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Fernandes S, Brousse Y, Zendjidjian X, Cano D, Riedberger J, Llorca PM, Samalin L, Dassa D, Trichard C, Laprevote V, Sauvaget A, Abbar M, Misdrahi D, Berna F, Lancon C, Coulon N, El-Hage W, Rozier PE, Benoit M, Giordana B, Caqueo-Urízar A, Yon DK, Tran B, Auquier P, Fond G, Boyer L. Psychometric Assessment of an Item Bank for Adaptive Testing on Patient-Reported Experience of Care Environment for Severe Mental Illness: Validation Study. JMIR Ment Health 2024; 11:e49916. [PMID: 38753416 PMCID: PMC11140279 DOI: 10.2196/49916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/15/2023] [Accepted: 01/21/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND The care environment significantly influences the experiences of patients with severe mental illness and the quality of their care. While a welcoming and stimulating environment enhances patient satisfaction and health outcomes, psychiatric facilities often prioritize staff workflow over patient needs. Addressing these challenges is crucial to improving patient experiences and outcomes in mental health care. OBJECTIVE This study is part of the Patient-Reported Experience Measure for Improving Quality of Care in Mental Health (PREMIUM) project and aims to establish an item bank (PREMIUM-CE) and to develop computerized adaptive tests (CATs) to measure the experience of the care environment of adult patients with schizophrenia, bipolar disorder, or major depressive disorder. METHODS We performed psychometric analyses including assessments of item response theory (IRT) model assumptions, IRT model fit, differential item functioning (DIF), item bank validity, and CAT simulations. RESULTS In this multicenter cross-sectional study, 498 patients were recruited from outpatient and inpatient settings. The final PREMIUM-CE 13-item bank was sufficiently unidimensional (root mean square error of approximation=0.082, 95% CI 0.067-0.097; comparative fit index=0.974; Tucker-Lewis index=0.968) and showed an adequate fit to the IRT model (infit mean square statistic ranging between 0.7 and 1.0). DIF analysis revealed no item biases according to gender, health care settings, diagnosis, or mode of study participation. PREMIUM-CE scores correlated strongly with satisfaction measures (r=0.69-0.78; P<.001) and weakly with quality-of-life measures (r=0.11-0.21; P<.001). CAT simulations showed a strong correlation (r=0.98) between CAT scores and those of the full item bank, and around 79.5% (396/498) of the participants obtained a reliable score with the administration of an average of 7 items. CONCLUSIONS The PREMIUM-CE item bank and its CAT version have shown excellent psychometric properties, making them reliable measures for evaluating the patient experience of the care environment among adults with severe mental illness in both outpatient and inpatient settings. These measures are a valuable addition to the existing landscape of patient experience assessment, capturing what truly matters to patients and enhancing the understanding of their care experiences. TRIAL REGISTRATION ClinicalTrials.gov NCT02491866; https://clinicaltrials.gov/study/NCT02491866.
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Affiliation(s)
- Sara Fernandes
- Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, UR3279: Health Service Research and Quality of Life Center - CEReSS, Marseille, France
| | - Yann Brousse
- Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, UR3279: Health Service Research and Quality of Life Center - CEReSS, Marseille, France
| | - Xavier Zendjidjian
- Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, UR3279: Health Service Research and Quality of Life Center - CEReSS, Marseille, France
| | - Delphine Cano
- Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, UR3279: Health Service Research and Quality of Life Center - CEReSS, Marseille, France
| | - Jérémie Riedberger
- Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, UR3279: Health Service Research and Quality of Life Center - CEReSS, Marseille, France
| | - Pierre-Michel Llorca
- Department of Psychiatry, Centre Hospitalier Universitaire de Clermont-Ferrand, University of Clermont Auvergne, Centre national de la recherche scientifique, Institut national polytechnique de Clermont Auvergne, Institut Pascal UMR 6602, Clermont-Ferrand, France
| | - Ludovic Samalin
- Department of Psychiatry, Centre Hospitalier Universitaire de Clermont-Ferrand, University of Clermont Auvergne, Centre national de la recherche scientifique, Institut national polytechnique de Clermont Auvergne, Institut Pascal UMR 6602, Clermont-Ferrand, France
| | - Daniel Dassa
- Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, UR3279: Health Service Research and Quality of Life Center - CEReSS, Marseille, France
| | | | - Vincent Laprevote
