecting rater expectancy (bias) with standard psychiatric rating instruments has never been fully explored. This Phase II project is intended to develop an interactive video system for training research raters to use rating instruments with shared rating conventions and assess interrater reliability across sites and over time. Programs are to be written that will enable this video system to be used as (1) an interactive "tutorial" system that can be used to train raters on the use of the rating instrument, and (2) a "reliability testing" system, that uses an integrated database to record ratings and compute interrater reliability within an identified group of raters or with preset ratings, i.e., a "gold standard". The plan involves developing a complete library of 30 variations of the Hamilton Depression Rating Scale (HDRS) using four different actors of both genders and diverse ethnicity. The Phase II study will assess variability and rater bias as an interaction of demographic and professional characteristics of the raters and "patients" with 200 novice raters. Phase I created a prototype for assessing interrater reliability for the HDRS. Using scripts from actual patient interviews, a male and a female actor each portrayed three separate HDRS interviews reflecting depressive symptoms of various severity. In preparation for Phase II, the functionality of the system was found to be excellent. Feasibility was established by 1) having experienced raters assess videos of the HDRS interviews of both actors and actual patients and establish the validity of the actors' portrayals, 2) calculating interrater reliability scores for a group of experienced raters (0.97) and a group of novice raters (0.96) using the system prototype, and 3) convening focus groups to assess the positive and negative attributes of the system with both experienced and novice raters. Future product development will utilize the software and statistical methodology with other rating instruments, including those used to assess schizophrenia, anxiety disorders, and dementia.