TY - JOUR T1 - Developing tailored instruments: item banking and computerized adaptive assessment JF - Quality of Life Research Y1 - 2007 A1 - Bjorner, J. B. A1 - Chang, C-H. A1 - Thissen, D. A1 - Reeve, B. B. KW - *Health Status KW - *Health Status Indicators KW - *Mental Health KW - *Outcome Assessment (Health Care) KW - *Quality of Life KW - *Questionnaires KW - *Software KW - Algorithms KW - Factor Analysis, Statistical KW - Humans KW - Models, Statistical KW - Psychometrics AB - Item banks and Computerized Adaptive Testing (CAT) have the potential to greatly improve the assessment of health outcomes. This review describes the unique features of item banks and CAT and discusses how to develop item banks. In CAT, a computer selects the items from an item bank that are most relevant for and informative about the particular respondent; thus optimizing test relevance and precision. Item response theory (IRT) provides the foundation for selecting the items that are most informative for the particular respondent and for scoring responses on a common metric. The development of an item bank is a multi-stage process that requires a clear definition of the construct to be measured, good items, a careful psychometric analysis of the items, and a clear specification of the final CAT. The psychometric analysis needs to evaluate the assumptions of the IRT model such as unidimensionality and local independence; that the items function the same way in different subgroups of the population; and that there is an adequate fit between the data and the chosen item response models. Also, interpretation guidelines need to be established to help the clinical application of the assessment. Although medical research can draw upon expertise from educational testing in the development of item banks and CAT, the medical field also encounters unique opportunities and challenges. VL - 16 SN - 0962-9343 (Print) N1 - Bjorner, Jakob BueChang, Chih-HungThissen, DavidReeve, Bryce B1R43NS047763-01/NS/United States NINDSAG015815/AG/United States NIAResearch Support, N.I.H., ExtramuralNetherlandsQuality of life research : an international journal of quality of life aspects of treatment, care and rehabilitationQual Life Res. 2007;16 Suppl 1:95-108. Epub 2007 Feb 15. ER - TY - JOUR T1 - IRT health outcomes data analysis project: an overview and summary JF - Quality of Life Research Y1 - 2007 A1 - Cook, K. F. A1 - Teal, C. R. A1 - Bjorner, J. B. A1 - Cella, D. A1 - Chang, C-H. A1 - Crane, P. K. A1 - Gibbons, L. E. A1 - Hays, R. D. A1 - McHorney, C. A. A1 - Ocepek-Welikson, K. A1 - Raczek, A. E. A1 - Teresi, J. A. A1 - Reeve, B. B. KW - *Data Interpretation, Statistical KW - *Health Status KW - *Quality of Life KW - *Questionnaires KW - *Software KW - Female KW - HIV Infections/psychology KW - Humans KW - Male KW - Neoplasms/psychology KW - Outcome Assessment (Health Care)/*methods KW - Psychometrics KW - Stress, Psychological AB - BACKGROUND: In June 2004, the National Cancer Institute and the Drug Information Association co-sponsored the conference, "Improving the Measurement of Health Outcomes through the Applications of Item Response Theory (IRT) Modeling: Exploration of Item Banks and Computer-Adaptive Assessment." A component of the conference was presentation of a psychometric and content analysis of a secondary dataset. OBJECTIVES: A thorough psychometric and content analysis was conducted of two primary domains within a cancer health-related quality of life (HRQOL) dataset. RESEARCH DESIGN: HRQOL scales were evaluated using factor analysis for categorical data, IRT modeling, and differential item functioning analyses. In addition, computerized adaptive administration of HRQOL item banks was simulated, and various IRT models were applied and compared. SUBJECTS: The original data were collected as part of the NCI-funded Quality of Life Evaluation in Oncology (Q-Score) Project. A total of 1,714 patients with cancer or HIV/AIDS were recruited from 5 clinical sites. MEASURES: Items from 4 HRQOL instruments were evaluated: Cancer Rehabilitation Evaluation System-Short Form, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, Functional Assessment of Cancer Therapy and Medical Outcomes Study Short-Form Health Survey. RESULTS AND CONCLUSIONS: Four lessons learned from the project are discussed: the importance of good developmental item banks, the ambiguity of model fit results, the limits of our knowledge regarding the practical implications of model misfit, and the importance in the measurement of HRQOL of construct definition. With respect to these lessons, areas for future research are suggested. The feasibility of developing item banks for broad definitions of health is discussed. VL - 16 SN - 0962-9343 (Print) N1 - Cook, Karon FTeal, Cayla RBjorner, Jakob BCella, DavidChang, Chih-HungCrane, Paul KGibbons, Laura EHays, Ron DMcHorney, Colleen AOcepek-Welikson, KatjaRaczek, Anastasia ETeresi, Jeanne AReeve, Bryce B1U01AR52171-01/AR/United States NIAMSR01 (CA60068)/CA/United States