TY - JOUR
T1 - Advancing the efficiency and efficacy of patient reported outcomes with multivariate computer adaptive testing
AU - Morris, Scott
AU - Bass, Mike
AU - Lee, Mirinae
AU - Neapolitan, Richard E.
N1 - Funding Information:
This work was supported by National Library of Medicine grants R01LM011962 and R01LM011663.
Publisher Copyright:
© The Author 2017.
PY - 2017/9/1
Y1 - 2017/9/1
N2 - Objective: 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. Methods: 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. Results: 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%. Discussion: 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. Conclusion: By reducing the number of items administered, MCAT can allow clinicians and researchers to assess a wider range of PROs with less patient burden.
AB - Objective: 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. Methods: 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. Results: 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%. Discussion: 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. Conclusion: By reducing the number of items administered, MCAT can allow clinicians and researchers to assess a wider range of PROs with less patient burden.
KW - Computer adaptive testing
KW - Item response theory
KW - MCAT
KW - MIRT
KW - Patient reported outcomes
KW - Precision medicine
UR - http://www.scopus.com/inward/record.url?scp=85031914137&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85031914137&partnerID=8YFLogxK
U2 - 10.1093/jamia/ocx003
DO - 10.1093/jamia/ocx003
M3 - Article
C2 - 28444397
AN - SCOPUS:85031914137
SN - 1067-5027
VL - 24
SP - 897
EP - 902
JO - Journal of the American Medical Informatics Association
JF - Journal of the American Medical Informatics Association
IS - 5
ER -