Quality of Life Research

, Volume 4, Issue 4, pp 293–307 | Cite as

Individual-patient monitoring in clinical practice: are available health status surveys adequate?

  • C. A. McHorney
  • A. R. Tarlov
Research Papers


Interest has increased in recent years in incorporating health status measures into clinical practice for use at the individual-patient level. We propose six measurement standards for individual-patient applications: (1) practical features, (2) breadth of health measured, (3) depth of health measured, (4) precision for cross-sectional assessment, (5) precision for longitudinal monitoring and (6) validity. We evaluate five health status surveys (Functional Status Questionnaire, Dartmouth COOP Poster Charts, Nottingham Health Profile, Duke Health Profile, and SF-36 Health Survey) that have been proposed for use in clinical practice. We conducted an analytical literature review to evaluate the six measurement standards for individual-patient applications across the five surveys. The most problematic feature of the five surveys was their lack of precision for individual-patient applications. Across all scales, reliability standards for individual assessment and monitoring were not satisfied, and the 95% Cls were very wide. There was little evidence of the validity of the five surveys for screening, diagnosing, or monitoring individual patients. The health status surveys examined in this paper may not be suitable for monitoring the health and treatment status of individual patients. Clinical usefulness of existing measures might be demonstrated as clinical experience is broadened. At this time, however, it seems that new instruments, or adaptation of existing measures and scaling methods, are needed for individual-patient assessment and monitoring.

Key words

Clinical practice health status assessment individual patient applications measurement standards reliability score distributions validity 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Jenkinson C, Fitzpatrick R, Argyle M. The Nottingham Health Profile: an analysis of its sensitivity in differentiating illness groups.Soc Sci Med 1988;27: 1411–1414.Google Scholar
  2. 2.
    Stewart AL, Greenfield S, Hays RD, et al. Functional status and well-being of patients with chronic conditions: results from the Medical Outcomes Study.JAMA 1989;262: 907–913.Google Scholar
  3. 3.
    Alonso J, Anto JM, Gonzalez M, et al. Measurement of general health status of non-oxygen-dependent chronic obstructive pulmonary disease patients.Med Care 1992;30 (Suppl): MS125-MS135.Google Scholar
  4. 4.
    Deyo RA, Inui TS, Leininger J, Overman S. Physical and psychosocial function in rheumatoid arthritis.Arch Intern Med 1982;142: 879–882.Google Scholar
  5. 5.
    Heaton RK, Grant I, McSweeney J, Adams K, Petty T. Psychological effects of continuous and nocturnal oxygen therapy in hypoxemic chronic obstructive pulmonary disease.Arch Intern Med 1983:143: 1941–1947.Google Scholar
  6. 6.
    Hart LG, Evans RW. The functional status of ESRD patients as measured by the Sickness Impact Profile.J Chron Dis 1987:40 (Suppl): 117S-130S.Google Scholar
  7. 7.
    Bombardier C, Ware J, Russell IJ, et al. Auranofin therapy and quality of life in patients with rheumatoid arthritis: results of a multicenter trial.Amer J Med 1986;81: 565–578.Google Scholar
  8. 8.
    Canadian Erythropoietin Study Group. Association between recombinant human erythropoietin and quality of life and exercise capacity of patients receiving haemodialysis.BMJ 1990;300: 573–578.Google Scholar
  9. 9.
    Ware JE, Brook RH, Rogers WH,et al. Comparison of health outcomes at a health maintenance organization with those of a fee-for-service care.Lancet 1986; 1017–1022.Google Scholar
  10. 10.
    Retchin SM, Clement DG, Rossiter LF, et al. How the elderly fare in HMOs: outcomes from the Medicare competition demonstration.Health Serv Res 1992;27: 651–669.Google Scholar
  11. 11.
    Patrick DL, Erickson P.Health Status and Health Policy: Allocating Resources to Health Care. New York: Oxford University Press, 1993.Google Scholar
  12. 12.
    Kaplan RM.The Hippocratic Predicament: Affordability, Access, and Accountability in American Medicine. San Diego: Academic Press, 1993.Google Scholar
  13. 13.
    Newhouse JP, Manning WG, Keeler EB, Sloss EM. Adjusting capitation rates using objective health measures and prior utilization.Health Care Fin Rev 1989;10: 41–54.Google Scholar
  14. 14.
