Improve the selection of your health measure instrument with COnsensus-based Standards for the selection of health Measurement Instruments’ (COSMIN) critical appraisal tool (a checklist) containing standards for evaluating the methodological quality of studies on the measurement properties of health measurement instruments.
Selecting a HealthMeasure
There are many factors to consider in selecting a HealthMeasure for a specific purpose.
- Intended use of the data:
- Measures used for screening multiple symptoms or conditions need to be brief to reduce respondent burden. However, short measures are typically less precise than longer measures unless computer adaptive tests (CATs) are used.
- Measures used to diagnose a condition, or risk for condition, (e.g., depression), should be longer to ensure the condition is measured reliably. Longer questionnaires or CAT–based assessment are a good options.
- Measures that monitor a person’s health over time require more precision than screening measures. This will allow a clinician to evaluate how the patient’s health is changing based on the nature of the disease or treatment initiation. CAT-based assessments are good options as they can accurately capture change over time.
- Measures can be used as an indicator of quality of healthcare. Measures of the performance of healthcare providers or healthcare delivery organizations are being designed to evaluate change in health status over time in individuals (e.g., pre- to post-hip surgery physical functioning). Longer questionnaires (or CAT) are recommended.
- Patient population:
- The health condition or disease of the population will inform the type of outcomes that need to be assessed. For example, physical functioning is critical for arthritis patients and the impact of asthma is important for children with asthma.
- As older populations may have multiple chronic conditions, PROMIS® profiles may be of interest as they capture a range of outcomes including physical functioning, pain severity, pain interference, fatigue, sleep disturbance, depression, anxiety, and ability to participate in social roles and activities.
Watch this 4-minute tutorial with on how to select a PRO.
Review our detailed Guide on Selecting a HealthMeasure. It addresses:
- Identification of goals and/or aims of the assessment
- When to consider performance-based measures
- Deciding between global and specific outcomes
- Determining if your measure is for a primary, secondary, or exploratory endpoint
- Differences between universal outcomes and disease/condition-specific outcomes
- Differences between fixed length short forms and computer adaptive tests
- Determining needed reliability, precision, and length of a measure
- Appropriateness for target population
The International Society for Quality of Life Research and the National Cancer Institute hosted a webinar on selecting the appropriate outcome measure. Factors to consider include:
- Conceptual and measurement model
- Low respondent and administrative burden
- Alternate forms
- Cultural and language adaptations
Differences between Measures for the Same Domain
- Many domains of self-reported health offer a computer adaptive test (CAT) and one or more short forms. Select that type of measure that fits your needs and resources.
- Tailored selection of items for each respondent
- Requires administration technology
- High measurement precision across a wide range of symptom/function severity
- Short forms
- All respondents answer all questions
- No special administration technology needed
- Degree of measurement precision varies
- Pediatric self-report and parent-proxy report measures are available.
- Pediatric self-report is the standard for measuring outcomes among children.
- Parent-proxy report can be used when the child is too young, cognitively impaired, or too ill to complete a measure.
- Self-report and parent-proxy report are not equivalent.
- It is optimal to assess both the child and parent as their perspectives may independently relate to healthcare utilization, risk factors, or quality of care
- The Scoring Manuals for PROMIS include information on many topics including descriptions of:
- Differences between short forms for the same domain (e.g., Physical Function 4a vs 10a)
- Differences between versions (e.g., v1.0 and v2.0)
- Differences between item-level calibrations
- Find HealthMeasures scoring manuals>>
Measurement Precision: CAT versus Short Form
In 2019, Segawa and colleagues compared PROMIS CATs with 4-, 6-, and 8-item short forms. Specifically, they evaluated the range of accurate scores, number of items administered, floor (level of the worst symptom/function a measure can quantify), and ceiling (level of the best symptom/function a measure can quantify).
- CATs offer the widest range of accurate scores.
- CATs averaged 4.7 items administered.
- 4-, 6-, and 8-item short forms provide a range of accurate scores that improves with longer measures. Figure 1 in their manuscript provides the specific range for each short form. This can be used to evaluate how well each short form is likely to cover the desired range of scores for a target patient sample.
- Use CATs “(1) when a substantial number of participants with extremely poor health is anticipated; (2) when there is a need to measure very healthy participants accurately;” and (3) “when the administration of small number of items is required” (p. 217).
- Some HealthMeasures have multiple versions (e.g., v1.0, v1.1, v2.0)
- Generally, it is recommended that you use the most recent version available (highest number)
- A decimal increase (v1.0 to v1.1) usually retains the same item-level parameters as well as instrument reliability and validity
- Whole number increases (e.g., v1.0 to v2.0) are used with more substantial changes
- Scoring manuals include detailed information on version differences including when scores from different versions of a measure can be compared with each other.
- Find HealthMeasures scoring manuals>>