Item Banking Across the Continuum of Care
Craig A. Velozo PhD MS BS
North Florida/South Georgia Veterans Health System, Gainesville, FL
Gainesville, FL
Funding Period: December 2011 - November 2014

BACKGROUND/RATIONALE:
Evaluating the Veteran's Health Administration (VHA) 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). Since VA health professionals use a variety of functional instruments, valuable information may be lost as Veterans move across health care settings. In particular, within the VHA, researchers and clinicians face challenges when comparing results from the Functional Independence Measure, which is collected to monitor functional outcomes in VA inpatient rehabilitation facilities (IRF), and results from the Minimum Data Set (MDS) of the Resident Assessment Instrument, which is collected to monitor functional status in VA Community Living Centers (CLC - previously referred to as Nursing Home Care Units). While tremendous resources have been invested in developing and implementing these useful instruments, currently data collected with the FIM cannot be readily compared to similar data collected with the MDS.

OBJECTIVE(S):
The long-term objective of this proposed research is to provide the VA with a state-of-the-art measurement system that builds upon the well-established VA 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 computerized 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 model (IRT) requirements; 2) Generate IRT-based short forms and computerized adaptive tests from the item bank; 3) Compare the precision of the IRT-based short forms, computerized adaptive tests and item bank to the original FIM and MDS measures; and 4) Assess the accuracy of the IRT-based short forms, computerized adaptive tests and item bank in classifying Veterans into Function Related Groups.

METHODS:
We will obtain linked FIM-MDS data from the Austin Information Technology Center for 1500 Veterans. The final items for the physical functioning and cognitive item banks will be selected based on meeting the criteria of unidimensionality, model fit, monotonicity, local independence and differential item functioning. We will produce IRT-based short forms and computerized adaptive tests that will be designed to reduce respondent/administrator burden and maximize precision across the breadth of the item bank. We will use a second, independent sample of 1500 Veterans to compare the precision of the different short forms, computerized adaptive tests and item bank by comparing the information functions for each administration procedure. We will investigate the accuracy of the short forms, computerized adaptive tests and item bank in classifying Veterans into Function Related Groups.

FINDINGS/RESULTS:
No findings/results to report at this time.

IMPACT:
No impact to report at this time.

PUBLICATIONS:
None at this time.

DRA: Aging, Older Veterans' Health and Care, Health Systems
DRE: Diagnosis, Prognosis
Keywords: Frailty, Functional Status
MeSH Terms: none