Item Banking Across the Continuum of Care

Veterans Health Administration, Decatur PA

Investigators

Linked publications & trials

Abstract

DESCRIPTION (provided by applicant): Evaluating the VHA health care system service structure, processes, and outcomes is contingent upon an integrated information system that monitors a Veteran's functional status across the continuum of care (acute, post-acute and community care). VA health professionals use a variety of functional instruments across different health care settings. Thus, when Veterans move from one setting to another, researchers, managers, and clinicians are often challenged to track functional status changes efficiently and precisely. In particular, researcher and clinicians face challenges when comparing results derived from the Functional Independence Measure (FIMTM), which is collected to monitor functional outcomes in VA inpatient rehabilitation facilities (IRFs), and results obtained from the Minimum Data Set (MDS) of the Resident Assessment Instrument (RAI), which is collected to monitor functional status in VA Community Living Centers (CLC). While considerable resources have been invested in developing and implementing these instruments, they are limited in their ability to speak to one another. This limitation is referred to as test-dependency. Currently, data gathered using the FIM cannot be readily compared to similar data gathered with the MDS. The broad, long-term objective of this proposed research is to advance Veteran health care delivery by providing the VHA with a state-of-the-art measurement system that builds upon the well-established VHA infrastructure use of the FIM in IRFs and the MDS in CLCs. The proposed measurement system will use contemporary item banking methodologies to provide practitioners with: 1) measures that translate between the two instruments, 2) flexibility in test administration (e.g., practitioners can choose to administer either the FIM or MDS in their entirety or in abbreviated forms), 3) reduced administration and Veteran burden through the use of short forms and computer adaptive test administration, and 4) equiprecise measurement (i.e., equal measurement precision across patient diagnosis severity).The Specific Aims of this study are to: 1) Create a FIM-MDS item bank that meets Item Response Theory (IRT) model requirements; 2) Generate IRT-based short forms and computer adaptive tests from the item bank; 3) Compare the precision of the IRT-based short forms, computer adaptive tests and item bank to the original FIM and MDS measures; and 4) Assess the accuracy of the IRT- based short forms, computer adaptive tests and item bank in classifying patients into Function Related Groups.