@conference {2669, title = {FastCAT {\textendash} Customizing CAT Administration Rules to Increase Response Efficiency}, booktitle = {IACAT 2017 Conference}, year = {2017}, month = {08/2017}, publisher = {Niigata Seiryo University}, organization = {Niigata Seiryo University}, address = {Niigata, Japan}, abstract = {

A typical pre-requisite for CAT administration is the existence of an underlying item bank completely covering the range of the trait being measured. When a bank fails to cover the full range of the trait, examinees who are close to the floor or ceiling will often never achieve a standard error cut-off and examinees will be forced to answer items increasingly less relevant to their trait level. This scenario is fairly typical for many patients responding to patient reported outcome measures (PROMS). For IACAT 2017 ABSTRACTS BOOKLET 65 example, in the assessment of physical functioning, many item banks ceiling at about the 50\%ile. For most healthy patients, after a few items the only items remaining in the bank will represent decreasing ability (even though the patient has already indicated that they are at or above the mean for the population). Another example would be for a patient with no pain taking a Pain CAT. They will probably answer \“Never\” pain for every succeeding item out to the maximum test length. For this project we sought to reduce patient burden, while maintaining test accuracy, through the reduction of CAT length using novel stopping rules.

We studied CAT administration assessment histories for patients who were administered Patient Reported Outcomes Measurement Information System (PROMIS) CATs. In the PROMIS 1 Wave 2 Back Pain/Depression Study, CATs were administered to N=417 cases assessed across 11 PROMIS domains. Original CAT administration rules were: start with a pre-identified item of moderate difficulty; administer a minimum four items per case; stop when an estimated theta\’s SE declines to \< 0.3 OR a maximum 12 items are administered.

Original CAT. 12,622 CAT administrations were analyzed. CATs ranged in number of items administered from 4 to 12 items; 72.5\% were 4-item CATs. The second and third most frequently occurring CATs were 5-item (n=1102; 8.7\%) and 12-item CATs (n=964; 7.6\%). 64,062 items total were administered, averaging 5.1 items per CAT. Customized CAT. Three new CAT stopping rules were introduced, each with potential to increase item-presentation efficiency and maintain required score precision: Stop if a case responds to the first two items administered using an \“extreme\” response category (towards the ceiling or floor for the in item bank, or at ); administer a minimum two items per case; stop if the change in SE estimate (previous to current item administration) is positive but \< 0.01.

The three new stopping rules reduced the total number of items administered by 25,643 to 38,419 items (40.0\% reduction). After four items were administered, only n=1,824 CATs (14.5\%) were still in assessment mode (vs. n=3,477 (27.5\%) in the original CATs). On average, cases completed 3.0 items per CAT (vs. 5.1).

Each new rule addressed specific inefficiencies in the original CAT administration process: Cases not having or possessing a low/clinically unimportant level of the assessed domain; allow the SE \<0.3 stopping criterion to come into effect earlier in the CAT administration process; cases experiencing poor domain item bank measurement, (e.g., \“floor,\” \“ceiling\” cases).

}, keywords = {Administration Rules, Efficiency, FastCAT}, url = {https://drive.google.com/open?id=1oPJV-x0p9hRmgJ7t6k-MCC1nAoBSFM1w}, author = {Richard C. Gershon} } @conference {2634, title = {Issues in Trait Range Coverage for Patient Reported Outcome Measure CATs - Extending the Ceiling for Above-average Physical Functioning}, booktitle = {IACAT 2017 Conference}, year = {2017}, month = {08/2017}, publisher = {Niigata Seiryo University}, organization = {Niigata Seiryo University}, address = {Niigata, Japan}, abstract = {

The use of a measure which fails to cover the upper range of functioning may produce results which can lead to serious misinterpretation. Scores produced by such a measure may fail to recognize significant improvement, or may not be able to demonstrate functioning commensurate with an important milestone. Accurate measurement of this range is critical for the assessment of physically active adults, e.g., athletes recovering from injury and active military personnel who wish to return to active service. Alternatively, a PF measure with a low ceiling might fail to differentiate patients in rehabilitation who continue to improve, but for whom their score ceilings due to the measurement used.

The assessment of physical function (PF) has greatly benefited from modern psychometric theory and resulting scales, such as the Patient-Reported Outcomes Measurement Information System (PROMIS\®) PF instruments. While PROMIS PF has extended the range of function upwards relative to older \“legacy\” instruments, few PROMIS PF items asses high levels of function. We report here on the development of higher functioning items for the PROMIS PF bank.

An expert panel representing orthopedics, sports/military medicine, and rehabilitation reviewed existing instruments and wrote new items. After internal review, cognitive interviews were conducted with 24 individuals of average and high levels of physical function. The remaining candidate items were administered along with 50 existing PROMIS anchor items to an internet panel screened for low, average, and high levels of physical function (N = 1,600), as well as members of Boston-area gyms (N= 344). The resulting data was subjected to standard psychometric analysis, along with multiple linking methods to place the new items on the existing PF metric. The new items were added to the full PF bank for simulated computerized adaptive testing (CAT).

Item response data was collected on 54 candidate items. Items that exhibited local dependence (LD) or differential item functioning (DIF) related to gender, age, race, education, or PF status. These items were removed from consideration. Of the 50 existing PROMIS PF items, 31 were free of DIF and LD and used as anchors. The parameters for the remaining new candidate items were estimated twice: freelyestimated and linked with coefficients and fixed-anchor calibration. Both methods were comparable and had appropriate fit. The new items were added to the full PF bank for simulated CATs. The resulting CAT was able to extend the ceiling with high precision to a T-score of 68, suggesting accurate measurement for 97\% of the general population.

Extending the range of items by which PF is measured will substantially improve measurement quality, applicability, and efficiency. The bank has incorporated these extension items and is available for use in research and clinics for brief CAT administration (see www.healthmeasures.net). Future research projects should focus on recovery trajectories of the measure for individuals with above average function who are recovering from injury.

Session Video

}, keywords = {CAT, Issues, Patient Reported Outcome}, url = {https://drive.google.com/open?id=1ZC02F-dIyYovEjzpeuRdoXDiXMLFRuKb}, author = {Richard C. Gershon} }