- Department of Addictology and Psychiatry, Centre Psychothérapique de Nancy, Laxou, France
- Département de Psychiatrie, Centre Hospitalier Régional Universitaire de Strasbourg, Université de Strasbourg, Institut national de la santé et de la recherche médicale U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - Anne Sauvaget
- Nantes Université, Centre Hospitalier Régional Universitaire de Nantes, Movement - Interactions - Performance - MIP UR 4334, Nantes, France
| | - Mocrane Abbar
- Department of Psychiatry, Centre Hospitalier Universitaire de Nîmes, University of Montpellier, Nîmes, France
| | - David Misdrahi
- National Centre for Scientific Research UMR 5287 - Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, University of Bordeaux, Centre Hospitalier Charles Perrens, Bordeaux, France
| | - Fabrice Berna
- Département de Psychiatrie, Centre Hospitalier Régional Universitaire de Strasbourg, Université de Strasbourg, Institut national de la santé et de la recherche médicale U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - Christophe Lancon
- Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, UR3279: Health Service Research and Quality of Life Center - CEReSS, Marseille, France
| | - Nathalie Coulon
- Centre Expert Schizophrénie, Centre Expert TSA-SDI et Centre Référent de Réhabilitation Psychosociale et de Remédiation Cognitive - C3R, Centre Hospitalier Alpes Isère, Grenoble, France
| | - Wissam El-Hage
- Centre Hospitalier Régional Universitaire de Tours, Clinique Psychiatrique Universitaire, Tours, France
| | | | - Michel Benoit
- Department of Psychiatry, Hopital Pasteur, University Hospital of Nice, Nice, France
| | - Bruno Giordana
- Department of Psychiatry, Hopital Pasteur, University Hospital of Nice, Nice, France
| | | | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Department of Pediatrics, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Bach Tran
- Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, UR3279: Health Service Research and Quality of Life Center - CEReSS, Marseille, France
- Institute of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Pascal Auquier
- Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, UR3279: Health Service Research and Quality of Life Center - CEReSS, Marseille, France
| | - Guillaume Fond
- Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, UR3279: Health Service Research and Quality of Life Center - CEReSS, Marseille, France
| | - Laurent Boyer
- Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, UR3279: Health Service Research and Quality of Life Center - CEReSS, Marseille, France
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Fernandes S, Fond G, Zendjidjian X, Michel P, Baumstarck K, Lancon C, Berna F, Schurhoff F, Aouizerate B, Henry C, Etain B, Samalin L, Leboyer M, Llorca PM, Coldefy M, Auquier P, Boyer L. The Patient-Reported Experience Measure for Improving qUality of care in Mental health (PREMIUM) project in France: study protocol for the development and implementation strategy. Patient Prefer Adherence 2019; 13:165-177. [PMID: 30718945 PMCID: PMC6345324 DOI: 10.2147/ppa.s172100] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Measuring the quality and performance of health care is a major challenge in improving the efficiency of a health system. Patient experience is one important measure of the quality of health care, and the use of patient-reported experience measures (PREMs) is recommended. The aims of this project are 1) to develop item banks of PREMs that assess the quality of health care for adult patients with psychiatric disorders (schizophrenia, bipolar disorder, and depression) and to validate computerized adaptive testing (CAT) to support the routine use of PREMs; and 2) to analyze the implementation and acceptability of the CAT among patients, professionals, and health authorities. METHODS This multicenter and cross-sectional study is based on a mixed method approach, integrating qualitative and quantitative methodologies in two main phases: 1) item bank and CAT development based on a standardized procedure, including conceptual work and definition of the domain mapping, item selection, calibration of the item bank and CAT simulations to elaborate the administration algorithm, and CAT validation; and 2) a qualitative study exploring the implementation and acceptability of the CAT among patients, professionals, and health authorities. DISCUSSION The development of a set of PREMs on quality of care in mental health that overcomes the limitations of previous works (ie, allowing national comparisons regardless of the characteristics of patients and care and based on modern testing using item banks and CAT) could help health care professionals and health system policymakers to identify strategies to improve the quality and efficiency of mental health care. TRIAL REGISTRATION NCT02491866.