NCIY1-PC-3028-01/PC/United States NCIResearch Support, N.I.H., ExtramuralNetherlandsQuality of life research : an international journal of quality of life aspects of treatment, care and rehabilitationQual Life Res. 2007;16 Suppl 1:121-32. Epub 2007 Mar 10. ER - TY - JOUR T1 - Methodological issues for building item banks and computerized adaptive scales JF - Quality of Life Research Y1 - 2007 A1 - Thissen, D. A1 - Reeve, B. B. A1 - Bjorner, J. B. A1 - Chang, C-H. AB - Abstract This paper reviews important methodological considerations for developing item banks and computerized adaptive scales (commonly called computerized adaptive tests in the educational measurement literature, yielding the acronym CAT), including issues of the reference population, dimensionality, dichotomous versus polytomous response scales, differential item functioning (DIF) and conditional scoring, mode effects, the impact of local dependence, and innovative approaches to assessment using CATs in health outcomes research. VL - 16 SN - 0962-93431573-2649 ER - TY - JOUR T1 - Patient-reported outcomes measurement and management with innovative methodologies and technologies JF - Quality of Life Research Y1 - 2007 A1 - Chang, C-H. KW - *Health Status KW - *Outcome Assessment (Health Care) KW - *Quality of Life KW - *Software KW - Computer Systems/*trends KW - Health Insurance Portability and Accountability Act KW - Humans KW - Patient Satisfaction KW - Questionnaires KW - United States AB - Successful integration of modern psychometrics and advanced informatics in patient-reported outcomes (PRO) measurement and management can potentially maximize the value of health outcomes research and optimize the delivery of quality patient care. Unlike the traditional labor-intensive paper-and-pencil data collection method, item response theory-based computerized adaptive testing methodologies coupled with novel technologies provide an integrated environment to collect, analyze and present ready-to-use PRO data for informed and shared decision-making. This article describes the needs, challenges and solutions for accurate, efficient and cost-effective PRO data acquisition and dissemination means in order to provide critical and timely PRO information necessary to actively support and enhance routine patient care in busy clinical settings. VL - 16 Suppl 1 SN - 0962-9343 (Print)0962-9343 (Linking) N1 - Chang, Chih-HungR21CA113191/CA/NCI NIH HHS/United StatesResearch Support, N.I.H., ExtramuralNetherlandsQuality of life research : an international journal of quality of life aspects of treatment, care and rehabilitationQual Life Res. 2007;16 Suppl 1:157-66. Epub 2007 May 26. ER - TY - JOUR T1 - A system for interactive assessment and management in palliative care JF - Journal of Pain Symptom Management Y1 - 2007 A1 - Chang, C-H. A1 - Boni-Saenz, A. A. A1 - Durazo-Arvizu, R. A. A1 - DesHarnais, S. A1 - Lau, D. T. A1 - Emanuel, L. L. KW - *Needs Assessment KW - Humans KW - Medical Informatics/*organization & administration KW - Palliative Care/*organization & administration AB - The availability of psychometrically sound and clinically relevant screening, diagnosis, and outcome evaluation tools is essential to high-quality palliative care assessment and management. Such data will enable us to improve patient evaluations, prognoses, and treatment selections, and to increase patient satisfaction and quality of life. To accomplish these goals, medical care needs more precise, efficient, and comprehensive tools for data acquisition, analysis, interpretation, and management. We describe a system for interactive assessment and management in palliative care (SIAM-PC), which is patient centered, model driven, database derived, evidence based, and technology assisted. The SIAM-PC is designed to reliably measure the multiple dimensions of patients' needs for palliative care, and then to provide information to clinicians, patients, and the patients' families to achieve optimal patient care, while improving our capacity for doing palliative care research. This system is innovative in its application of the state-of-the-science approaches, such as item response theory and computerized adaptive testing, to many of the significant clinical problems related to palliative care. VL - 33 SN - 0885-3924 (Print) N1 - Chang, Chih-HungBoni-Saenz, Alexander ADurazo-Arvizu, Ramon ADesHarnais, SusanLau, Denys TEmanuel, Linda LR21CA113191/CA/United States NCIResearch Support, N.I.H., ExtramuralReviewUnited StatesJournal of pain and symptom managementJ Pain Symptom Manage. 