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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.

Publication ,  Journal Article
Harrison, C; Apon, I; Ardouin, K; Sidey-Gibbons, C; Klassen, A; Cano, S; Wong Riff, K; Pusic, A; Versnel, S; Koudstaal, M; Allori, AC ...
Published in: Journal of medical Internet research
April 2023

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.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.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.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.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.

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Published In

Journal of medical Internet research

DOI

EISSN

1438-8871

ISSN

1439-4456

Publication Date

April 2023

Volume

25

Start / End Page

e41870

Related Subject Headings

  • Surgery, Plastic
  • Plastic Surgery Procedures
  • Patient Reported Outcome Measures
  • Medical Informatics
  • Humans
  • Computerized Adaptive Testing
  • Cleft Palate
  • Cleft Lip
  • 4203 Health services and systems
  • 17 Psychology and Cognitive Sciences
 

Citation

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Harrison, C., Apon, I., Ardouin, K., Sidey-Gibbons, C., Klassen, A., Cano, S., … Rodrigues, J. (2023). 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, 25, e41870. https://doi.org/10.2196/41870
Harrison, Conrad, Inge Apon, Kenny Ardouin, Chris Sidey-Gibbons, Anne Klassen, Stefan Cano, Karen Wong Riff, et al. “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 25 (April 2023): e41870. https://doi.org/10.2196/41870.
Harrison C, Apon I, Ardouin K, Sidey-Gibbons C, Klassen A, Cano S, et al. 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. 2023 Apr;25:e41870.
Harrison C, Apon I, Ardouin K, Sidey-Gibbons C, Klassen A, Cano S, Wong Riff K, Pusic A, Versnel S, Koudstaal M, Allori AC, Rogers-Vizena C, Swan MC, 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. Journal of medical Internet research. 2023 Apr;25:e41870.

Published In

Journal of medical Internet research

DOI

EISSN

1438-8871

ISSN

1439-4456

Publication Date

April 2023

Volume

25

Start / End Page

e41870

Related Subject Headings

  • Surgery, Plastic
  • Plastic Surgery Procedures
  • Patient Reported Outcome Measures
  • Medical Informatics
  • Humans
  • Computerized Adaptive Testing
  • Cleft Palate
  • Cleft Lip
  • 4203 Health services and systems
  • 17 Psychology and Cognitive Sciences