    Hunt SM, McEwen J, McKenna SP. Perceived health: age and sex comparisons in a community.J. Epid Commun Health 1984;38: 156–160.Google Scholar
  15. 15.
    Brorsson B, Ifver J, Hays RD. The Swedish Health-Related Quality of Life Survey (SWED-QUAL).Quality Life Res 1993;2: 33–45.Google Scholar
  16. 16.
    McHorney CA, Kosinski M, Ware JE. Comparisons of the costs and quality of norms for the SF-36 Survey collected by mail versus telephone interview: results from a national survey.Med Care 1994;32: 551–567.Google Scholar
  17. 17.
    Patrick DL, Bush JW, Chen MM. Toward an operational definition of health.J Health Soc Behav 1973;14: 6–21.Google Scholar
  18. 18.
    Bergner M, Bobbitt RA, Carter WB, Gilson BS. The Sickness Impact Profile: development and final revision of a health status measure.Med Care 19(8): 787–805.Google Scholar
  19. 19.
    Chambers LW. The McMaster Health Index Questionnaire: an update. In: Walker SR, Rosser RM, eds.Quality of Life: Assessment and Application. Lancaster: MTP Press Limited, 1988: 113–131.Google Scholar
  20. 20.
    Brook RH, Ware JE, Davies-Avery A, et al. Overview of adult health status measures fielded in RAND's Health Insurance Study.Med Care 17(Suppl) 1979: 1–131.Google Scholar
  21. 21.
    Hunt SM, McEwen J. The development of a subjective health indicator.Soc Health Illness 1980;2: 231–246.Google Scholar
  22. 22.
    Parkerson GR, Gehlbach SH, Wagner EH, et al. The Duke-UNC Health Profile: an adult health status instrument for primary care.Med Care 1981;19: 806–828.Google Scholar
  23. 23.
    Parkerson GR, Broadhead WE, Tse CJ. The Duke Health Profile: A 17-item measure of health and dysfunction.Med Care 1990;28: 1056–1072.Google Scholar
  24. 24.
    Stewart AL, Hays RD, Ware JE. The MOS Short-Form General Health Survey: reliability and validity in a patient population.Med Care 1980;26: 724–735.Google Scholar
  25. 25.
    Stewart AL, Ware JE.Measuring Functioning and Well-Being: The Medical Outcomes Study Approach. Chapel Hill, NC: Duke University, 1992.Google Scholar
  26. 26.
    Ware JE, Sherbourne CD. The MOS 36-Item Short-Form Health Survey (SF-36): I. Conceptual framework and item selection.Med Care 1993;30: 473–483.Google Scholar
  27. 27.
    Greenfield S. What's the next step for outcomes assessment?The Internest 1990; 6–10.Google Scholar
  28. 28.
    Wolfe F, Pincus T. Standard self-report questionnaires in routine clinical and research practice—an opportunity for patients and rheumatologists.J Rheumat 1991;18: 643–646.Google Scholar
  29. 29.
    Meyer KB, Espindle DM, DeGiacomo JM, et al. Monitoring dialysis patients' health status.Am J Kidney Dis 1993;9: 267–279.Google Scholar
  30. 30.
    Kane RA, Kane RL.Assessing the Elderly: A Practical Guide to Measurement. Lexington MA: 1981.Google Scholar
  31. 31.
    Applegate WB, Blass JP, Williams TF. Instruments for the functional assessment of older patients.NEJM 1990;322: 1207–1214.Google Scholar
  32. 32.
    Greenfield S, Nelson EC. Recent developments and future issues in the use of health status assessment measures in clinical settings.Med Care 1992;30(Suppl) MS23-MS41.Google Scholar
  33. 33.
    Engel GL. The need for a new medical model: a challenge for biomedicine.Science 1976: 129–136.Google Scholar
  34. 34.
    Lipkin M, Quill TE, Napodano RJ. The medical interview: a core curriculum for residents in internal medicine.Ann Intern Med 1984;100: 277–284.Google Scholar
  35. 35.
    Fretwell MD. Comprehensive functional assessment (CFA) in everyday practice. In: Hazzard WR, Andes R, et al. eds.Principles of Geriatric Medicine and Gerontology. New York: McGraw-Hill 1990 218–223.Google Scholar
  36. 36.
