Questionnaires are traditionally administered in a ‘paper-pencil’ format.
Although this approach is simple, it has several psychometric and practical limitations.
Limitations of paper-pencil questionnaires
Burdensome
For most paper-pencil questionnaires, all the items (questions) have to be administered and answered in exactly the order that they are listed. This ‘one size fits all’ approach means that paper-pencil questionnaires are often burdensome to administer and answer, leading to lower response rates and reduced data quality.
Limited measurement
Paper-pencil questionnaires also struggle to provide comprehensive and
targeted measurement as they contain limited domains and items.
Many so-called ‘quality of life’ questionnaires only measure activity limitation, or have quality of life domains comprising only a few items.
Resource-intensive
Paper-pencil questionnaires also take up storage space, and data must be manually entered which is resource intensive and increases the chance of human error.
Solution: Item-banking and CAT
Item banking and CAT offer sophisticated solutions to measuring patient-reported outcomes that overcome most of the problems with paper-pencil questionnaires.
The benefits of using item banking and CAT compared to traditional paper-pencil questionnaires are explained further in this video.
What are item banks and CAT?
An item bank is a group of items (questions) that measures a subjective construct such as ‘activity limitation’. An item bank usually contains far more items than would normally be found in a paper-pencil questionnaire. The items are calibrated on the same scale (like a ruler) using Item Response Theory methods.
A CAT system administers the items from the calibrated item bank. Using an algorithm and information from the person’s previous answers, the CAT iteratively selects the next item that most closely matches the person’s level of the construct estimated at that point in the test.
For example, if a person has no difficulty with ‘cooking a meal’, the next selected item would be a more difficult task such as ‘reading the newspaper’. However, if ‘cooking a meal’ is a challenge, an easier task like ‘watching TV’ will be presented. This process continues until the CAT obtains a precise estimate of the person’s level of the construct. Even though each person may answer different items, scores are comparable as the items belong to the same calibrated item bank.
Benefits of CAT
SAVES TIME
CAT requires fewer items and 50-90% less time to arrive at equally precise scores, reducing burden for busy clinics and clinical trials with a large testing protocol.
PERSONALISED
With items tailored to a person’s level of the construct, testing is personalised. This increases test-takers’ motivation and improves data quality.
FLEXIBLE
New items can be added to align with innovations in disease management or technology, and out of date items can be removed without threatening test validity. This ensures items remain relevant.
REAL-TIME FEEDBACK
CAT mitigates the need for data entry and manual calculation of scores by providing real-time feedback, facilitating the integration of results promptly into the therapeutic process.
CATs in practice
Clients are provided with a web login to their own personalised test portal where they can access all their specific tests online.
Tests can be administered on a tablet, smartphone, laptop or computer.
At the completion of each test, a score is automatically computed and presented on screen and a final report can be generated.
Data storage
Data are encrypted and stored on a password-protected virtual private cloud server with mandatory access control, firewalled from the public network with regular, automated security patches. Data are backed up daily.
Our CAT platform complies with the technical requirements of HIPAA (Health Insurance Portability and Accountability Act) and GDPR (General Data Protection Regulation).
Optimising PROM assessment in healthcare using CAT
As healthcare moves from a volume-based to value-based system, measuring the impact of disease and treatments from the patient’s perspective using high-quality PROMs is essential.
Use of PROM data in healthcare can help guide clinical care and personalize disease management, support shared decision-making, and improve patient experience.
For PROM assessment to succeed in busy clinics, it needs to be valid, reliable, and fast, and easily integrated into electronic medical records.
Our CATs offer the potential for innovative, feed-forward models of PROM assessment in healthcare.
Patients answer selected CAT tests accessed via our online portal and their scores are automatically and securely pushed via API (Application Programming Interface) to their electronic health records, ready for review and discussion with their treating doctor during the consultation.
Our CATs are currently being implemented at
(GlauCAT)
(IVI-CAT)
