Computerized Adaptive Assessment of Asthma Impact

描述（由申请人提供）：最近的一些举措强调了开发和测试新技术来衡量患者报告结果（PRO）的重要性。使用项目反应理论（IRT）可以大大改善哮喘的PRO措施，并且使用计算机化自适应测试（CAT）可以在大范围的严重程度上实现更实用和更精确的评估目标，该测试将问卷项目与每个患者的水平相匹配。如果获得更多的信息，这些信息可以补充哮喘管理计划，加强患者与护理人员的沟通，并改善临床决策。限制因素之一是当今HRQOL测量的不实用性（受访者负担）。简短的形式（例如SF-36(r)， AQLQ）更实用，然而，“上限”和“下限”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。在第一阶段，我们开发并试验了一种基于互联网的原型评估（asthma - cat），它将哮喘影响、哮喘控制和一般HRQOL措施结合在一个“无缝”管理中，并在一个用户友好的汇总（或组级）报告中串联显示结果。asthma - cat的初步测试结果表明，动态评估几乎达到了与全身调查一样精确的评分估计，受访者负担远低于全身调查，并且可以很好地区分轻度，中度和重度哮喘。患者和医护人员对哮喘- cat评估和报告给予积极评价。II期的目标是：(1)评估我们目前哮喘库中的项目的心理测量性能和临床相关性，并通过收集和分析来自不同哮喘严重程度成人的大样本的反应来校准项目的增强；(2)构建功能完备的哮喘- cat系统，集中数据采集、评分和“实时”反馈报告，并通过数据模拟研究评估其心理测量性能；(3)对ASTHMA-CAT进行纵向前瞻性实地研究，以验证其响应性、信度和结构效度；并记录不同管理模式的可比性（例如，纸笔，平板电脑，互联网）；(4)评估哮喘- cat在远程自我管理中的应用潜力；(5)通过综合文献和教材的开发，促进哮喘- cat融入临床实践。这项工作的目标是建立一个高效、负担较少的哮喘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；将在多种管理模式中产生有效和可比较的分数；并将为其在护理管理中的日常应用提供有益的解释指南。公共卫生相关性：asthma - cat将提供全面、精确、实用、基于患者的评估，可用于常规监测哮喘影响、哮喘控制和各种环境下的一般HRQOL结果。它将产生有意义和有用的结果，告知临床决策和改善护理管理。

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.