Computerized Adaptive Assessment of Disease Impact

描述（由申请人提供）：该SBIR II期项目将开发和评估一种更实用和全面的方法，以标准化疾病特异性健康相关生活质量（HRQOL）的自我评估，该方法适用于不断增长的老年（45岁以上）成人人群，并有合并慢性疾病的风险。具体而言，我们建议简化疾病影响筛查（用于预防和早期预警），并通过调整以消费者为中心的智能测量系统来监测HRQOL结果，该系统使用项目反应理论（IRT）开发以改善结果测量，利用计算机自适应测试（CAT）软件来改善数据捕获和分数估计，并通过互联网提供内容。第一阶段展示了行政可行性，并支持了特定疾病影响项目内容标准化及其在各种疾病之间的校准所依据的假设，以实现更能反映结果并在各种疾病之间具有有意义的可比性的措施。其他以单一疾病为重点的补充SBIR项目已经证明了在广泛的严重程度上进行更实际和精确评估的潜力-以及消除“天花板”和“地板”效应的可能性。在第II阶段，我们将联合收割机结合这些努力，并通过管理新标准化疾病特异性项目库中的项目以及先前验证的疾病特异性和通用HRQOL指标，在患有多种共病的老年人的更大样本中扩展我们对标准化疾病特异性和通用测量模型的测试，以实现以下目标：（1）利用（a）定性方法和专家/消费者评价，（B）对最普遍和最沉重的慢性病（例如，哮喘、CHF、CKD、抑郁症、糖尿病、头痛、肥胖、骨关节炎），以及（c）更有效的静态和动态短形式与“传统”之间的头对头比较（以前验证过的）工具;（2）制定和评估适合消费者的特定疾病和通用反馈报告（目前是和不是“患者”）及其临床医生，具有用户友好的规范/基准解释信息;（3）在纵向前瞻性小组研究中评估自我评估系统，以复制心理测量学特性的测试，测试预测效度，（医疗支出，角色/社会参与，死亡率）和响应性，并解决数据质量，背景和模式的影响，互联网的可访问性，以及受访者特征的影响;（4）通过对有和无慢性病的代表性美国人口样本实施通用和疾病特异性措施来收集规范。第二阶段产品将是一个全面运作的自我评估系统，用于筛查和监测患有多种共病的老龄人口的疾病影响，包括：用于评估疾病影响和一般健康结果的改进的“静态”和动态（CAT）简表，方便用户的反馈报告和文件。公共卫生相关性：疾病影响评估工具将衡量多种合并症对身体功能和心理健康的影响。它将简化疾病负担筛查，提供更多可操作的信息，用于早期预警和医疗保健分层，并使医疗服务提供者、支付者、政府、研究人员以及最重要的是鼓励自我管理和以患者为中心的医疗服务的消费者能够对健康结果进行更实际的监测。

DESCRIPTION (provided by applicant): This SBIR Phase II project will develop and evaluate a more practical and comprehensive approach to standardizing the self-assessment of disease-specific Health-Related Quality of Life (HRQOL) in the growing population of aging (45+ years) adults with, and at-risk of, co-morbid chronic conditions. Specifically, we propose to simplify disease impact screening (for prevention and early warning), and monitoring of HRQOL outcomes by adapting a consumer-focused Smart Measurement" system, developed using item response theory (IRT) to improve outcomes measures, utilizing computerized adaptive testing (CAT) software to improve data capture and score estimation, and deliver content via the Internet. Phase I demonstrated administrative feasibility and supported the assumptions underlying the standardization of the content of disease-specific impact items and their calibration across diseases to achieve measures that are more responsive to outcomes as well as meaningfully comparable across diseases. Other complimentary SBIR projects focusing on single diseases have demonstrated the potential for more practical and precise assessments over a wide range of severity levels - and the possibility of eliminating "ceiling" and "floor" effects. In Phase II we will combine these efforts and expand our tests of standardized disease-specific and generic measurement models among larger samples of aging adults with multiple co-morbid conditions by administering items from new standardized disease specific item banks as well as previously-validated disease-specific and generic HRQOL measures to address the following aims: (1) Improve the instrument and item pools using (a) qualitative methods and expert/consumer evaluation, (b) quantitative studies among large samples of the most prevalent and burdensome chronic conditions (e.g., asthma, CHF, CKD, depression, diabetes, headache, obesity, osteoarthritis), and (c) head-to-head comparisons between more efficient static and dynamic short forms versus "legacy" (previously-validated) tools; (2) Develop and evaluate aggregated disease-specific and generic feedback report(s), suitable for consumers (who are and are not currently "patients") and their clinicians, with user-friendly normative/benchmark interpretive information; (3) Evaluate the self-assessment system in a longitudinal prospective panel study to replicate tests of psychometric properties, test predictive validity (medical expenditures, role/social participation, mortality) and responsiveness, and address data quality, context and mode effects, accessibility of the Internet, and effects of respondent characteristics; (4) Gather norms by administering generic and disease specific measures to representative US population samples with and without chronic conditions. The Phase II product will be a fully operational self-assessment system for screening and monitoring disease impact for the aging population with multiple co-morbid conditions, including: improved "static" and dynamic (CAT) short forms for assessing disease impact and generic health outcomes, user-friendly feedback reports and documentation. PUBLIC HEALTH RELEVANCE: The Disease Impact Assessment Tool will measure the impact of multiple co-morbidities across the spectrum of physical functioning and mental well-being. It will simplify disease burden screening and provide more actionable information for use in early warning and health care stratification, and enable more practical monitoring of health outcomes for use by providers, payors, governments, researchers and most importantly, consumers that encourage self-management and patient-centered care delivery.