Quality of Life Research

, Volume 24, Issue 8, pp 1809–1822 | Cite as

Testing item response theory invariance of the standardized Quality-of-life Disease Impact Scale (QDIS®) in acute coronary syndrome patients: differential functioning of items and test

  • Nina Deng
  • Milena D. Anatchkova
  • Molly E. Waring
  • Kyung T. Han
  • John E. WareJr.



The Quality-of-life (QOL) Disease Impact Scale (QDIS®) standardizes the content and scoring of QOL impact attributed to different diseases using item response theory (IRT). This study examined the IRT invariance of the QDIS-standardized IRT parameters in an independent sample.


The differential functioning of items and test (DFIT) of a static short-form (QDIS-7) was examined across two independent sources: patients hospitalized for acute coronary syndrome (ACS) in the TRACE-CORE study (N = 1,544) and chronically ill US adults in the QDIS standardization sample. “ACS-specific” IRT item parameters were calibrated and linearly transformed to compare to “standardized” IRT item parameters. Differences in IRT model-expected item, scale and theta scores were examined. The DFIT results were also compared in a standard logistic regression differential item functioning analysis.


Item parameters estimated in the ACS sample showed lower discrimination parameters than the standardized discrimination parameters, but only small differences were found for thresholds parameters. In DFIT, results on the non-compensatory differential item functioning index (range 0.005–0.074) were all below the threshold of 0.096. Item differences were further canceled out at the scale level. IRT-based theta scores for ACS patients using standardized and ACS-specific item parameters were highly correlated (r = 0.995, root-mean-square difference = 0.09). Using standardized item parameters, ACS patients scored one-half standard deviation higher (indicating greater QOL impact) compared to chronically ill adults in the standardization sample.


The study showed sufficient IRT invariance to warrant the use of standardized IRT scoring of QDIS-7 for studies comparing the QOL impact attributed to acute coronary disease and other chronic conditions.


Item response theory invariance Differential item functioning Differential test (scale) functioning Measurement invariance Disease-specific quality-of-life measures 



Acute coronary syndrome


ACS-specific linearly transformed


Computerized adaptive testing


Compensatory differential item functioning


Confirmatory factor analysis


Differential functioning of items and tests


The computerized adaptive Assessment of disease impact project


Differential item functioning


Differential test (scale) functioning


Generalized partial credit model


Item characteristic curve


Item parameter drift


Item response theory


Minnesota Living with Heart Failure Questionnaire


Non-compensatory differential item functioning


Patient-reported outcome


Patient Reported Outcomes Measurement Information System


Quality-of-life Disease Impact Scale


7-item short-form of QDIS®




Root-mean-square difference


Seattle Angina Questionnaire


Test characteristic curve


The Transitions, Risks, and Actions in Coronary Events-Center for Outcomes Research and Education project



TRACE-CORE is supported by the National Institutes of Health National Heart, Lung, and Blood Institute (1U01HL105268). DICAT is supported by the National Institutes of Health National Institute of Aging (2R44AG025589). Partial salary support was provided by TRACE-CORE and PhRMA foundation Research Starter Grant (M.D.A.). Additional support was provided by NIH Grant KL2TR000160 (M.E.W.). The authors are very grateful for the editor and reviewers’ comments and personal communication with Jakob Bjørner.


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Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Nina Deng
    • 1
    • 2
  • Milena D. Anatchkova
    • 1
    • 3
  • Molly E. Waring
    • 1
  • Kyung T. Han
    • 4
  • John E. WareJr.
    • 1
    • 5
  1. 1.Department of Quantitative Health SciencesUniversity of Massachusetts Medical SchoolWorcesterUSA
  2. 2.Measured Progress, Inc.DoverUSA
  3. 3.EvideraLexingtonUSA
  4. 4.Graduate Management Admission CouncilRestonUSA
  5. 5.John Ware Research Group, IncorporatedWorcesterUSA

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