    Jachuck SJ, Brierly H, Jachuch S, Wilcox PM. The effect of hypotensive drugs on the quality of life.J Royal College Gen Pract 1982;32 103–105.Google Scholar
  37. 37.
    Patrick DL, Peach H, Gregg I. Disablement and care: a comparison of patient views and general practitioner knowledge.J Royal College Gen Pract 1982;32 429–434.Google Scholar
  38. 38.
    Nelson EC, Conger B, Douglass R, et al. Functional health status levels of primary care patients.JAMA 1983;249 3331–3338.Google Scholar
  39. 39.
    Calkins DR, Rubenstein LV, Cleary PD, et al. Failure of physicians to recognize functional disability in ambulatory patients.Ann Intern Med 1991;114: 451–454.Google Scholar
  40. 40.
    Nerenz DR, Repasky DP, Whitehouse FW, Kahkonen DM. Ongoing assessment of health status in patients with diabetes.Med Care 1992;30(Suppl): MS112-MS124.Google Scholar
  41. 41.
    Cluff LE. Chronic disease, function, and the quality of care.J Chron Dis 1981;34: 299–304.Google Scholar
  42. 42.
    McDermott W. Absence of indicators of the influence of its physicians on a society's health.Am J Med 1981;70: 833–843.Google Scholar
  43. 43.
    Tarlov AR. The increasing supply of physicians, the changing structure of the health services system, and the future practice of medicine.NEJM 1983;308: 1235–1244.Google Scholar
  44. 44.
    Tarlov AR. The coming influence of a social sciences perspective on medical education.Acad Med 1992;67: 724–731.Google Scholar
  45. 45.
    Ware JE. Methodological considerations in the selection of health status assessment procedures. In: Wenger NK, Mattson ME, Furberg CD, Elinson J eds.Assessment of Quality of Life in Clinical Trials of Cardiovascular Therapies. New York: Le Jacq Publishing, 1984: 87–111.Google Scholar
  46. 46.
    Bergner M, Rothman ML. Health status measures: an overview and guide for selection.Ann Rev Pub Health 1987;8: 191–210.Google Scholar
  47. 47.
    Hays RD, Anderson R, Revicki D. Psychometric considerations in evaluating health-related quality of life measures.Qual Life Res 1993;2: 441–449.Google Scholar
  48. 48.
    Jette AM Davies AR, Cleary PD, et al. The Functional Status Questionnaire: reliability and validity when used in primary care.J Gen Intern Med 1986;1: 143–149.Google Scholar
  49. 49.
    Nelson E, Wasson J, Kirk J, et al.. Assessment of function in routine clinical practice: description of the COOP chart method and preliminary findings.J Chron Dis 1987;40 (Suppl): 55S-63S.Google Scholar
  50. 50.
    Hunt SM, McEwen J, McKenna SP.Measuring Health Status Dover NH: Croom Helm, 1986.Google Scholar
  51. 51.
    Greenwald HP, Peterson ML, Garrison LP, et al. Interspeciality variation in office-based care.Med Care 1984;22: 14–29.Google Scholar
  52. 52.
    Williams JI, Naylor CD. How should health status measures be assessed? Cautionary notes on procrustean frameworks.J Clin Epidem 1992;45: 1347–1351.Google Scholar
  53. 53.
    American Psychological Association.Standards for Educational and Psychological Testing. Washington, DC: American Psychological Association, 1985.Google Scholar
  54. 54.
    Overall JE. Contradictions can never a paradox resolve.Appl Psych Meas 1989;13: 426–428.Google Scholar
  55. 55.
    Bergner M. Measurement of health status.Med Care 1985;23: 696–704.Google Scholar
  56. 56.
    Patrick DL, Erickson P. What constitutes quality of life?Qual Life Cardiovasc Care 1988;4: 103–127.Google Scholar
  57. 57.
    Nunnally JC.Psychometric Theory. New York: McGraw-Hill, 1978.Google Scholar
  58. 58.
    Kaplan RM, Saccuzzo DP.Psychological Testing. Principles, Applications, and Issues. Pacific Grove, CA: Brooks/Cole Publishing Company, 1989.Google Scholar
  59. 59.
