Article

Efficiency of static and computer adaptive short forms compared to full-length measures of depressive symptoms.

Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
Quality of Life Research (Impact Factor: 2.86). 11/2009; 19(1):125-36. DOI: 10.1007/s11136-009-9560-5
Source: PubMed

ABSTRACT Short-form patient-reported outcome measures are popular because they minimize patient burden. We assessed the efficiency of static short forms and computer adaptive testing (CAT) using data from the Patient-Reported Outcomes Measurement Information System (PROMIS) project.
We evaluated the 28-item PROMIS depressive symptoms bank. We used post hoc simulations based on the PROMIS calibration sample to compare several short-form selection strategies and the PROMIS CAT to the total item bank score.
Compared with full-bank scores, all short forms and CAT produced highly correlated scores, but CAT outperformed each static short form in almost all criteria. However, short-form selection strategies performed only marginally worse than CAT. The performance gap observed in static forms was reduced by using a two-stage branching test format.
Using several polytomous items in a calibrated unidimensional bank to measure depressive symptoms yielded a CAT that provided marginally superior efficiency compared to static short forms. The efficiency of a two-stage semi-adaptive testing strategy was so close to CAT that it warrants further consideration and study.

0 Followers
 · 
89 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND Supportive oncology practice can be enhanced by the integration of a brief and validated electronic patient-reported outcome assessment into the electronic health record (EHR) and clinical workflow.METHODS Six hundred thirty-six women receiving gynecologic oncology outpatient care received instructions to complete clinical assessments through Epic MyChart, an EHR patient communication portal. Patient Reported Outcomes Measurement Information System (PROMIS) computer adaptive tests (CATs) were administered to assess fatigue, pain interference, physical function, depression, and anxiety. Checklists identified psychosocial concerns, informational and nutritional needs, and risk factors for inadequate nutrition. Assessment results, including PROMIS T scores with documented severity thresholds, were immediately populated in the EHR. Clinicians were notified of clinically elevated symptoms through EHR messages. EHR integration was designed to provide automated triage to social work providers for psychosocial concerns, to health educators for information, and to dietitians for nutrition-related concerns.RESULTSFour thousand forty-two MyChart messages sent, and 3203 (79%) were reviewed by patients. The assessment was started by 1493 patients (37%), and once they started, 93% (1386 patients) completed the assessment. According to first assessments only, 49.8% of the patients who reviewed the MyChart message completed the assessment. Mean PROMIS CAT T scores indicated a lower level of physical function and elevated anxiety in comparison with the general population. Fatigue, pain, and depression scores were comparable to those of the general population. Impaired physical functioning was the most common basis for clinical alerts and occurred in 4% of the patients.CONCLUSIONSPROMIS CATs were used to measure common cancer symptoms in routine oncology outpatient care. Immediate EHR integration facilitated the use of symptom reporting as the basis for referral to psychosocial and supportive care. Cancer 2014. © 2014 American Cancer Society.
    Cancer 11/2014; DOI:10.1002/cncr.29104 · 4.90 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: For classification problems in psychology (e.g., clinical diagnosis), batteries of tests are often administered. However, not every test or item may be necessary for accurate classification. In the current article, we introduce a combination of classification and regression trees (CART) and stochastic curtailment (SC) to reduce assessment length of questionnaire batteries. First, the CART algorithm provides relevant subscales and cutoffs needed for accurate classification, in the form of a decision tree. Second, for every subscale and cutoff appearing in the decision tree, SC reduces the number of items needed for accurate classification. This procedure is illustrated by post-hoc simulation on a dataset of 3579 patients, to whom the Mood and Anxiety Symptoms Questionnaire (MASQ) was administered. Subscales of the MASQ are used for predicting diagnoses of depression. Results show that CART-SC provided an assessment length reduction of 56%, without loss of accuracy, compared to the more traditional prediction method of performing linear discriminant analysis (LDA) on subscale scores. CART-SC appears to be an efficient and accurate algorithm for shortening test batteries.
    Applied Psychological Measurement 01/2014; 38(1):3-17. · 1.49 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Computerized adaptive testing (CAT) based on Item Response Theory, (IRT) offers an efficient way for accurate measurement of patient reported outcomes. The efficiency lies within a minimal response burden and a high measurement precision over a broad measurement range. The objective of the study was to evaluate and compare the responsiveness of CATs measuring anxiety, depression, and stress reaction to standard static self-assessment tools. Longitudinal data of n=595 psychosomatic inpatients were analyzed for evaluating retest-reliability and sensitivity to change of the CATs compared to static measures (GAD-7, PHQ-9, and PSQ) using correlational and ANOVA statistics. The study hypothesized that CATs are at least as retest-reliable and as sensitive to change as static tools. The three CATs show a low burden for patients, administering on average 5-7 (±2-6SD) items with similar retest-reliability compared to the static tools applied (A-CAT: r=.78 vs. GAD-7: r=.75, D-CAT: r=.71 vs. PHQ-9: r=.75, S-CAT: r=.80 vs. PSQworries scale: r=.80). The CATs were overall as sensitive to change as the static tools (Cohen׳s d ranged between .19 and .69). This is a monocenter, observational, longitudinal study without external clinical criteria; thus generalization to other settings may be limited. The tested CATs belong to the first generation of CATs being used in daily routine for more than a decade. They are as retest reliable and sensitive to change as static tools. Newer CATs may provide further practical advantages. Copyright © 2014 Elsevier B.V. All rights reserved.
    Journal of Affective Disorders 11/2014; DOI:10.1016/j.jad.2014.10.063 · 3.71 Impact Factor

Full-text (2 Sources)

Download
35 Downloads
Available from
May 29, 2014