Item selection via Bayesian IRT models

With reference to a questionnaire that aimed to assess the quality of life for dysarthric speakers, we investigate the usefulness of a model‐based procedure for reducing the number of items. We propose a mixed cumulative logit model, which is known in the psychometrics literature as the graded response model: responses to different items are modelled as a function of individual latent traits and as a function of item characteristics, such as their difficulty and their discrimination power. We jointly model the discrimination and the difficulty parameters by using a k‐component mixture of normal distributions. Mixture components correspond to disjoint groups of items. Items that belong to the same groups can be considered equivalent in terms of both difficulty and discrimination power. According to decision criteria, we select a subset of items such that the reduced questionnaire is able to provide the same information that the complete questionnaire provides. The model is estimated by using a Bayesian approach, and the choice of the number of mixture components is justified according to information criteria. We illustrate the proposed approach on the basis of data that are collected for 104 dysarthric patients by local health authorities in Lecce and in Milan. Copyright © 2014 John Wiley & Sons, Ltd.     

中小学生心理健康发育评价量表初步编制及信效度评价

目的 初步编制中小学生心理健康发育评价量表,评价其信效度。方法 问卷中认知发育维度的评价直接利用华文认知能力量表,其余指标的条目均根据理论构思和文献研究自行编写。于2012-2014年12月通过多阶随机抽样,抽取湖北省3个地区共7500名中小学生进行问卷调查,运用项目分析、探索性因素分析筛选条目,通过主成分分析和信效度检验方法验证该问卷理论结构的合理性。结果 确定从认知发育、人格发育、情绪发育、意志发育、自我意识发育5个角度评价中小学生心理健康发育情况。根据条目筛选及因子分析,小学量表由5个维度67个条目组成;中学量表由5个维度65个条目组成。小学全量表的Cronbach's α系数与分半系数分别为0.905、0.850,各分量表的Cronbach's α系数、分半信度分别为0.720~0.757、0.650~0.770;中学全量表的Cronbach's α系数与分半系数分别为0.919、0.812,各分量表的Cronbach's α系数、分半信度分别为0.752~0.837、0.632~0.752,2个量表均有较好的信度;小学量表因子载荷在0.475~0.792之间,中学量表因子载荷在0.515~0.763之间,量表各分量表与总量表的相关在0.699~0.903之间,分量表的相关在0.356~0.670之间,两量表均有一定的效度。结论 初步完成的中小学心理发育特征评价量表具有较好的信效度,达到了编制的要求。     

资源消耗分类法在医疗项目成本核算中的应用

目的:提出一种相对准确、高效、便于操作的医疗项目成本核算方法。方法:分析医疗项目所消耗的各种类型的资源,以及同种类型资源的不同消耗方式,确定分摊基准和数据采集途径,计算医疗项目服务成本。结果:提出利用资源消耗分类法核算医疗项目成本的具体方法步骤。     

某医院近距离后装治疗项目设计干预与防护效果验证

目的干预近距离后装机室设计与运行模式,验证放射防护效果,降低射线项目对医务人员和患者健康的影响。方法根据相关标准和资料,对某医院后装治疗机室设计布局进行干预,利用多功能辐射仪和热释光剂量计对相关工作场所进行环境辐射监测,对后装机室防护效果进行验证。对后装机项目的运行进行调研和指导。结果该项目经设计干预后防护效果符合标准要求。结论在放射卫生单位严格按照国家有关法规标准设计建设大型医用射线项目的同时,加强设汁干预效果验证与放射防护指导,对于消除项目隐患、节省建设经费,提高放射诊疗质量和保证安全防护具有深远的意义。     

谈军队医院医疗合作项目管理

本文通过调研某军区医院医疗合作项目管理现状,指出军队医院在医疗合作项目管理上存在的主要问题,针对性地提出相关对策,探讨适合军队医院实际的医疗合作项目管理方法。     

Mixture randomized item‐response modeling: a smoking behavior validation study

Misleading response behavior is expected in medical settings where incriminating behavior is negatively related to the recovery from a disease. In the present study, lung patients feel social and professional pressure concerning smoking and experience questions about smoking behavior as sensitive and tend to conceal embarrassing or threatening information. The randomized item‐response survey method is expected to improve the accuracy of self‐reports as individual item responses are masked and only randomized item responses are observed. We explored the validation of the randomized item‐response technique in a unique experimental study. Therefore, we administered a new multi‐item measure assessing smoking behavior by using a treatment–control design (randomized response (RR) or direct questioning). After the questionnaire, we administered a breath test by using a carbon monoxide (CO) monitor to determine the smoking status of the patient. We used the response data to measure the individual smoking behavior by using a mixture item‐response model. It is shown that the detected smokers scored significantly higher in the RR condition compared with the directly questioned condition. We proposed a Bayesian latent variable framework to evaluate the diagnostic test accuracy of the questionnaire using the randomized‐response technique, which is based on the posterior densities of the subject's smoking behavior scores together with the breath test measurements. For different diagnostic test thresholds, we obtained moderate posterior mean estimates of sensitivity and specificity by observing a limited number of discrete randomized item responses. Copyright © 2013 John Wiley & Sons, Ltd.     