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Affiliation(s)
- Sara Fernandes
- Aix-Marseille University, School of Medicine, CEReSS - Health Service Research and Quality of Life Center - EA 3279 Research Unit, Marseille, France, Email
| | - Guillaume Fond
- Aix-Marseille University, School of Medicine, CEReSS - Health Service Research and Quality of Life Center - EA 3279 Research Unit, Marseille, France, Email
| | - Xavier Zendjidjian
- Aix-Marseille University, School of Medicine, CEReSS - Health Service Research and Quality of Life Center - EA 3279 Research Unit, Marseille, France, Email
| | - Pierre Michel
- Aix-Marseille University, School of Medicine, CEReSS - Health Service Research and Quality of Life Center - EA 3279 Research Unit, Marseille, France, Email
| | - Karine Baumstarck
- Aix-Marseille University, School of Medicine, CEReSS - Health Service Research and Quality of Life Center - EA 3279 Research Unit, Marseille, France, Email
| | - Christophe Lancon
- Aix-Marseille University, School of Medicine, CEReSS - Health Service Research and Quality of Life Center - EA 3279 Research Unit, Marseille, France, Email
| | | | | | | | | | | | | | | | | | - Magali Coldefy
- Institute for Research and Information in Health Economics (IRDES), Paris, France
| | - Pascal Auquier
- Aix-Marseille University, School of Medicine, CEReSS - Health Service Research and Quality of Life Center - EA 3279 Research Unit, Marseille, France, Email
| | - Laurent Boyer
- Aix-Marseille University, School of Medicine, CEReSS - Health Service Research and Quality of Life Center - EA 3279 Research Unit, Marseille, France, Email
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Michel P, Baumstarck K, Loundou A, Ghattas B, Auquier P, Boyer L. Computerized adaptive testing with decision regression trees: an alternative to item response theory for quality of life measurement in multiple sclerosis. Patient Prefer Adherence 2018; 12:1043-1053. [PMID: 29950817 PMCID: PMC6016264 DOI: 10.2147/ppa.s162206] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The aim of this study was to propose an alternative approach to item response theory (IRT) in the development of computerized adaptive testing (CAT) in quality of life (QoL) for patients with multiple sclerosis (MS). This approach relied on decision regression trees (DRTs). A comparison with IRT was undertaken based on precision and validity properties. MATERIALS AND METHODS DRT- and IRT-based CATs were applied on items from a unidi-mensional item bank measuring QoL related to mental health in MS. The DRT-based approach consisted of CAT simulations based on a minsplit parameter that defines the minimal size of nodes in a tree. The IRT-based approach consisted of CAT simulations based on a specified level of measurement precision. The best CAT simulation showed the lowest number of items and the best levels of precision. Validity of the CAT was examined using sociodemographic, clinical and QoL data. RESULTS CAT simulations were performed using the responses of 1,992 MS patients. The DRT-based CAT algorithm with minsplit = 10 was the most satisfactory model, superior to the best IRT-based CAT algorithm. This CAT administered an average of nine items and showed satisfactory precision indicators (R = 0.98, root mean square error [RMSE] = 0.18). The DRT-based CAT showed convergent validity as its score correlated significantly with other QoL scores and showed satisfactory discriminant validity. CONCLUSION We presented a new adaptive testing algorithm based on DRT, which has equivalent level of performance to IRT-based approach. The use of DRT is a natural and intuitive way to develop CAT, and this approach may be an alternative to IRT.
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Affiliation(s)
- Pierre Michel
- Aix-Marseille Univ, School of Medicine, CEReSS - Health Service Research and Quality of Life Center, Marseille, France
- Mathematics Institute of Marseille, Aix-Marseille University, Marseille, France
| | - Karine Baumstarck
- Aix-Marseille Univ, School of Medicine, CEReSS - Health Service Research and Quality of Life Center, Marseille, France
| | - Anderson Loundou
- Aix-Marseille Univ, School of Medicine, CEReSS - Health Service Research and Quality of Life Center, Marseille, France
| | - Badih Ghattas
- Mathematics Institute of Marseille, Aix-Marseille University, Marseille, France
| | - Pascal Auquier
- Aix-Marseille Univ, School of Medicine, CEReSS - Health Service Research and Quality of Life Center, Marseille, France
| | - Laurent Boyer
- Aix-Marseille Univ, School of Medicine, CEReSS - Health Service Research and Quality of Life Center, Marseille, France
- Correspondence: Laurent Boyer, Aix-Marseille Univ, School of, MEDICINE - La Timone Medical, Campus, EA 3279: CEReSS – Health, Service Research and Quality of Life, Center, 27 Boulevard Jean Moulin, 13005 Marseille, France, Tel +33 6 8693 6276, Email
