Using Rasch analysis to form plausible health states amenable to valuation: the development of CORE-6D from CORE-OM in order to elicit preferences for common mental health problems

Purpose: To describe a new approach for deriving a preference-based index from a condition specific measure that uses Rasch analysis to develop health states. Methods: CORE-OM is a 34-item instrument monitoring clinical outcomes of people with common mental health problems. CORE-OM is characterised by high correlation across its domains. Rasch analysis was used to reduce the number of items and response levels in order to produce a set of unidimensionally-behaving items, and to generate a credible set of health states corresponding to different levels of symptom severity using the Rasch item threshold map. Results: The proposed methodology resulted in the development of CORE-6D, a 2-dimensional health state description system consisting of a unidimensionally-behaving 5-item emotional component and a physical symptom item. Inspection of the Rasch item threshold map of the emotional component helped identify a set of 11 plausible health states, which, combined with the physical symptom item levels, will be used for the valuation of the instrument, resulting in the development of a preference-based index. Conclusions: This is a useful new approach to develop preference-based measures where the domains of a measure are characterised by high correlation. The CORE-6D preference-based index will enable calculation of Quality Adjusted Life Years in people with common mental health problems

HEDS Discussion Paper 09-15: Developing preference-based health measures: using Rasch analysis to generate health state values

Background/aims: Condition specific measures may not always have independent items, and existing techniques of developing health state values from these measures are inappropriate when items are not independent. This study develops methods for deriving and valuing health states for a preference-based measure. Methods: Three key stages are presented: Rasch analysis is used to develop a health state classification system and identify a set of health states for valuation. A valuation survey of the health states using time-trade-off (TTO) methods is conducted to elicit health state values. Finally, regression models are applied to map the relationship between mean TTO values and Rasch logit values. The model is then used to estimate health state values for all possible health states. Methods are illustrated using the Flushing Symptoms Questionnaire (FSQ). Results: Rasch models were fitted to 1270 responders to the FSQ and a series of 16 health states identified for the valuation exercise. An ordinary least squares model best described the relationship between mean TTO values and Rasch logit values. (R2 = 0.958; Root mean square error = 0.042). Conclusions: We have shown how the valuation of health states can be mapped onto the Rasch scale in order to value all states defined by the FSQ. This should significantly enhance work in this field

HEDS Discussion Paper 09-15: Developing preference-based health measures: using Rasch analysis to generate health state values

Background/aims: Condition specific measures may not always have independent items, and existing techniques of developing health state values from these measures are inappropriate when items are not independent. This study develops methods for deriving and valuing health states for a preference-based measure. Methods: Three key stages are presented: Rasch analysis is used to develop a health state classification system and identify a set of health states for valuation. A valuation survey of the health states using time-trade-off (TTO) methods is conducted to elicit health state values. Finally, regression models are applied to map the relationship between mean TTO values and Rasch logit values. The model is then used to estimate health state values for all possible health states. Methods are illustrated using the Flushing Symptoms Questionnaire (FSQ). Results: Rasch models were fitted to 1270 responders to the FSQ and a series of 16 health states identified for the valuation exercise. An ordinary least squares model best described the relationship between mean TTO values and Rasch logit values. (R2 = 0.958; Root mean square error = 0.042). Conclusions: We have shown how the valuation of health states can be mapped onto the Rasch scale in order to value all states defined by the FSQ. This should significantly enhance work in this field

