Quality of Life Research

, Volume 27, Issue 8, pp 2195–2206 | Cite as

A new algorithm to build bridges between two patient-reported health outcome instruments: the MOS SF-36® and the VR-12 Health Survey

  • Alfredo Selim
  • William Rogers
  • Shirley Qian
  • James A. Rothendler
  • Erin E. Kent
  • Lewis E. KazisEmail author



To develop bridging algorithms to score the Veterans Rand-12 (VR-12) scales for comparability to those of the SF-36® for facilitating multi-cohort studies using data from the National Cancer Institute Surveillance, Epidemiology, and End Results Program (SEER) linked to Medicare Health Outcomes Survey (MHOS), and to provide a model for minimizing non-statistical error in pooled analyses stemming from changes to survey instruments over time.


Observational study of MHOS cohorts 1–12 (1998–2011). We modeled 2-year follow-up SF-36 scale scores from cohorts 1–6 based on baseline SF-36 scores, age, and gender, yielding 100 clusters using Classification and Regression Trees. Within each cluster, we averaged follow-up SF-36 scores. Using the same cluster specifications, expected follow-up SF-36 scores, based on cohorts 1–6, were computed for cohorts 7–8 (where the VR-12 was the follow-up survey). We created a new criterion validity measure, termed “extensibility,” calculated from the square root of the mean square difference between expected SF-36 scale averages and observed VR-12 item score from cohorts 7–8, weighted by cluster size. VR-12 items were rescored to minimize this quantity.


Extensibility of rescored VR-12 items and scales was considerably improved from the “simple” scoring method for comparability to the SF-36 scales.


The algorithms are appropriate across a wide range of potential subsamples within the MHOS and provide robust application for future studies that span the SF-36 and VR-12 eras. It is possible that these surveys in a different setting outside the MHOS, especially in younger age groups, could produce somewhat different results.


VR-12 SF-36 Extensibility 


Data availability

Several types of Medicare HOS data files are available for research purposes. Medicare HOS data files are available as public use files (PUFs), limited data sets (LDSs), and research identifiable files (RIFs).

Author contributions

AS participated in the conception and design. WR participated in the analysis and interpretation of data. SQ performed the statistical analysis. JR participated in the conception and design and interpretation of data. EK participated in drafting and revising it critically for important intellectual content. LK participated in the study design and coordination and helped to draft the manuscript. All authors read and approved the final manuscript.


The study was supported by the Outcomes Research Branch/Healthcare Delivery Research Program Division of Cancer Control and Population Sciences, National Cancer Institute Contract # HHSN261201400530P. The views expressed represent those of the authors and not necessarily those of the National Cancer Institute, National Institutes of Health, and Boston University.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interest.

Ethical approval

The Boston University Institutional Review Board (IRB) provided ethical review of this study to protect the rights and welfare of human subjects of research and to assure that human research is conducted according to applicable federal, state, and local laws and regulations, and the relevant policies of the Human Research Protection Program, Boston University.

Supplementary material

11136_2018_1850_MOESM1_ESM.doc (208 kb)
Supplementary material 1 (DOC 208 KB)


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Copyright information

© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2018

Authors and Affiliations

  • Alfredo Selim
    • 1
  • William Rogers
    • 1
  • Shirley Qian
    • 1
  • James A. Rothendler
    • 1
  • Erin E. Kent
    • 2
  • Lewis E. Kazis
    • 3
    Email author
  1. 1.Center for the Assessment of Pharmaceutical Practices (CAPP), Department of Health Law, Policy and ManagementBoston University School of Public HealthBostonUSA
  2. 2.Outcomes Research Branch/Healthcare Delivery Research Program, Division of Cancer Control and Population SciencesNational Cancer InstituteRockvilleUSA
  3. 3.Health Outcomes Unit, Department of Health Law, Policy and Management, Center for the Assessment of Pharmaceutical Practices (CAPP)Boston University School of Public HealthBostonUSA

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