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Engelhard MM, Schmidt KM, Engel CE, Brenton JN, Patek SD, Goldman MD. The e-MSWS-12: improving the multiple sclerosis walking scale using item response theory. Qual Life Res 2016; 25:3221-3230. [PMID: 27342237 DOI: 10.1007/s11136-016-1342-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The Multiple Sclerosis Walking Scale (MSWS-12) is the predominant patient-reported measure of multiple sclerosis (MS) -elated walking ability, yet it had not been analyzed using item response theory (IRT), the emerging standard for patient-reported outcome (PRO) validation. This study aims to reduce MSWS-12 measurement error and facilitate computerized adaptive testing by creating an IRT model of the MSWS-12 and distributing it online. METHODS MSWS-12 responses from 284 subjects with MS were collected by mail and used to fit and compare several IRT models. Following model selection and assessment, subpopulations based on age and sex were tested for differential item functioning (DIF). RESULTS Model comparison favored a one-dimensional graded response model (GRM). This model met fit criteria and explained 87 % of response variance. The performance of each MSWS-12 item was characterized using category response curves (CRCs) and item information. IRT-based MSWS-12 scores correlated with traditional MSWS-12 scores (r = 0.99) and timed 25-foot walk (T25FW) speed (r = -0.70). Item 2 showed DIF based on age (χ 2 = 19.02, df = 5, p < 0.01), and Item 11 showed DIF based on sex (χ 2 = 13.76, df = 5, p = 0.02). CONCLUSIONS MSWS-12 measurement error depends on walking ability, but could be lowered by improving or replacing items with low information or DIF. The e-MSWS-12 includes IRT-based scoring, error checking, and an estimated T25FW derived from MSWS-12 responses. It is available at https://ms-irt.shinyapps.io/e-MSWS-12 .
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Affiliation(s)
- Matthew M Engelhard
- Department of Systems and Information Engineering, University of Virginia, P.O. Box 400747, Charlottesville, VA, 22904, USA.
| | - Karen M Schmidt
- Department of Psychology, University of Virginia, P.O. Box 400400, Charlottesville, VA, 22904, USA
| | - Casey E Engel
- College of Arts and Sciences, University of Virginia, P.O. Box 400133, Charlottesville, VA, 22904, USA
| | - J Nicholas Brenton
- Department of Neurology, University of Virginia, P.O. Box 800394, Charlottesville, VA, 22908, USA
| | - Stephen D Patek
- Department of Systems and Information Engineering, University of Virginia, P.O. Box 400747, Charlottesville, VA, 22904, USA
| | - Myla D Goldman
- Department of Neurology, University of Virginia, P.O. Box 800394, Charlottesville, VA, 22908, USA
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Michel P, Baumstarck K, Ghattas B, Pelletier J, Loundou A, Boucekine M, Auquier P, Boyer L. A Multidimensional Computerized Adaptive Short-Form Quality of Life Questionnaire Developed and Validated for Multiple Sclerosis: The MusiQoL-MCAT. Medicine (Baltimore) 2016; 95:e3068. [PMID: 27057832 PMCID: PMC4998748 DOI: 10.1097/md.0000000000003068] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The aim was to develop a multidimensional computerized adaptive short-form questionnaire, the MusiQoL-MCAT, from a fixed-length QoL questionnaire for multiple sclerosis.A total of 1992 patients were enrolled in this international cross-sectional study. The development of the MusiQoL-MCAT was based on the assessment of between-items MIRT model fit followed by real-data simulations. The MCAT algorithm was based on Bayesian maximum a posteriori estimation of latent traits and Kullback-Leibler information item selection. We examined several simulations based on a fixed number of items. Accuracy was assessed using correlations (r) between initial IRT scores and MCAT scores. Precision was assessed using the standard error measurement (SEM) and the root mean square error (RMSE).The multidimensional graded response model was used to estimate item parameters and IRT scores. Among the MCAT simulations, the 16-item version of the MusiQoL-MCAT was selected because the accuracy and precision became stable with 16 items with satisfactory levels (r ≥ 0.9, SEM ≤ 0.55, and RMSE ≤ 0.3). External validity of the MusiQoL-MCAT was satisfactory.The MusiQoL-MCAT presents satisfactory properties and can individually tailor QoL assessment to each patient, making it less burdensome to patients and better adapted for use in clinical practice.
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Affiliation(s)
- Pierre Michel
- From the Aix-Marseille University, EA 3279 - Public Health, Chronic Diseases and Quality of Life - Research Unit (PM, KB, BG, AL, MB, PA, LB); Aix-Marseille University - I2 M UMR 7373 - Mathematics Institute of Marseille (PM, BG); and Departments of Neurology and CRMBM CNRS6612, La Timone University Hospital, APHM, Marseille, France (JP)
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