Health Outcomes Assessment:
The Remaining Questions

In "Postscript: The Remaining Questions" (Medical Care, 2000, 38:9, Supplement II, 290-210), Donald Patrick and Yen-Pin Chiang identify deficiencies in the health outcomes assessment field:

"In particular, there are 4 issues, although we have strived to address them [in a recent 2-day conference], that nonetheless remain largely unresolved in our view. We believe, however, these are issues and concerns of critical importance and deserve much further deliberation as the field moves forward."

1. "Our critical deficiency in relating the measurement metrics to the patients/consumers and clinicians in sufficiently meaningful ways."

2. "It is clearly a daunting task to develop universal instruments that promise conceptual and psychometric equivalence across an array of diverse populations. The prospect of an infinite number of instruments simply based on whatever the characteristics are of the population subgroups is not entirely encouraging or appealing."

3. "... the minimal set of standards to be applied in all applications for defining minimally important change. ... What are the standardized reporting requirements for responsiveness and interpretation, and can these be made generalizable?"

4. "... all the different weights derived from different methods and elicitation procedures are not necessarily meant to capture the same concept."

For those acquainted with the history of physics, these issues will sound familiar. It required 250 years (1600-1850) for the science of thermometry to achieve meaningful metrics (issue 1), universal instruments (issue 2) and general standards (issue 3).

In its earliest stage, the thermoscope (perhaps invented by Galileo in 1593) confused heat with atmospheric pressure (issue 4). Consequently, the thermoscope became the ancestor of both the thermometer and the barometer.

But progress in health outcomes assessment is rapid. An intention of the coming ICOM conference (opposite) is to address these issues head-on.

John Michael Linacre

Patrick D., Chiang Y.-P. (2001) Health Outcomes Assessment: The Remaining Questions. Rasch Measurement Transactions 14:4 p.782

Health Outcomes Assessment: The Remaining Questions. Patrick D., Chiang Y.-P., Linacre J.M. … Rasch Measurement Transactions, 2001, 14:4 p.782

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