学龄前儿童注意缺陷多动障碍筛查量表的研究进展

注意缺陷多动障碍(ADHD)是一种常见的儿童行为问题,常在学龄期被诊断,但在学龄前期已经表现出较多的行为问题,因此,早期诊断注意ADHD成为一种趋势。本文对国内外关于学龄前儿童ADHD评估量表的研究进展进行了总结整理。     

建设项目环境医学评价公众参与方法研究

目的通过公众参与，对拟建项目可能造成的环境医学污染及其能取得的经济与社会效益进行定性评价，为拟建项目的环境医学评价工作提供可靠的公众参与信息。方法采用多种形式，对有关专家学者、拟建项目周边企事业单位以及项目所在地可能受到直接影响的居民进行调查。结果使公众了解工程性质、对人体健康和环境质量可能产生的影响，为工程的初步设计和环境医学保护措施实施提出合理化建议。结论本文介绍的公众参与方法在开展区域环境卫生学评价中有一定的使用价值，可以提高环境医学评价的有效性。     

加强领导 努力做好民族地区妇幼卫生合作项目工作

青海省黄南州自１９９０年被确立为《加强中国基层妇幼卫生／计划生育服务》合作 项目县后，州政府加强领导，与各项目单位层层签订项目协议书，认真抓好组织落实工作。为保证 项目的实施，州政府领导注意在人员培训、健康教育等方面落实经费，完成了项目配套要求，保证 了各项工作的顺利开展。同时，还建立健全县、乡、村三级妇幼保健网，在加强妇幼保健三级网络建 设中，结合民族地区特点，推行妇保、儿保、计划生育“三位一体”的管理模式，使黄南州妇幼卫生项 目工作取得了前所未有的成绩，推动了全州妇幼卫生事业的发展。     

Translation and Modification of a Mindful Eating Questionnaire for Children Assisted by Item Response Theory in Chinese Children and Adolescents

Mindful eating has gained attention in studies on healthy eating. However, measurement of it is scarce, particularly in pediatrics. This study aimed to translate and modify the 12-item Mindful Eating Questionnaire for Children (MEQ-C) using techniques based on both classical test theory (ICC) and item response theory (IRT) in Chinese children and adolescents. Of the 426 participants enrolled and randomly grouped, the test (n = 223) and validation (n = 203) subsamples were well-matched in age, gender, body mass index z score (BMIz), and waist to height ratio (WHtR) (p > 0.556). Three items were eliminated due to deviating from the mindful eating concept (content validity index < 0.71) and presenting as an independent dimension in parallel analysis, or yielding a poor distribution (−4.331 < b < −0.111). The final 5-item Mindless Eating and 4-item Awareness subscales were identified with sound Cronbach’s α of 0.802 and 0.779, respectively. The remaining items functioned well (a > 1, −3 < b < 3), and the Mindless Eating subscale was accurate for the low-to-medium range (−2 to 0) of the mindful eating measure. The Awareness one was reliable for the relatively high range (0 to 2). Participants’ mindful eating characteristics should be taken into consideration in practice.     

An Investigation of Age-Related Differential Item Functioning in the EQ-5D-5L Using Item Response Theory and Logistic Regression

ObjectivesIn economic evaluations, quality of life is measured using patient-reported outcome measures (PROMs), such as the EQ-5D-5L. A key assumption for the validity of PROMs data is measurement invariance, which requires that PROM items and response options are interpreted the same across respondents. If measurement invariance is violated, PROMs exhibit differential item functioning (DIF), whereby individuals from different groups with the same underlying health respond differently, potentially biasing scores. One important group of healthcare consumers who have been shown to have different views or priorities over health is older adults. This study investigates age-related DIF in the EQ-5D-5L using item response theory (IRT) and ordinal logistic regression approaches.MethodsMultiple-group IRT models were used to investigate DIF, by assessing whether older adults aged 65+ years and younger adults aged 18 to 64 years with the same underlying health had different IRT parameter estimates and expected item and EQ-5D-5L level sum scores. Ordinal logistic regression was also used to examine whether DIF resulted in meaningful differences in expected EQ level sum scores. Effect sizes examined whether DIF indicated meaningful score differences.ResultsThe anxiety/depression item exhibited meaningful DIF in both approaches, with older adults less likely to report problems. Pain/discomfort and mobility exhibited DIF to a lesser extent.ConclusionsWhen using the EQ-5D-5L to evaluate interventions and make resource allocation decisions, scoring bias due to DIF should be controlled for to prevent inefficient service provision, where the most cost-effective services are not provided, which could be detrimental to patients and the efficiency of health budgets.     

