Journal article
The Development, Deployment, and Evaluation of the CLEFT-Q Computerized Adaptive Test: A Multimethods Approach Contributing to Personalized, Person-Centered Health Assessments in Plastic Surgery
Journal of medical Internet research, Vol.25(9), e41870
27/04/2023
PMID: 37104031
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Abstract
Background: Routine use of patient-reported outcome measures (PROMs) and computerized adaptive tests (CATs) may improve care in a range of surgical conditions. However, most available CATs are neither condition-specific nor coproduced with patients and lack clinically relevant score interpretation. Recently, a PROM called the CLEFT-Q has been developed for use in the treatment of cleft lip or palate (CL/P), but the assessment burden may be limiting its uptake into clinical practice.
Objective: We aimed to develop a CAT for the CLEFT-Q, which could facilitate the uptake of the CLEFT-Q PROM internationally. We aimed to conduct this work with a novel patient-centered approach and make source code available as an open-source framework for CAT development in other surgical conditions.
Methods: CATs were developed with the Rasch measurement theory, using full-length CLEFT-Q responses collected during the CLEFT-Q field test (this included 2434 patients across 12 countries). These algorithms were validated in Monte Carlo simulations involving full-length CLEFT-Q responses collected from 536 patients. In these simulations, the CAT algorithms approximated full-length CLEFT-Q scores iteratively, using progressively fewer items from the full-length PROM. Agreement between full-length CLEFT-Q score and CAT score at different assessment lengths was measured using the Pearson correlation coefficient, root-mean-square error (RMSE), and 95% limits of agreement. CAT settings, including the number of items to be included in the final assessments, were determined in a multistakeholder workshop that included patients and health care professionals. A user interface was developed for the platform, and it was prospectively piloted in the United Kingdom and the Netherlands. Interviews were conducted with 6 patients and 4 clinicians to explore end-user experience.
Results: The length of all 8 CLEFT-Q scales in the International Consortium for Health Outcomes Measurement (ICHOM) Standard Set combined was reduced from 76 to 59 items, and at this length, CAT assessments reproduced full-length CLEFT-Q scores accurately (with correlations between full-length CLEFT-Q score and CAT score exceeding 0.97, and the RMSE ranging from 2 to 5 out of 100). Workshop stakeholders considered this the optimal balance between accuracy and assessment burden. The platform was perceived to improve clinical communication and facilitate shared decision-making.
Conclusions: Our platform is likely to facilitate routine CLEFT-Q uptake, and this may have a positive impact on clinical care. Our free source code enables other researchers to rapidly and economically reproduce this work for other PROMs.
Details
- Title
- The Development, Deployment, and Evaluation of the CLEFT-Q Computerized Adaptive Test: A Multimethods Approach Contributing to Personalized, Person-Centered Health Assessments in Plastic Surgery
- Creators
- Conrad Harrison - University of OxfordInge Apon - Erasmus MCKenny Ardouin - Cleft Lip and Palate Association (United Kingdon, London)Chris Sidey-Gibbons - The University of Texas MD Anderson Cancer CenterAnne Klassen - McMaster UniversityStefan Cano - Modus Outcomes, Letchworth Garden City, United KingdomKaren Wong Riff - Hospital for Sick ChildrenAndrea Pusic - Brigham and Women's HospitalSarah Versnel - Erasmus MCMaarten Koudstaal - Erasmus MCAlexander C Allori - Duke Children's Hospital & Health CenterCarolyn Rogers-Vizena - Boston Children's HospitalMarc C Swan - Oxford University Hospitals NHS TrustDominic Furniss - University of OxfordJeremy Rodrigues - University of Warwick
- Publication Details
- Journal of medical Internet research, Vol.25(9), e41870
- Publisher
- JMIR Publications, Inc
- Grant note
- The CLEFT-Q field-test study was funded by a grant from the Canadian Institute of Health Research (CIHR, FRN-130515).
- Identifiers
- 991013389814302368
- Copyright
- ©Conrad Harrison, Inge Apon, Kenny Ardouin, Chris Sidey-Gibbons, Anne Klassen, Stefan Cano, Karen Wong Riff, Andrea Pusic, Sarah Versnel, Maarten Koudstaal, Alexander C Allori, Carolyn Rogers-Vizena, Marc C Swan, Dominic Furniss, Jeremy Rodrigues.
- Academic Unit
- Faculty of Health
- Language
- English
- Resource Type
- Journal article