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Harrison C, Apon I, Ardouin K, Sidey-Gibbons C, Klassen A, Cano S, Wong Riff K, Pusic A, Versnel S, Koudstaal M, Allori A, Rogers-Vizena C, Swan M, Furniss D, Rodrigues J
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
The development, deployment, and evaluation of the CLEFT-Q Computerized Adaptive Test: A multi-methods approach, contributing to personalized, person-centered health assessments in plastic surgery
Conrad Harrison;
Inge Apon;
Kenny Ardouin;
Chris Sidey-Gibbons;
Anne Klassen;
Stefan Cano;
Karen Wong Riff;
Andrea Pusic;
Sarah Versnel;
Maarten Koudstaal;
Alexander Allori;
Carolyn Rogers-Vizena;
Marc Swan;
Dominic Furniss;
Jeremy Rodrigues
ABSTRACT
Background:
Routine use of patient-reported outcome measures (PROMs) and computerized adaptive tests (CATs) improves care in a range of surgical conditions. However most available CATs are not condition-specific, nor co-produced with patients, and lack clinically-relevant score interpretation.
Objective:
We aimed to develop a condition-specific, person-centered CAT for use in cleft lip and/or palate (CL/P) that will facilitate the uptake of the CLEFT-Q PROM internationally, and act as an open-source framework for CAT development in other surgical conditions.
Methods:
CATs were calibrated and validated with Rasch measurement theory, using full-length CLEFT-Q responses collected from 2434 (calibration) and 536 (external validation) patients. Agreement between full-length CLEFT-Q score and CAT score was measured by Pearson correlation coefficient, root mean squared error (RMSE) and 95% limits of agreement. CAT settings were determined in a multistakeholder workshop, a user interface was developed, and the platform was prospectively piloted in the UK and the Netherlands. Interviews were conducted with six patients and four clinicians to explore end-user experience.
Results:
The length of all eight CLEFT-Q scales in the International Consortium for Health Outcomes Measurement Standard Set combined was reduced from 76 to 59 items. CAT assessments reproduced full-length CLEFT-Q scores accurately (RMSE of 2-5 out of 100). The platform was perceived to improve clinical communication and facilitate shared decision making.
Conclusions:
Our platform can improve cleft care by facilitating routine CLEFT-Q uptake. Our free source code enables other researchers to rapidly and economically reproduce this work for other PROMs.
Citation
Please cite as:
Harrison C, Apon I, Ardouin K, Sidey-Gibbons C, Klassen A, Cano S, Wong Riff K, Pusic A, Versnel S, Koudstaal M, Allori A, Rogers-Vizena C, Swan M, Furniss D, Rodrigues J
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