Patient-Centered Item Selection for a New Preference-Based Generic Health Status Instrument: CS-Base

Objectives

To develop patient-centered health content for a novel generic instrument (Château Santé Base [CS-Base]) that is suitable to generate values for health status.

学习障碍儿童筛查量表区域性实施的信度与效度分析

目的对学习障碍儿童筛查量表（PRS）区域性实施的效度和信度进行分析,为学习障碍儿童筛查量表的广泛推广使用提供依据。方法采用分层整群随机抽样方法 ,抽取湛江市区4所小学1～6年级学生3991名,应用修订版《学习障碍儿童筛查量表》（PRS）进行调查,其后进行信度和效度检验。结果该量表除1个功能区的α信度系数为0.84外,其余4个功能区α信度系数均在0.90以上;言语型和非言语型部分α信度系数均在0.95以上;该量表用于筛检学习障碍儿童（LD）的灵敏度、特异度分别为70.2%和83.6%,ROC曲线下面积为0.821。因子分析从量表析出4个因子,即言语性因素、社会适应因素、时间方位因素和操作性因素。湛江市区学习障碍儿童的筛出率为10.3%,男童高于女童。结论 PRS量表区域性实施具有理想的信度和效度,适用于团体筛查LD儿童。     

Assessment of Differential Item Functioning for Demographic Comparisons in the MOS SF-36 Health Survey

Objective: To investigate whether items of the Medical Outcomes Study (MOS) 36-Item Short-Form Health Status Survey (SF-36) exhibited differential item functioning (DIF) with respect to age, education, race, and gender. Methods: The data for this study come from two large national datasets, the MOS and the 1990 National Survey of Functional Health Status (NSFHS). We used logistic regression to identify items exhibiting DIF. Results: We found DIF to be most problematic for age comparisons. Items flagged for age DIF were vigorous activities, bend/kneel/stoop, bathing or dressing, limited in kind of work, health in general, get sick easier than others, expect health to get worse, felt calm and peaceful, and all four vitality items. Items flagged for education DIF include vigorous activities, health in general, health is excellent, felt calm and peaceful, and been a happy person. Vigorous activities, walk more than a mile, health in general, and expect health to get worse were identified as DIF when comparing African-Americans with whites. No items were identified for gender DIF. Conclusions: We found several consistent patterns of DIF using two national datasets with different population characteristics. In the current study, the effect of DIF rarely transferred to the scale level. Further research is needed to corroborate these results and determine qualitatively why DIF may occur for these specific items. This work was completed while Dr. McHorney was at Indiana University. Dr. McHorney is now with Outcomes Research & Management, Merck & Co., Inc.     

医学统计学试题库建设的构想

目的 介绍建立医学统计学标准化试题库的思路.方法 基于2008～2011年期间的5116份医学统计学考试试卷,应用项目反应理论,对单项选择题采用单维三参数logistic模型、对简答题和计算分析题采用等级反应模型拟合项目特征曲线,运用最大边缘似然估计法估计试题参数,并以试题参数估计值和任课教师专业意见为依据,对试题进行筛选、入库.结果 建立医学统计学标准化试题库,并可利用所建立的试题库进行自动组卷和计算机自适应考试.结论 采用项目反应理论建立的医学统计学标准化试题库可以满足各种目的的考试要求,达到客观、公正、节省时间及人力的目的.     

新疆医疗服务价格调整前后的医疗服务项目成本补偿变化

通过对新疆区、地、县18家医院的100个医疗服务项目的实际成本测算发现,大部分项目的实际成本高于原有和现行收费标准。价格调整实现了提高医务人员劳务价值和降低检查费的目的,但地、县级医院医疗服务项目成本补偿仍存在较大缺口。结果表明:政府履行社会公共职能,发挥财政补偿的调节作用是实现医疗服务价格调整政策改革目标的根本。     