    Anastasi A.Psychological Testing New York: Macmillan, 1990.Google Scholar
  60. 60.
    Thorndike RM, Cunningham GK, Thorndike RL, Hagan EP.Measurement and Evaluation in Psychology and Education. New York: Macmillan, 1991.Google Scholar
  61. 61.
    Jacobson NS, Follette WC, Revenstorf, D. Psychotherapy outcome research: methods for reporting variability and evaluating clinical significance.Behav Therapy 1984;15: 336–352.Google Scholar
  62. 62.
    Christensen L, Mendoza JL. A method of assessing change in a single subject: an alteration of the RC Index.Behav Therapy 1986;17: 305–308.Google Scholar
  63. 63.
    Siu Al, Hays RD, Ouslander JG, et al. Measuring functioning and health in the very old.J Gerontol 1993;48: M10-M14.Google Scholar
  64. 64.
    Parkerson GR, January 14, 1994. [Personal communication]Google Scholar
  65. 65.
    Hunt SJ, Nottingham Health Profile. In: Walker SR, Rosser RM, eds.Quality of Life: Assessment and Application. Lancaster: MTP Press Limited, 1988: 165–169.Google Scholar
  66. 66.
    World Health Organization.Constitution of the World Health Organization. Basic Documents. Geneva, Switzerland: World Health Organization, 1948.Google Scholar
  67. 67.
    Anderson J, Sullivan F, Usherwood TP. The Medical Outcomes Study Instrument (MOSI)—use of a new health status measure in Britain.Family Practice 1990;7: 205–218.Google Scholar
  68. 68.
    Parkerson GR. January 21, 1994. [Personal communication]Google Scholar
  69. 69.
    McHorney CA, Ware JE, Lu JFR, Sherbourne CD. The MOS 36-Item Short-Form Survey (SF-36). III. Tests of data quality, scaling assumptions, and reliability across diverse patient groupsMed Care 1994;32: 40–66.Google Scholar
  70. 70.
    Brazier JE, Harper R, Jones NMB, et al. Validating the SF-36 health survey questionnaire: new outcome measure for primary care.BMJ 1992;305: 160–164.Google Scholar
  71. 71.
    Harwood RH, Gompertz P, Ebrahim S. Handicap one year after a stroke: validity of a new scale.J Neurol Neurosurg Psychiatry 1994;57: 825–829.Google Scholar
  72. 72.
    Hunt SM, McKenna SP, McEwen J, et al. The Nottingham Health Profile: subjective health status and medical consultations.Soc Sci Med 1981;15A: 221–229.Google Scholar
  73. 73.
    Leavy R, Wilkin D. A comparison of two survey measures of health status.Soc Sci Med 1988;27: 269–275.Google Scholar
  74. 74.
    Baum FE, Cooke RD Community-health needs assessment: use of the Nottingham Health Profile in an Australian study.Med J Australia 1989;150: 583–590.Google Scholar
  75. 75.
    Alonso J Anto JM, Moreno C. Spanish version of the Nottingham Health Profile: translation and preliminary validity.AJPH 1990;80: 704–708.Google Scholar
  76. 76.
    Permanyer-Miralda G, Alonso J, Anto JP, et al. Comparison of perceived health status and conventional evaluation in stable patients with coronary artery disease.J Clin Epid 1991;44: 779–786.Google Scholar
  77. 77.
    Doll HA, Black NA, Flood AB, McPherson K Patientperceived health status before and up to 12 months after transurethral resection of the prostate for benign prostatic hypertrophy.Brit J Urol 1993;71: 297–305.Google Scholar
  78. 78.
    Hunt SM, McKenna SP, McEwen J, et al. A quantitative approach to perceived health status: a validation study.J Epid Commun Health 1980;34: 281–286.Google Scholar
  79. 79.
    Hunt SM, McEwen J, McKenna SP, et al. Subjective health of patients with peripheral vascular disease.The Practitioner 1982;226: 133–136.Google Scholar
  80. 80.
    Ebrahim S, Barer D, Nouri F. Use of the Nottingham Health Profile with patients after a stroke.J Epid Commun Health 1986;40: 166–169.Google Scholar
  81. 81.
    Wiklund I, Romanus B, Hunt SM: Self-assessed disability in patients with arthrosis of the hip joint.Int Disabil Studies 1988;10: 159–163.Google Scholar
  82. 82.
