The simplicity and practicality of Rasch''s probabilistic scale-free measurement models have brought within reach universal metrics for educational and psychological tests, and for rating scale-based instruments in general. There are at least 3 implications to the application of Rasch''s models to the health-related calibration of universal metrics for each of the variables relevant to the Electronic Health Record (EHR) that are typically measured using rating scale instruments.
First, establishing a single metric standard with a defined range and unit will arrest the burgeoning proliferation of new scale-dependent metrics.
Second, the communication of the information pertaining to patient status represented by these measures (physical, cognitive, and psychosocial health status, quality of life, satisfaction with services, etc.) will be simplified.
Third, common standards of data quality will be used to evaluate and improve instrument performance. The vast majority of test and survey data quality is currently almost completely unknown, and when quality is evaluated, it is via many different methods that are often insufficient to the task, misapplied, misinterpreted, or even contradictory in their aims.
Fourth, currently unavailable economic benefits will accrue from the implementation of measurement methods based on quality-assessed data and widely accepted reference standard metrics. The potential magnitude of these benefits can be seen in an assessment of 12 different metrological improvement studies conducted by the National Science and Technology Council (Subcommittee on Research, 1996). The average return on investment associated with these twelve studies was 147 %. Is there any reason to suppose that similar instrument improvement efforts in the psychosocial sciences will result in markedly lower returns?
Until now, it has been assumed that the Practice E 1384
For instance, payors may want to know outcome information that tells them what percentage of patients discharged can function independently at home. A hospital manager, referral source, or accreditor might want to know more detail, such as percentages of patients discharged who can dress, bathe, walk, and eat independently. Clinicians will want to know still more detail about amounts of independence, such as whether there are safety issues, needs for assistive devices, or specific areas in which functionality could be improved. Researchers may seek even more detail yet, as they evaluate differences in outcomes across treatment programs, diagnostic groups, facilities, levels of care, etc.
Members of each of these groups have, at some time, felt that their particular information needs have not been met by the tools designed and developed by members of another group. Despite the fact that the information provided by these different tools appears in many different forms and at different levels of detail, to the extent that the........
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