Item Analysis to Improve Reliability for an Internal Medicine Undergraduate OSCE

Utilization of objective structured clinical examinations (OSCEs) for final assessment of medical students in Internal Medicine requires a representative sample of OSCE stations. The reliability and generalizability of OSCE scores provides validity evidence for OSCE scores and supports its contribution to the final clinical grade of medical students. The objective of this study was to perform item analysis using OSCE stations as the unit of analysis and evaluate the extent to which OSCE score reliability can be improved using item analysis data. OSCE scores from eight cohorts of fourth-year medical students (n = 435) in a 6-year undergraduate program were analyzed. Generalizability (G) coefficients of OSCE scores were computed for each cohort. Item analysis was performed by considering each OSCE station as an item and computing the corrected item-total correlation. OSCE stations which negatively impacted the reliability were deleted and the G-coefficient was recalculated. The G-coefficients of OSCE scores from the eight cohorts ranged from 0.48 to 0.80 (median 0.62). The median number of OSCE stations that negatively impacted the G-coefficient was 3.5 (out of a median of 25 total stations). When the ‘‘problem stations’’ were deleted, the median G-coefficient across eight cohorts increased to 0.62--0.72. In conclusion, item analysis of OSCE stations is useful and should be performed to improve the reliability of total OSCE scores. Problem stations can then be identified and improved.     

社区2型糖尿病患者健康素养量表编制研究

目的初步编制社区糖尿病患者健康素养量表,评价其信度和效度。方法根据世界卫生组织健康素养的定义,确定量表的理论结构,编制社区糖尿病患者健康素养量表,并进行预调查和信度及效度检验。结果通过预调查后调整量表,确定社区糖尿病患者健康素养量表分为5个维度,其中防治基本知识14个条目,膳食治疗知识7个条目,运动知识6个条目,药物与心理知识5个条目,防治行为9个条目,根据各条目具体内容进行赋分后,总分共100分。经内部一致性分析,克朗巴哈系数α=0.903,大于一般标准0.800,认为量表内部一致性较好。因子分析量表的KMO值为0.891,各条目在其公因子上的负荷值均大于0.400,认为内容效度较高。结论编制的社区糖尿病患者健康素养量表具有较好的信度和效度,可作为社区糖尿病患者健康素养的测量和干预效果评价的简易工具。     

MoCA量表对脑梗死患者认知功能障碍评估的临床研究

目的 探讨MoCA量表对脑梗死患者认知功能障碍评估的临床价值.方法 应用蒙特利尔认知评测量表(Montreal Cognitive Assessment,MoCA)对无症状脑梗死患者进行认知功能障碍评价,并对相关危险因素进行分析研究.结果 研究组患者的MoCA评分明显低于对照组,而且研究组中MCI发生率较对照组明显升高,且差异有统计学意义(t或x2=5.61、18.18,P均＜0.05).研究组患者的MoCA评分明显低于对照组,而且研究组中MCI发生率较对照组明显升高,且差异有统计学意义(t或x2=5.61、18.18,P均＜0.05).年龄≥65岁、多发梗死灶,合并高血压、糖尿病、高脂血症等因素是脑梗死患者发生认知功能障碍的危险因素.结论 MoCA量表可操作性强、测试简便快捷、敏感度高,MoCA可以作为对脑梗死患者进行认知功能障碍评估和筛查的良好工具,值得在临床推广使用.     

Developing a New Generic Health and Wellbeing Measure: Psychometric Survey Results for the EQ-HWB

ObjectivesThe development of measures such as the EQ-HWB (EQ Health and Wellbeing) requires selection of items. This study explored the psychometric performance of candidate items, testing their validity in patients, social carer users, and carers.MethodsArticle and online surveys that included candidate items (N = 64) were conducted in Argentina, Australia, China, Germany, United Kingdom, and the United States. Psychometric assessment on missing data, response distributions, and known group differences was undertaken. Dimensionality was explored using exploratory and confirmatory factor analysis. Poorly fitting items were identified using information functions, and the function of each response category was assessed using category characteristic curves from item response theory (IRT) models. Differential item functioning was tested across key subgroups.ResultsThere were 4879 respondents (Argentina = 508, Australia = 514, China = 497, Germany = 502, United Kingdom = 1955, United States = 903). Where missing data were allowed, it was low (UK article survey 2.3%; US survey 0.6%). Most items had responses distributed across all levels. Most items could discriminate between groups with known health conditions with moderate to large effect sizes. Items were less able to discriminate across carers. Factor analysis found positive and negative measurement factors alongside the constructs of interest. For most of the countries apart from China, the confirmatory factor analysis model had good fit with some minor modifications. IRT indicated that most items had well-functioning response categories but there was some evidence of differential item functioning in many items.ConclusionsItems performed well in classical psychometric testing and IRT. This large 6-country collaboration provided evidence to inform item selection for the EQ-HWB measure.