Valuing condition specific health states using simulation contact lenses

OBJECTIVE: This paper reports on a study that used contact lenses to simulate the effects of a visual impairment caused by Age Related Macular Degeneration (ARMD). The aim was to examine the feasibility of using this method of simulation and to compare the results from this experiment with those obtained from ARMD patients (n=209) using generic preference-based measures (HUI3 and EQ-5D) and patient time trade-off TTO. METHODS: Utility values were elicited from healthy participants (n=108) by TTO for three ARMD states simulated using contact lenses. RESULTS: A significant relationship was found between visual acuity and TTO values elicited from members of the general population (n=108). It was stronger than that found for HUI3, EQ-5D and own TTO values from patients (n=209). General population values informed by the experience of simulation were found to be significantly different to values from patient TTO and generic preference-based measures for the same level of visual impairment. Socio-demographic characteristics did not significantly affect results, although baseline TTO utility values were positively associated with TTO values for simulated states. CONCLUSIONS: ARMD has a major impact on general population TTO health state values. Differences across four visual health states appear larger than those found for a generic preference-based measures and patient TTO values. For conditions that are difficult to describe and imagine, simulation methods may offer an important method for obtaining better informed general population preferences

Estimating a preference-based single index from the Asthma Quality of Life Questionnaire (AQLQ)

This paper presents a study to estimate a preference-based single index from the Asthma Quality of Life Questionnaire (AQLQ). Based on the AQL-5D which is a health classification system directly derived from AQLQ, 98 health states were valued by a sample of 307 members of the UK general population. Models were estimated to predict all possible 3125 health states defined by the AQL-5D and compared using a set of criteria. The mean model of main effects was recommended of preferable prediction ability and logically consistent and significant coefficients for levels of dimensions. However, there are concerns over condition-specific valuation issues, such as presenting asthma information to general public and the choice of condition specific full health as the upper anchor for TTO valuation

Improving the measurement of QALYs in dementia: Developing patient- and carer-reported health state classification systems using Rasch analysis

Objectives: Cost-utility analysis is increasingly used to inform resource allocation. This requires a means of valuing health states before and after intervention. Although generic measures are typically used to generate values, these do not perform well with people with dementia. We report the development of a health state classification system amenable to valuation for use in studies of dementia, derived from the DEMQOL system, a measure of health-related quality of life in dementia by patient self-report (DEMQOL) and carer proxy-report (DEMQOL-Proxy). Methods: Factor analysis was used to determine the dimensional structure of DEMQOL and DEMQOL-Proxy. Rasch analysis was subsequently used to investigate item performance across factors in terms of item-level ordering, functioning across subgroups, model fit and severity-range coverage. This enabled the selection of one item from each factor for the classification system. A sample of people with a diagnosis of mild/moderate dementia (n=644) and a sample of carers of those with mild/moderate dementia (n=683) were used. Results: Factor analysis found different 5-factor solutions for DEMQOL and DEMQOL-Proxy. Following item reduction and selection using Rasch analysis, a 5-dimension classification for DEMQOL and a 4-dimension classification for DEMQOL-Proxy were developed. Each item contained 4 health state levels. Conclusion: Combining Rasch and classical psychometric analysis is a valid method of selecting items for dementia health state classifications from both the patient and carer perspectives. The next stage is to obtain preference weights so that the measure can be used in the economic evaluation of treatment, care and support arrangements for dementia

Structural study of Cu2−x_{2-x}Se alloys produced by mechanical alloying

The crystalline structures of superionic high temperature copper selenides Cu$_{2-x}$Se ($0 \le x \le 0.25$) produced by Mechanical Alloying were investigated using X-ray diffraction (XRD) technique. The measured XRD patterns showed the presence of the peaks corresponding to the crystalline superionic high temperature $\alpha$-Cu$_2$Se phase in the as-milled sample, and its structural data were determined by means of a Rietveld refinement procedure. After a heat treatment in argon at 200$^\circ$C for 90 h, this phase transforms to the superionic high temperature $\alpha$-Cu$_{1.8}$Se phase, whose structural data where also determined through the Rietveld refinement. In this phase, a very low occupation of the trigonal 32(f) sites ($\sim 3$%) by Cu ions is found. In order to explain the evolution of the phases in the samples, two possible mechanisms are suggested: the high mobility of Cu ions in superionic phases and the intense diffusive processes in the interfacial component of samples produced by Mechanical Alloying.Comment: 2 figures, submitted to Acta Crystallographic

