Chinman Matthew, Young Alexander S, Schell Terry, Hassell Joseph, Mintz Jim
VA VISN-22 Mental Illness Research, Education, and Clinical Center (MIRECC), Los Angeles, Calif. 90073, USA.
J Clin Psychiatry. 2004 Oct;65(10):1343-51. doi: 10.4088/jcp.v65n1008.
It has been difficult to improve care for severe mental illness (SMI) in usual care settings because clinical information is not reliably and efficiently managed. Methods are needed for efficiently collecting this information to evaluate and improve health care quality. Audio computer-assisted self-interviewing (ACASI) can facilitate this data collection and has improved outcomes for a number of disorders, suggesting the need to test its accuracy and reliability in people with SMI.
Ninety patients with DSM-IV schizophrenia or schizoaffective disorder (N = 45) or bipolar disorder (N = 45) recruited between Oct. 15, 2002, and July 1, 2003, were randomly assigned to 1 of 2 study groups and completed 2 standardized symptom surveys (Revised Behavior and Symptom Identification Scale and the symptom severity scale of the Schizophrenia Outcomes Module 2) 20 minutes apart in a crossover study design. Half of the patients first completed the scales via an in-person interview, and the other half first completed the scales via an ACASI survey self-administered through an Internet browser using a touchscreen developed to meet the cognitive needs of people with SMI. We evaluated attitudes toward ACASI, understanding of the ACASI survey, internal consistency, correlations between the ACASI and interview modes, concurrent validity, and a possible administration mode bias.
All ACASI and in-person interview scales had similar internal reliability, high correlations (r = 0.78-1.00), and mean scores similar enough as not to be different at p < .05. A large majority rated the ACASI survey as easier, more enjoyable, more preferable if monthly completion of a survey were required, and more private, and 97% to 99% perfectly answered questions about how to use it.
ACASI data collection is reliable among people with bipolar disorder and schizophrenia and could be a valuable tool to improve their care.
在常规护理环境中，改善严重精神疾病（SMI）的护理一直很困难，因为临床信息无法得到可靠且有效的管理。需要一些方法来有效收集这些信息，以评估和改善医疗质量。音频计算机辅助自我访谈（ACASI）有助于这种数据收集，并且已改善了多种疾病的治疗效果，这表明有必要测试其在SMI患者中的准确性和可靠性。
2002年10月15日至2003年7月1日招募的90例患有DSM-IV精神分裂症或分裂情感性障碍（N = 45）或双相情感障碍（N = 45）的患者被随机分配到2个研究组中的1个，并在交叉研究设计中相隔20分钟完成2项标准化症状调查（修订的行为和症状识别量表以及精神分裂症结局模块2的症状严重程度量表）。一半患者首先通过面对面访谈完成量表，另一半首先通过使用为满足SMI患者认知需求而开发的触摸屏通过互联网浏览器自行管理的ACASI调查完成量表。我们评估了对ACASI的态度、对ACASI调查的理解、内部一致性、ACASI与访谈模式之间的相关性、同时效度以及可能的施测模式偏差。
所有ACASI和面对面访谈量表具有相似的内部信度、高度相关性（r = 0.78 - 1.00），且平均得分相似，在p <.05时无差异。绝大多数人认为ACASI调查更简单、更有趣、如果需要每月完成一次调查则更可取且更私密，并且97%至99%的人能完美回答关于如何使用它的问题。
ACASI数据收集在双相情感障碍和精神分裂症患者中是可靠的，并且可能是改善他们护理的有价值工具。
