Computerized Adaptive Assessment of Asthma Impact

描述（由申请人提供）：使用项目反应理论（IRT）可以显著改善对哮喘对健康相关生活质量（HRQOL）的功能性影响的理解，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，这些信息可能有助于加强病人与护理人员的沟通。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”，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。为了解决这些缺陷，第一阶段的目标是使用先前开发的IRT校准，用于涵盖哮喘影响主要领域的哮喘特异性问卷的项目组合“池”，以：（1）管理哮喘影响、哮喘控制和一般HRQOL测量作为“无缝”评估，并在单个用户友好的汇总报告中显示其结果;（2）获得项目使用情况的初步估计，（所需项目数量和给药次数），测量的水平范围（上限和下限效应），以及与完整问卷调查相比的评分准确性;（3）相对于完整问卷调查，对CAT管理的接受程度进行初步评估;以及（4）对原型汇总报告的有用性进行初步评估。第一阶段的产品将是一个原型的全面ASTHMA-CAT的可行性，可接受性和可能的经验表现的初步证据。在第一阶段，我们将把新的哮喘特异性CAT与通用CAT表的项目库（基于SF-36和其他广泛使用的HRQOL指标）“结合”，以创建一个单一的综合系统。我们的方法在第二阶段的一个重大优势是能够利用IRT模型来“交叉校准”新的指标与得分从目前广泛使用的哮喘特异性和通用的影响工具，使有意义的比较结果。ASTHMA-CAT软件的编程将在互联网上全面运行，并在第二阶段与PC兼容，这将促进临床研究并改进临床实践中使用的评估方法。将从评分的可靠性、有效性和精确性方面对输出进行评估。通过大大降低数据收集成本，减少受访者的负担，消除“天花板”和“地板”的影响，并提高个体患者评分的精度，HRQOL的常规监测可能成为可行的临床工具，哮喘患者和其他慢性疾病患者。

DESCRIPTION (provided by applicant): Understanding the functional impact of asthma on health-related quality of life (HRQOL) 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 be useful in enhancing patient-caregiver communication. Among the limiting factors is the impracticality (respondent burden) of today's HRQOL measures. Short-forms (e.g., SF-36", AQLQ) are more practical, however, "ceiling" and "floor" effects limit their ranges and they lack the precision to detect changes in individual patient scores. To address these deficiencies, the aims of Phase I are to use previously developed IRT calibrations for a combined "pool" of items from asthma-specific questionnaires covering major domains of asthma impact to: (1) administer asthma impact, asthma control, and generic HRQOL measures as a "seamless" assessment and display their results in tandem in a single user-friendly aggregate report; (2) obtain preliminary estimates of item usage, respondent burden (number of items required and administration times), range of levels measured (ceiling and floor effects), and score accuracy in comparison with a full length survey; (3) conduct preliminary evaluations of the acceptance of CAT administrations relative to full length questionnaire; and (4) conduct preliminary evaluations of the usefulness of the prototype aggregate report. The product of Phase I will be a prototype comprehensive ASTHMA-CAT with preliminary evidence regarding feasibility, acceptability, and likely empirical performance. In Phase I1, we will "marry" the new asthma-specific CAT with item pools for generic CAT forms (based on SF-36 and other widely-used HRQOL measures) to create a single comprehensive system. A substantial advantage of our approach in Phase II is the ability to utilize IRT models to "cross-calibrate" the new metrics with scores from current widely used asthma-specific and generic impact tools to enable meaningful comparisons of results. ASTHMA-CAT software, programmed to be fully operational on the Internet and PC-compatible in Phase II, will facilitate clinical research and improve assessment methods for use in clinical practice. Output will be evaluated in terms of reliability, validity and precision of scores. By greatly lowering data collection costs, reducing respondent burden, eliminating "ceiling" and "floor" effects and increasing the precision of individual patient scores, routine monitoring of HRQOL may become feasible as a clinical tool among asthma sufferers and patients with other chronic illnesses.