Deriving a preference-based utility measure for cancer patients from the European Organisation for the Research and Treatment of Cancer's Quality of Life Questionnaire C30: a confirmatory versus exploratory approach

Background: Multi attribute utility instruments (MAUIs) are preference-based measures that comprise a health state classification system (HSCS) and a scoring algorithm that assigns a utility value to each health state in the HSCS. When developing a MAUI from a health-related quality of life (HRQOL) questionnaire, first a HSCS must be derived. This typically involves selecting a subset of domains and items because HRQOL questionnaires typically have too many items to be amendable to the valuation task required to develop the scoring algorithm for a MAUI. Currently, exploratory factor analysis (EFA) followed by Rasch analysis is recommended for deriving a MAUI from a HRQOL measure. Aim: To determine whether confirmatory factor analysis (CFA) is more appropriate and efficient than EFA to derive a HSCS from the European Organisation for the Research and Treatment of Cancer’s core HRQOL questionnaire, Quality of Life Questionnaire (QLQ-C30), given its well-established domain structure. Methods: QLQ-C30 (Version 3) data were collected from 356 patients receiving palliative radiotherapy for recurrent/metastatic cancer (various primary sites). The dimensional structure of the QLQ-C30 was tested with EFA and CFA, the latter informed by the established QLQC30 structure and views of both patients and clinicians on which are the most relevant items. Dimensions determined by EFA or CFA were then subjected to Rasch analysis. Results: CFA results generally supported the proposed QLQ-C30 structure (comparative fit index =0.99, Tucker–Lewis index =0.99, root mean square error of approximation =0.04). EFA revealed fewer factors and some items cross-loaded on multiple factors. Further assessment of dimensionality with Rasch analysis allowed better alignment of the EFA dimensions with those detected by CFA. Conclusion: CFA was more appropriate and efficient than EFA in producing clinically interpretable results for the HSCS for a proposed new cancer-specific MAUI. Our findings suggest that CFA should be recommended generally when deriving a preference-based measure from a HRQOL measure that has an established domain structure

Comparison of case note review methods for evaluating quality and safety in health care

Objectives: To determine which of two methods of case note review – holistic (implicit) and criterion-based (explicit) – provides the most useful and reliable information for quality and safety of care, and the level of agreement within and between groups of health-care professionals when they use the two methods to review the same record. To explore the process–outcome relationship between holistic and criterion-based quality-of-care measures and hospital-level outcome indicators. © 2010 Crown Copyrigh

The ATLAS3D project - XXVI : H I discs in real and simulated fast and slow rotators

One quarter of all nearby early-type galaxies (ETGs) outside Virgo host a disc/ring of H I with size from a few to tens of kpc and mass up to ∼109 M⊙. Here we investigate whether this H I is related to the presence of a stellar disc within the host making use of the classification of ETGs in fast and slow rotators (FR/SR). We find a large diversity of H I masses and morphologies within both families. Surprisingly, SRs are detected as often, host as much H I and have a similar rate of H I discs/rings as FRs. Accretion of H I is therefore not always linked to the growth of an inner stellar disc. The weak relation between H I and stellar disc is confirmed by their frequent kinematical misalignment in FRs, including cases of polar and counterrotating gas. In SRs the H I is usually polar. This complex picture highlights a diversity of ETG formation histories which may be lost in the relative simplicity of their inner structure and emerges when studying their outer regions. We find that Λ CDM hydrodynamical simulations have difficulties reproducing the H I properties of ETGs. The gas discs formed in simulations are either too massive or too small depending on the star formation feedback implementation. Kinematical misalignments match the observations only qualitatively. The main point of conflict is that nearly all simulated FRs and a large fraction of all simulated SRs host corotating H I. This establishes the H I properties of ETGs as a novel challenge to simulationsPeer reviewedFinal Accepted Versio