2007 Jun;33(6):745-55. Epub 2007 Mar 23. ER - TY - CONF T1 - Developing tailored instruments: Item banking and computerized adaptive assessment T2 - Paper presented at the conference “Advances in Health Outcomes Measurement: Exploring the Current State and the Future of Item Response Theory Y1 - 2004 A1 - Chang, C-H. JF - Paper presented at the conference “Advances in Health Outcomes Measurement: Exploring the Current State and the Future of Item Response Theory CY - Item Banks, and Computer-Adaptive Testing,” Bethesda MD N1 - {PDF file, 181 KB} ER - TY - JOUR T1 - Item banking to improve, shorten and computerized self-reported fatigue: an illustration of steps to create a core item bank from the FACIT-Fatigue Scale JF - Quality of Life Research Y1 - 2003 A1 - Lai, J-S. A1 - Crane, P. K. A1 - Cella, D. A1 - Chang, C-H. A1 - Bode, R. K. A1 - Heinemann, A. W. KW - *Health Status Indicators KW - *Questionnaires KW - Adult KW - Fatigue/*diagnosis/etiology KW - Female KW - Humans KW - Male KW - Middle Aged KW - Neoplasms/complications KW - Psychometrics KW - Research Support, Non-U.S. Gov't KW - Research Support, U.S. Gov't, P.H.S. KW - Sickness Impact Profile AB - Fatigue is a common symptom among cancer patients and the general population. Due to its subjective nature, fatigue has been difficult to effectively and efficiently assess. Modern computerized adaptive testing (CAT) can enable precise assessment of fatigue using a small number of items from a fatigue item bank. CAT enables brief assessment by selecting questions from an item bank that provide the maximum amount of information given a person's previous responses. This article illustrates steps to prepare such an item bank, using 13 items from the Functional Assessment of Chronic Illness Therapy Fatigue Subscale (FACIT-F) as the basis. Samples included 1022 cancer patients and 1010 people from the general population. An Item Response Theory (IRT)-based rating scale model, a polytomous extension of the Rasch dichotomous model was utilized. Nine items demonstrating acceptable psychometric properties were selected and positioned on the fatigue continuum. The fatigue levels measured by these nine items along with their response categories covered 66.8% of the general population and 82.6% of the cancer patients. Although the operational CAT algorithms to handle polytomously scored items are still in progress, we illustrated how CAT may work by using nine core items to measure level of fatigue. Using this illustration, a fatigue measure comparable to its full-length 13-item scale administration was obtained using four items. The resulting item bank can serve as a core to which will be added a psychometrically sound and operational item bank covering the entire fatigue continuum. VL - 12 N1 - 0962-9343Journal Article ER - TY - JOUR T1 - Advances in quality of life measurements in oncology patients JF - Seminars in Oncology Y1 - 2002 A1 - Cella, D. A1 - Chang, C-H. A1 - Lai, J. S. A1 - Webster, K. KW - *Quality of Life KW - *Sickness Impact Profile KW - Cross-Cultural Comparison KW - Culture KW - Humans KW - Language KW - Neoplasms/*physiopathology KW - Questionnaires AB - Accurate assessment of the quality of life (QOL) of patients can provide important clinical information to physicians, especially in the area of oncology. Changes in QOL are important indicators of the impact of a new cytotoxic therapy, can affect a patient's willingness to continue treatment, and may aid in defining response in the absence of quantifiable endpoints such as tumor regression. Because QOL is becoming an increasingly important aspect in the management of patients with malignant disease, it is vital that the instruments used to measure QOL are reliable and accurate. Assessment of QOL involves a multidimensional approach that includes physical, functional, social, and emotional well-being, and the most comprehensive instruments measure at least three of these domains. Instruments to measure QOL can be generic (eg, the Nottingham Health Profile), targeted toward specific illnesses (eg, Functional Assessment of Cancer Therapy - Lung), or be a combination of generic and targeted. Two of the most widely used examples of the combination, or hybrid, instruments are the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 Items and the Functional Assessment of Chronic Illness Therapy. A consequence of the increasing international collaboration in clinical trials has been the growing necessity for instruments that are valid across languages and cultures. To assure the continuing reliability and validity of QOL instruments in this regard, item response theory can be applied. Techniques such as item response theory may be used in the future to construct QOL item banks containing large sets of validated questions that represent various levels of QOL domains. As QOL becomes increasingly important in understanding and approaching the overall management of cancer patients, the tools available to clinicians and researchers to assess QOL will continue to evolve. While the instruments currently available provide reliable and valid measurement, further improvements in precision and application are anticipated. VL - 29 N1 - 0093-7754 (Print)Journal ArticleReview ER - TY - JOUR T1 - Feasibility and acceptability of computerized adaptive testing (CAT) for fatigue monitoring in clinical practice JF - Quality of Life Research Y1 - 2002 A1 - Davis, K. M. A1 - Chang, C-H. A1 - Lai, J-S. A1 - Cella, D. VL - 11(7) ER -