A System for Interactive Assessment and Management in Palliative Care

描述（由申请人提供）：背景：高质量姑息治疗评估和管理的关键是心理测量学健全和临床相关的筛查、诊断和结果评估工具的可用性，这些工具将使医疗保健提供者能够获得最佳的患者评估、预后、治疗选择、患者满意度和生活质量改善。我们建议使用创新的方法和技术开发一个以患者为中心、模型驱动、基于证据的系统，称为姑息治疗互动评估和管理系统（SIAM-PC）。目的：我们的四个不同但相关的具体目标是：1)识别和完善姑息治疗领域，使用现有的理论框架为指导；2)编制多维姑息治疗信息库项目，借鉴现有措施，补充新编写项目；3)运用项目反应理论（IRT）实证构建姑息治疗信息库；4)对计算机化自适应测试（CAT）平台进行试点测试，以动态管理临床环境中的姑息治疗评估。方法：首先，我们将在现有框架的指导下，通过深入的个人访谈（n=50； 20名患者，20名家庭成员和10名临床医生）和文献综述（目标1），确定和完善姑息治疗的关键领域。其次，我们将从现有措施中编译与这些领域相关的项目，为未覆盖的领域编写新项目（目标2）。第三，我们将通过收集和分析接受姑息治疗的患者（n=200）的数据来检验这些项目（目标3）。最后，我们将在临床实践中对CAT系统进行试点测试（n=40）（目标4）。结果：在R21项目结束时，我们期望：(1)姑息治疗测量的概念模型可以得到改进；(2)可构建缓和医疗领域/项目的初始集合；(3)能够识别和修改显示DIF的项目；(4) CAT原型将演示如何在临床环境中实施该系统。姑息治疗是一个主要的公共卫生问题。文献中有重要的共识和充分的证据呼吁采用综合的、跨学科的方法来解决这一问题。这种全面的评估和护理要求很高，因为它依赖于多种信息来源，而现实生活中护理的实用性依赖于简明的信息。我们提出的研究是建立有效的方法，将综合评估与患者评估和护理中的简明信息联系起来。

DESCRIPTION (provided by applicant): Background: Essential to high-quality palliative care assessment and management is the availability of psychometrically-sound and clinically-relevant screening, diagnosis, and outcome evaluation tools that will enable healthcare providers to attain optimal patient evaluation, prognosis, treatment selection, patient satisfaction, and quality of life improvement. We propose to develop a patient-centered, model-driven, evidence-based system called the System for Interactive Assessment and Management in Palliative Care (SIAM-PC) using innovative methodologies and technologies. Aims: Our four distinct but related specific aims are to: 1) identify and refine the domains of palliative care, using existing theoretical frameworks as a guide; 2) compile the items for multidimensional palliative care item bank, drawing from existing measures and supplementing with newly written items; 3) empirically construct a palliative care item bank using item response theory (IRT); and 4) pilot test a computerized adaptive testing (CAT) platform to dynamically administer palliative care assessment in clinical settings. Methods: First, we will identify and refine the key domains of palliative care, guided by existing frameworks, from in-depth individual interviews (n=50; 20 patients, 20 family members and 10 clinicians) and literature review (Aim 1). Second, we will compile items pertinent to these domains from existing measures, writing new items for un-covered domains (Aim 2). Third, we will test these items by collecting and analyzing data from patients (n=200) receiving palliative (Aim 3). Finally, we will pilot test the CAT system (n=40) in clinical practice (Aim 4). Outcomes: At the end of this R21 project, we expect that (1) the conceptual model of palliative care measurement can be improved; (2) the initial sets of palliative care domains/items can be constructed; (3) items displaying DIF can be identified and revised; and (4) the CAT prototype will demonstrate how the system should be implemented in clinical settings. Palliative care is a major public health concern. There is significant consensus and ample evidence in the literature to call for a comprehensive, interdisciplinary approach to address this concern. This comprehensive assessment and care is demanding in that it depends upon multiple sources of information, and yet the practicalities of real-life care depend upon concise information. Our proposed study is to create valid methods to connect comprehensive assessment with concise information in patient assessment and care.