Morris Scott, Bass Mike, Lee Mirinae, Neapolitan Richard E
Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA.
Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
J Am Med Inform Assoc. 2017 Sep 1;24(5):897-902. doi: 10.1093/jamia/ocx003.
The Patient Reported Outcomes Measurement Information System (PROMIS) initiative developed an array of patient reported outcome (PRO) measures. To reduce the number of questions administered, PROMIS utilizes unidimensional item response theory and unidimensional computer adaptive testing (UCAT), which means a separate set of questions is administered for each measured trait. Multidimensional item response theory (MIRT) and multidimensional computer adaptive testing (MCAT) simultaneously assess correlated traits. The objective was to investigate the extent to which MCAT reduces patient burden relative to UCAT in the case of PROs.
One MIRT and 3 unidimensional item response theory models were developed using the related traits anxiety, depression, and anger. Using these models, MCAT and UCAT performance was compared with simulated individuals.
Surprisingly, the root mean squared error for both methods increased with the number of items. These results were driven by large errors for individuals with low trait levels. A second analysis focused on individuals aligned with item content. For these individuals, both MCAT and UCAT accuracies improved with additional items. Furthermore, MCAT reduced the test length by 50%.
For the PROMIS Emotional Distress banks, neither UCAT nor MCAT provided accurate estimates for individuals at low trait levels. Because the items in these banks were designed to detect clinical levels of distress, there is little information for individuals with low trait values. However, trait estimates for individuals targeted by the banks were accurate and MCAT asked substantially fewer questions.
By reducing the number of items administered, MCAT can allow clinicians and researchers to assess a wider range of PROs with less patient burden.
患者报告结局测量信息系统（PROMIS）计划开发了一系列患者报告结局（PRO）测量指标。为减少所问问题的数量，PROMIS采用单维项目反应理论和单维计算机自适应测试（UCAT），这意味着针对每个测量的特质会给出一组不同的问题。多维项目反应理论（MIRT）和多维计算机自适应测试（MCAT）可同时评估相关特质。目的是研究在PROs方面，相对于UCAT，MCAT能在多大程度上减轻患者负担。
使用相关特质焦虑、抑郁和愤怒开发了一个MIRT模型和3个单维项目反应理论模型。利用这些模型，将MCAT和UCAT的表现与模拟个体进行比较。
令人惊讶的是，两种方法的均方根误差都随项目数量增加而增大。这些结果是由特质水平较低的个体的较大误差导致的。第二项分析聚焦于与项目内容相符的个体。对于这些个体，MCAT和UCAT的准确性都随着额外项目的增加而提高。此外，MCAT将测试长度缩短了50%。
对于PROMIS情绪困扰库，UCAT和MCAT都未能为特质水平较低的个体提供准确估计。因为这些库中的项目旨在检测临床水平的困扰，对于特质值较低的个体几乎没有信息。然而，针对该库所针对个体的特质估计是准确的，且MCAT问的问题要少得多。
通过减少所问项目的数量，MCAT可以使临床医生和研究人员在减轻患者负担的情况下评估更广泛的PROs。