    Einarsson G, Grimby G. Disability and handicap in late poliomyelitis.Scand J Rehab Med 1990;22: 113–121.Google Scholar
  83. 83.
    Cleary PD, Greenfield S, McNeil BJ. Assessing quality of life after surgery.Controlled Clinical Trials 1991;12: 189S-203S.Google Scholar
  84. 84.
    Katz JN, Larson MG, Phillips CB, et al. Comparative measurement sensitivity of short and longer health status instruments.Med Care 1992;30: 917–925.Google Scholar
  85. 85.
    Nelson EC, Landgraf JM, Hays RD, et al. The functional status of patients: how can it be measured in physicians' offices?Med Care 1990;28: 1111–1126.Google Scholar
  86. 86.
    Meyboom-De Jong M, Smith RJA. Studies with the Dartmouth COOP charts in general practice: comparison with the Nottingham Health Profile and the General Health Questionnaire. In: WONCA Classification Committee eds.Functional Status in Primary Care. New York: Springer-Verlag, 1990: 132–149.Google Scholar
  87. 87.
    Siu A, Reuben D, Ouslander J, Osterwell D. Using multidimensional health measures in older persons to identify risk of hospitalization and skilled nursing placement.Qual Life Res 1993;2: 253–261.Google Scholar
  88. 88.
    Parkerson GR, Broadhead WE, Tse CJ. Comparison of the Duke Health Profile and the MOS short-form in healthy young adults.Med Care 1991;29: 679–683.Google Scholar
  89. 89.
    Parkerson GR, Broadhead WE, Tse CJ. Quality of life and functional health of primary care patients.J Clin Epid 1992;45: 1303–1313.Google Scholar
  90. 90.
    Parkerson GR, Broadhead WE, Tse CJ. Anxiety and depressive symptom identification using the Duke Health Profile.J Clin Epidem, in press.Google Scholar
  91. 91.
    Parkerson GR, Broadhead WE, Tse CJ. Health status and severity of illness as predictors of outcomes in primary care.Med Care 1995;33(1: 53–66.Google Scholar
  92. 92.
    McHorney CA, Ware JE, Rogers W, et al. The validity and relative precision of MOS short- and long-form health status scales and Dartmouth COOP Charts: results from the Medical Outcomes Study.Med Care 1992;30(Suppl): MS253-MS265.Google Scholar
  93. 93.
    Weinberger M, Samsa GP, Hanlon JT, et al. An evaluation of a brief health status measure in elderly veterans.JAGS 1991;39: 691–694.Google Scholar
  94. 94.
    Brazier J, Jones N, Kind P. Testing the validity of the Euroqol and comparing it with the SF-36 health survey questionnaire.Qual Life Res 1993;2: 169–180.Google Scholar
  95. 95.
    Garratt AM, Ruta DA, Abdalla MI, et al. The SF 36 health survey questionnaire: an outcome measure suitable for routine use within the NHS?BMJ 1993;306: 1440–1444.Google Scholar
  96. 96.
    Jenkinson C, Coulter A, Wright L. Short form 36 (SF 36) health survey questionnaire: normative data for adults of working age.BMJ 1993;306: 1437–1440.Google Scholar
  97. 97.
    Phillips RC, Lansky DJ. Outcomes management in heart valve replacement surgery: early experience.J Heart Valve Dis 1992;1: 42–50.Google Scholar
  98. 98.
    Vickrey BG, Hays RD, Graber J, et al. A health-related quality of life instrument for patients evaluated for epilepsy surgery.Med Care 1992;30: 299–319.Google Scholar
  99. 99.
    Wells KB, Burnam MA, Rogers W, Camp P. The course of depression in adult outpatients: results from the Medical Outcomes Study.Arch Gen Psychiatry 1992;49: 788–794.Google Scholar
  100. 100.
    McHorney CA, Ware JE, Raczek AE. The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs.Med Care 1993;31: 247–263.Google Scholar
  101. 101.
    Caine N, Harrison SCW, Sharples LD, Wallwork J. Prospective study of quality of life before and after coronary artery bypass grafting.BMJ 1991;302: 511–516.Google Scholar
  102. 102.
