Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA.
Center for Clinical Outcomes Development and Application (CODA), Department of Physical Medicine & Rehabilitation, University of Michigan, North Campus Research Complex, 2800 Plymouth Road, Building NCRC B14, Room G216, Ann Arbor, MI, 48109-2800, USA.
J Gen Intern Med. 2023 Jul;38(9):2164-2178. doi: 10.1007/s11606-023-08147-x. Epub 2023 Mar 24.
Housing security is a key social determinant of behavior related to health outcomes.
The purpose of this study was to develop a new patient-reported outcome measure that evaluates aspects of housing security for use in the Re-Engineered Discharge for Diabetes-Computer Adaptive Test (REDD-CAT) measurement system.
Qualitative data, literature reviews, and cross-sectional survey study.
A total of 225 people with T2DM provided responses to the items in this item pool.
A new item pool that evaluates important aspects of housing security was developed using stakeholder data from focus groups of persons with T2DM.
For the Housing Affordability scale, factor analysis (both exploratory and confirmatory) supported the retention of six items. Of these items, none exhibited sparse cells or problems with monotonicity; no items were deleted due to low item-adjusted total score correlations. For the six affordability items, a constrained graded response model indicated no items exhibited misfit; thus, all were retained. No items indicated differential item functioning (examined for age, sex, education, race, and socioeconomic status). Thus, the final Affordability item bank comprised six items. A Housing Safety index (three items) and a Home Features index (eight items) were also developed. Reliability (i.e., internal consistency and test-retest reliability) and validity (i.e., convergent, discriminant, and known-groups) of the new measures were also supported.
The REDD-CAT Housing Security Measure provides a reliable and valid assessment of housing affordability, safety, and home features in people with type 2 diabetes mellitus. Future work is needed to establish the clinical utility of this measure in other clinical populations.
住房保障是与健康结果相关行为的一个关键社会决定因素。
本研究旨在开发一种新的患者报告结局测量工具，用于评估住房保障的各个方面，用于再设计糖尿病出院-计算机自适应测试（REDD-CAT）测量系统。
定性数据、文献回顾和横断面调查研究。
共有 225 名 T2DM 患者对该条目库中的条目做出了回应。
使用 T2DM 患者焦点小组的利益相关者数据，开发了一个新的条目库，用于评估住房保障的重要方面。
对于住房负担能力量表，因子分析（探索性和验证性）支持保留六项条目。在这些条目中，没有一个出现稀疏单元格或单调性问题；没有一个因单项调整总分相关性低而被删除。对于六个负担能力项目，约束等级反应模型表明没有项目存在拟合不良；因此，所有项目都被保留。没有项目显示出不同的项目功能（按年龄、性别、教育、种族和社会经济地位进行检查）。因此，最终的负担能力条目库由六项组成。还开发了住房安全指数（三项）和家庭功能指数（八项）。新测量工具的可靠性（即内部一致性和重测信度）和有效性（即收敛、判别和已知组）也得到了支持。
REDD-CAT 住房保障测量工具为 2 型糖尿病患者提供了可靠有效的住房负担能力、安全性和家庭功能评估。未来需要开展工作，以确定该测量工具在其他临床人群中的临床实用性。
