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DHI 07-144 – HSR&D Study

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DHI 07-144
A Computer Adaptive Test to Measure Community Reintegration
Linda J Resnik PhD MS
Providence VA Medical Center, Providence, RI
Providence, RI
Funding Period: December 2007 - May 2011

BACKGROUND/RATIONALE:
Research on the CRIS measure of community reintegration supports its validity, however the CRIS's length makes it burdensome to administer.

OBJECTIVE(S):
1) Develop a computer adaptive test (the CRIS-CAT) to facilitate efficient data collection; 2) Assess the test's concurrent, discriminant and predictive validity; 3) Identify factors associated with community reintegration; 4) Compare telephone and in-person administration.

METHODS:
This 3-part study involved: a 517 person field study of 3 Veteran groups: homeless, employed, and Operation Enduring Freedom / Operation Iraqi Freedom/ (OEF/OIF); a 1 year longitudinal cohort study of 135 OEF/OIF Veterans; and a 102-person study which randomized subjects to groups for CRIS administration once by telephone and once in person. Subjects completed CRIS item sets, SF-36V, Quality of Life (QOL), two scales from the CHART and questions about Activities of Daily Living. Data on health service utilization and new mental health diagnoses (mhdx) were abstracted from the medical record. Exploratory and confirmatory factor analyses were used to identify dimensionality of scales and IRT methods were used to calibrate items. Reliability, accuracy, precision of the CATs were examined. Pearson product correlations and ANOVAs were used to examine concurrent and known group validity, and logistic regression was used to examine relationships between CRIS-CAT and 1 year outcomes of Emergency Room (ER) use, Quality of Life, and diagnosis of new mental health conditions (MHdx). Multivariable regression was used to identify factors associated with logarithmically transformed CRIS-CAT scores. Equivalency of administration mode was examined by calculating ICCs (2,1).

FINDINGS/RESULTS:
Rasch models fit the CRIS data. EFA showed a dominant factor in all three CRISCAT scales and CFA demonstrated good model fit. The resulting scales were: Extent Scale 77 items, Perceived 144 items and Satisfaction 86 items. Reliability scores of scales was above 0.75, accuracy of 10 item scales was above 0.88. CRIS-CAT scores were correlated with concurrent validity indicators and differed between the three Veteran groups (P<.001). Odds of having any ER visits were reduced for Veterans with better CRIS-CAT scores (OR=0.93). CRIS-CAT scores were predictive of SF-12 PCS and MCS scores and new MHdx at 1 year. The following variables were significant in the final multivariable models: ADL difficulties, dx of depression, dx of PTSD, dx any other mental illness, alcohol or drug abuse, time since deployment, marital status, and education. ICCs showed that telephone and in-person modes of administration were nearly equivalent (ICCs >0,85).

IMPACT:
Study findings support the use of the CRIS-CAT as a brief measure of community reintegration, and illuminate factors associated with community reintegration. Findings suggest that telephone and in-person administration would yield equivalent results.

PUBLICATIONS:

Journal Articles

  1. Resnik L, Borgia M, Ni P, Pirraglia PA, Jette A. Reliability, validity and administrative burden of the community reintegration of injured service members computer adaptive test (CRIS-CAT)". BMC medical research methodology. 2012 Sep 17; 12(1):145.
  2. Resnik LJ, Clark MA, Borgia M. Telephone and face to face methods of assessment of veteran's community reintegration yield equivalent results. BMC medical research methodology. 2011 Jun 25; 11:98.


DRA: Health Systems, Military and Environmental Exposures, Mental, Cognitive and Behavioral Disorders
DRE: Diagnosis, Treatment - Preclinical, Prevention
Keywords: Adjustment Disorders, Care Management Tools, Deployment, Operation Enduring Freedom, Operation Iraqi Freedom, Reintegration Post-Deployment, Social Support
MeSH Terms: none

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