    Cox IM, Campbell MJ, Dowson D. Red blood cell magnesium and chronic fatigue syndrome.Lancet 1991;337: 757–760.Google Scholar
  103. 103.
    Monks J. Interpretation of subjective measures in a clinical trial of hyperbaric oxygen therapy for multiple sclerosis.J Psychosom Res 1988;32: 365–372.Google Scholar
  104. 104.
    O'Brien BJ, Banner NR, Gibson S, Yacoub MH. The Nottingham Health Profile as a measure of quality of life following combined heart and lung transplantation.J Epid Commun Health 1988;42: 232–234.Google Scholar
  105. 105.
    Parr G, Darekar B, Fletcher A, Bulpitt CJ. Joint pain and quality of life: results of a randomized trial.Br J Clin Pharmac 1989;27: 235–242.Google Scholar
  106. 106.
    Allen JK, Becker DM, Swank RT. Factors related to functional status after coronary artery bypass surgery.Heart and Lung 1990;19: 337–343.Google Scholar
  107. 107.
    Allen JK, Fitzgerald ST, Swank RT, Becker DM. Functional status after coronary artery bypass grafting and percutaneous transluminal coronary angioplasty.Am J Cardiol 1990;66: 921–925.Google Scholar
  108. 108.
    Lancaster TR, Singer DE, Sheehan MA, et al. The impact of long-term warfarin therapy on quality of life: evidence from a randomized trial.Arch Intern Med 1991;151: 1944–1949.Google Scholar
  109. 109.
    Wiklund I, Romanus C. A comparison of quality of life before and after arthroplasty in patients who had arthritis of the hip joint.J Bone Joint Surg 1991;73-A: 765–769.Google Scholar
  110. 110.
    Lansky D, Butler JBJ, Waller FT. Using health status measures in the hospital setting: from acute care to outcomes management.Med Care 1992;30(Suppl): MS57-MS73.Google Scholar
  111. 111.
    Messick S. The once and future issues of validity: assessing the meaning and consequences of measurement. In: Wainer H, Braun H, eds.Test Validity. Hillsdale, NJ: Larrence Erlbaum, 1988: 33–45.Google Scholar
  112. 112.
    Berwick DM, Murphy JM, Goldman PA, et al. Performance of a five-item mental health screening test.Med Care 1991;29, 169–176.Google Scholar
  113. 113.
    Street RL, Gold WR, McDowell T. Using health status measures in medical consultations.Med Care 1994;32: 732–744.Google Scholar
  114. 114.
    Schor EL, Lerner DJ, Malspeis S. Physician's assessment of functional health status and well-being: the patient's perspective.Arch Intern Med 1995;155: 309–314.Google Scholar
  115. 115.
    Health and Public Policy Committe, American College of Physicians. Comprehensive functional assessment for elderly patients.Ann Intern Med 1988;107: 70–72.Google Scholar
  116. 116.
    Calkins DR, Rubenstein LV, Cleary PD, Jette AM, Brook RH, Delbanco TL. The Functional Status Questionnaire: a controlled trial in a hospital-based practice.Clin Res 1986;34: 359A.Google Scholar
  117. 117.
    Rubenstein LV, Calkins DR, Young RT, et al. Improving patient functional status: can questionnaires help?Clin Res 1986;34: 835A.Google Scholar
  118. 118.
    Rubenstein LV, Calkins DR, Young RT, et al. Improving patient function: a randomized trial of functional disability screening.Ann Intern Med 1989;111: 836–842.Google Scholar
  119. 119.
    Kazis LE, Callahan LF, Meenan RF, Pincus T. Health status reports in the care of patients with rhematoid arthritis.J Clin Epid 190;43: 1243–1253.Google Scholar
  120. 120.
    Krumholz HM, McHorney CA, Clark L,et al. Changes in health-related quality of life after elective percutaneous coronary revascularization. Manuscript under review.Google Scholar
  121. 121.
    Parkerson GR. February 16, 1995. [Personal communication]Google Scholar
  122. 122.
    Cronbach LJ.Essentials of Psychological Testing. New York: Harper and Brothers, 1949.Google Scholar
  123. 123.
    Flanagan JC. Units, scores, and norms. In: Fuchs VR, ed.Essays in the Economics of Health and Medical Care. New York: National Bureau of Economic Research, 1972: 695–763.Google Scholar
  124. 124.
