TY - JOUR
T1 - Classification and regression tree uncovered hierarchy of psychosocial determinants underlying quality-of-life response shift in HIV/AIDS
AU - Li, Yuelin
AU - Rapkin, Bruce
N1 - Funding Information:
The authors acknowledge funding from the New York State Department of Health AIDS Institute (US Health Resources and Services Administration grant: 2X07 HA 0025-17) (B.R.) and the Weill Cornell Medical College Clinical and Translational Science Award (NIH UL1-RR024996) (Y.L.).
PY - 2009/11
Y1 - 2009/11
N2 - Objectives: Rapkin and Schwartz define response shift as otherwise unexplained, discrepant change in health-related quality of life (HRQOL) that is associated with change in cognitive appraisal. In this article, we demonstrate how a recursive partitioning (rpart) regression tree analytic approach may be used to explore cognitive changes to gain additional insight into response-shift phenomena. Study Design and Setting: Data are from the "Choices in Care Study," an evaluation of HIV+ Medicaid recipients' experiences and outcomes in care (N = 394). Cognitive assessment was based on the QOL appraisal battery. HRQOL was measured by the SF-36 Health Survey, version 2 (SF-36v2). Results: We used rpart to examine 6-month change in SF-36v2 mental composite score as a function of changes in appraisal, after controlling for patient characteristics, health changes, and intervening events. Rpart identified nine distinct patterns of cognitive change, including three associated with negative discrepancies, four with positive discrepancies, and two with no discrepancies. Conclusion: Rpart classification provides a nuanced treatment of response shift. This methodology has implications for evaluating programs, guiding decisions, and targeting care.
AB - Objectives: Rapkin and Schwartz define response shift as otherwise unexplained, discrepant change in health-related quality of life (HRQOL) that is associated with change in cognitive appraisal. In this article, we demonstrate how a recursive partitioning (rpart) regression tree analytic approach may be used to explore cognitive changes to gain additional insight into response-shift phenomena. Study Design and Setting: Data are from the "Choices in Care Study," an evaluation of HIV+ Medicaid recipients' experiences and outcomes in care (N = 394). Cognitive assessment was based on the QOL appraisal battery. HRQOL was measured by the SF-36 Health Survey, version 2 (SF-36v2). Results: We used rpart to examine 6-month change in SF-36v2 mental composite score as a function of changes in appraisal, after controlling for patient characteristics, health changes, and intervening events. Rpart identified nine distinct patterns of cognitive change, including three associated with negative discrepancies, four with positive discrepancies, and two with no discrepancies. Conclusion: Rpart classification provides a nuanced treatment of response shift. This methodology has implications for evaluating programs, guiding decisions, and targeting care.
KW - Classification and regression trees
KW - Health-related quality of life
KW - Idiographic quality of life assessment
KW - Response shift
KW - Rpart
KW - Segmentation strategies
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U2 - 10.1016/j.jclinepi.2009.03.021
DO - 10.1016/j.jclinepi.2009.03.021
M3 - Article
C2 - 19595576
AN - SCOPUS:70349337186
SN - 0895-4356
VL - 62
SP - 1138
EP - 1147
JO - Journal of Clinical Epidemiology
JF - Journal of Clinical Epidemiology
IS - 11
ER -