Latest news from JWRG


March 7, 2018

Choosing Patient-Reported Outcomes and Measurement Methods for Team Based Health Care

March 7, 2018 | Integrated Health Care Conference, Arizona State University Doctor of Behavioral Health Program, Scottsdale, AZ In a keynote lecture, Dr. Ware provided an overview of the history of the conceptualization and measurement of patient-reported outcomes (PROs), and noteworthy methodological advances and their implications for going forward.  Applications of item response theory (IRT) methods have improved the quantification of health-related quality of life (QOL) domains and are the basis for more efficient computerized adaptive test (CAT) survey administrations and scoring.  However, a consequence of the development of very homogeneous survey item banks preferred by IRT models is a conceptual shift favoring measures of very specific symptoms (e.g., depression) and activities (e.g., walking) as opposed to broader concepts of mental, physical and social functioning and well-being.  In contrast, an emphasis on summary measures – the “tips of the QOL icebergs” that enable more efficient adaptive approaches – makes it practical to drill down to measure specific limitations in QOL only when are more likely to occur and to adapt automatically to multiple chronic conditions when they are present. This adaptive approach is the most practical and useful way represent PROs in “big data.” Dr. Ware presented examples of published and forthcoming JWRG findings from evaluations of new generic “super” short-form items that improve survey efficiency over legacy tools and use standardized IRT-based metrics to cross-calibrate new and legacy PROs.  New, more valid and responsive disease-specific PROs were also discussed.  The latter QOL Disease Impact Scale (QDIS) measures, which are standardized across diseases and […]
November 29, 2017

Integrating Generic Health Outcomes Monitoring and Depression Screening

April 12, 2018 | 39th Annual Meeting of the Society of Behavioral Medicine, New Orleans, Louisiana In a panel discussion session entitled “PHQ-9: Is it a Good Match for Integrated Primary Care?,” at the annual meeting of the Society of Behavioral Medicine, Dr. Ware will summarize how the adoption of measures used in the routine monitoring of generic physical and mental health outcomes can be used to more efficiently screen and manage patients in greatest need of mental and behavioral health services. The session will be chaired by Jennifer S. Funderburk, PhD from the VA Center for Integrated Healthcare. Other panelists will include Kurt Kroenke, MD, co-developer of the PHQ-9, and Rodger S. Kessler, PhD, an expert researcher on integrated care. The discussion will be led and summarized by William Douglas Tynan, PhD, a leader within the American Psychological Association on integrated health care.
October 21, 2017

Advances in the Measurement of Patient-Reported Outcomes: Implications for Comparative Effectiveness Research

November 5th-8th, 2017 | 2017 NCRI Cancer Conference, Liverpool, UK In a session entitled “Quality of Life – from PROMs to ICERs” at the 2017 NCRI Cancer Conference, Dr. Ware will summarize advances in PRO measurement and their implications for effectiveness research. Understanding has never been greater regarding the: (1) breadth of health concepts that are essential for validity in quantifying patient reported outcomes (PROs); (2) importance of matching operational definitions (e.g., behavioral functioning, subjective ill-being and well-being,personal evaluation) to each health concept; (3) advantages of better single items for both psychometric and utility methods; and (4) implications of standardizing metrics across a wide range of higher and lower levels of health to enable comparisons of results across diverse populations. For example,meaningful comparisons can be made between population norms, average scores for treated and untreated groups, and individual scores for patients with mild to severe conditions, using standardized metrics for a composite (psychometric or utility) score or a profile of outcome scores.Because all surveys begin with the first item, at the core of advances in both generic and disease-specific PRO surveys are significantly better single-item measures that can and should be standardized across psychometric and utility methods. Although the enumeration of these measures differs across the two methods, their concept representation and item content should not. For most respondents and for some measurement purposes (e.g., calculation of composite scores), the best single item can be the only one administered for each health concept. The proven features of such “super items” […]
October 20, 2017

Improving Single-Item Generic Health Survey Measures

October 20, 2017 | 24th Annual Conference of the International Society for Quality of Life Research (ISOQOL), Philadelphia, Pennsylvania Because all surveys begin with the first item, at the core of advances in patient-reported outcome measurement are better single-item measures of the most frequently-measured health domains. For many outcomes monitoring and cost prediction purposes in the future, the shortest health survey forms will administer only the best single item for each domain. Also, because the first item determines what happens next in adaptive surveys, more efficient single-item measurement is crucial. At the 24th Annual ISOQOL Conference, Drs. Ware and Gandek summarized advances in understanding of the content that best represents health domains and the implications of better operational definitions for capturing the essence of each domain, focusing on the Physical Function, Vitality and Mental Health domains. Survey items were self-administered on the Internet to representative samples of U.S. adults (N=2,938), ages 18-94. Results for new General Quality of Life (QGEN®) 10-item form items were compared with SF-36 and PROMIS-29 items for the same domains and in terms of how well they predicted SF-36 physical and mental component summary measures, to identify the reasons for superior item performance. Multiple psychometric criteria and tests of convergent and discriminant validity were reported. They reported that the best single-item measures were not found within the Medical Outcomes Study SF-36 or PROMIS-29 multiple-item scales or global items from those projects. Significant improvements in QGEN single-item performance, in comparison with SF-36 and PROMIS-29 for the same […]
September 13, 2017

Measurement, Design, andAnalysis Methods for Health Outcomes Research Course: Ware Lecture and Workshop

September 25th-27th, 2017 | Harvard School of Public Health,Boston, MA Dr. Ware will present his annual lecture entitled “New Techniques for Health Outcomes Measurement and Evaluation” at the Measurement, Design, and Analysis Methods for Health Outcomes Research course held from September 25-27 at the Harvard School of Public Health. The lecture will cover the 40-year evolution of survey content and noteworthy milestones in the history of patient-reported outcomes (PROs) as well as some of the most innovative and important recent conceptual and methodological advances.  The latter include new features of items shown to improve their performance over legacy items, standardized underlying metrics for the domains common to most legacy generic PROs, and a new generation of standardized disease-specific PROs that fill the gap between disease-specific symptoms that are not QOL and generic QOL measures that are not disease-specific.  In the afternoon workshop, entitled “The How and Why of Integrating Disease-Specific and Generic Patient-Reported Outcome Measures (PROMS)”, Dr. Ware will discuss the use of QOL impact attributions to specific diseases to improve the validity and responsiveness of disease-specific measures, how improved measures can be integrated and compared in a profile that can be standardized across diseases, and the first norm-based scoring for disease-specific measures for the chronically-ill population.  Case studies from early adoptions of these advances in academic medical center applications and clinical trials will be discussed. 
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