    Applegate WB. Use of assessment instruments in clinical settings.JAGS 1987;35: 45–50.Google Scholar
  125. 125.
    Hays RD, Sherbourne CD, Mazel RM. The RAND 36-Item Health Survey 1.0.Health Economics 1993;2: 217–227.Google Scholar
  126. 126.
    Bozzete SA, Hays RD, Berry SH, Kanouse DE. A perceived health index for use in persons with advanced HIV disease: derivation, reliability, and validity.Med Care 1994;32: 716–731.Google Scholar
  127. 27.
    Ware JE, Kosinski M, Bayliss MS,et al. Comparisons of methods for the scoring and statistical analysis of the SF-36 health profile and summary measures: results from the Medical Outcomes Study.Med Care, 1995; in press.Google Scholar
  128. 128.
    Hambleton RK. Principles and selected applications of item response theory. In: Linn LR, ed.Educational Measurement (3rd edn). New York: Macmillan, 1989: 147–200.Google Scholar
  129. 129.
    McHorney CA, Haley SM, Ware JE. Evaluation of the MOS SF-36 physical functioning scale (PF-10). II. Comparison of relative precision using Likert and Rasch scoring methods. Under review.Google Scholar
  130. 130.
    Haley SM, McHorney CA, Ware JE. Evaluation of the MOS SF-36 physical functioning scale (PF-10). I. Unidimensionality and reproducibility of the Rasch Item Scale.J Clin Epidem 1994;47: 671–684.Google Scholar
  131. 131.
    Rector TS, Kubo SH, Cohn JN. Patients' self-assessment of their congestive heart failure. Part 2: Content, reliability and validity of a new measure. The Minnesota Living with Heart Failure Questionnaire.Heart Failure 1987;47: 198–209.Google Scholar
  132. 132.
    Tugwell P, Bombardier C, Buchanan WW, et al. The MACTAR Patient Preference Disability Questionnaire—An individualized functional priority approach for assessing improvement in physical disability in clinical trials in rheumatoid arthritis.J Rheum 1987;14: 446–451.Google Scholar
  133. 133.
    Mitchell A, Guyatt G, Singer J. Quality of life in patients with inflammatory bowel disease.J Clin Gastroenterol 1988;10: 306–310.Google Scholar
  134. 134.
    Bunderson CV, Inouye DK, Olsen JB. The four generations of computerized educational measurement. In: Linn LR, ed.Educational Measurement (3rd edition). New York: Macmillan, 1989: 367–407.Google Scholar
  135. 135.
    Koran LM. The reliability of clinical methods, data and judgements (first of two parts).NEJM 1975;293(13): 642–646.Google Scholar
  136. 136.
    Koran LM. The reliability of clinical methods, data and judgements (second of two parts).NEJM 1975;293(14): 695–701.Google Scholar
  137. 137.
    Helmstadter GC.Principles of Psychological Measurement. New York: Appleton-Century-Crofts, 1964.Google Scholar
  138. 138.
    Sox HC, Blatt MA, Higgins MC, Marton KI.Medical Decision Making. Boston: Butterworths, 1988.Google Scholar
  139. 139.
    Panzer RJ, Black ER, Griner PF.Diagnostic Strategies for Common Medical Problems. Philadelphia: American College of Physicians, 1991.Google Scholar
  140. 140.
    Hubbell AF, Waitzkin H, Rodriguez FI. Functional status and financial barriers to care among the poor.Southern Med J 1990;83: 548–550.Google Scholar
  141. 141.
    Hunt SM, McKenna SP, Williams J. Reliability of a population tool for measuring perceived health problems: a study of patients with osteoarthritis.J Epid Commun Health 1981;35: 297–300.Google Scholar

Copyright information

© Rapid Science Publishers 1995

Authors and Affiliations

  • C. A. McHorney
    • 1
    • 2
  • A. R. Tarlov
    • 3
  1. 1.Departments of Preventive Medicine and MedicineUniversity of Wisconsin-Madison Medical SchoolMadison
  2. 2.Health Services Research and Development ProgramWilliam S. Middleton Memorial Veterans HospitalMadison
  3. 3.The Health Institute of the New England Medical CenterThe Harvard School of Public Health and Tufts UniversityBoston

Personalised recommendations