Computerized Adaptive Assessment of Asthma Impact

描述(由申请人提供)：最近的几项倡议强调了开发和测试新技术以衡量患者报告结果(PRO)的重要性。使用项目反应理论(IRT)可以显著改善哮喘的PRO测量，使用将问卷项目与每个患者的水平相匹配的计算机化自适应测试(CAT)可以在广泛的严重程度上实现更实用和更准确的评估的相互竞争的目标。如果有更多可用的信息，这些信息可以补充哮喘管理计划，加强患者与照顾者的沟通，并改善临床决策。限制因素之一是今天的HRQOL测量方法的不切实际(反应负担)。短表格(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，它们缺乏检测单个患者评分变化的精确度。在第一阶段，我们开发并试行了一个基于互联网的评估原型(哮喘-CAT)，它将哮喘影响、哮喘控制和通用的HRQOL测量结合在一个“无缝”管理中，并在一个用户友好的汇总(或小组级别)报告中同步显示结果。哮喘-CAT的试点测试结果表明，动态评估获得了几乎与完整调查一样精确的分数估计，反应负担远远低于全程调查，并很好地区分了轻度、中度和重度哮喘。患者和提供者对哮喘-CAT评估和报告给予了积极评价。第二阶段的目标是：(1)评估我们目前哮喘库中的条目的心理测量学表现和临床相关性，并通过收集和分析哮喘严重程度不同的大样本的反应来校准条目增强；(2)建立一个完整功能和全面的哮喘-CAT系统，并通过数据模拟研究来评估其心理测量性能；(3)对哮喘-CAT进行纵向前瞻性现场研究，以证明其反应性、可靠性和结构效度；并记录不同给药模式(例如，纸和笔、平板电脑、互联网)的可比性；(4)评估哮喘猫在远程自我管理中的使用潜力；以及(5)通过全面的文件记录和教育材料的开发，促进哮喘猫融入临床实践。这项工作的目标是一种有效的、负担较轻的哮喘PRO监测系统，并证明其管理可行性、可靠性、有效性和响应性。如果成功，哮喘-CAT系统将提供简化的数据捕获、处理和“实时”报告功能；将在多种管理模式下产生有效和可比较的分数；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：哮喘-CAT将提供全面、准确但实用的以患者为基础的评估，有效地在各种环境下对哮喘影响、哮喘控制和一般HRQOL结果进行常规监测。它将产生有意义和有用的结果，为临床决策和改善护理管理提供信息。

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.