Home  Publications 20 Years Special Edition Looking Backward, Looking Forward |
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Looking Backward, Looking Forward |
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Page 3 of 5
The role of survey item banks sampled to represent the content of widely-used health surveys and crosscalibrating them in relation to a common underlying “ruler” for measuring their common health domains was forecast in the PRO Newsletter, as was the more efficient administration and scoring of those survey items using computerized adaptive testing (CAT). The PRO
Newsletter published articles about item banking and CAT as early as 19997 and devoted a special issue to this topic in 2004.8 However, the PRO field still is marked by a plethora of instruments that measure the same domains with similar items but different metrics, which makes comparison of data across research studies and the interpretation of study results for the clinical community all the more problematic. While every domain may end up with a CAT, an equally important issue is that of deciding which domains are worth measuring and for what purposes. There are many generic domains and subdomains and dozens of disease-specific symptoms and other concepts that may help to understand disease burden and treatment benefits. More attention should be focused on the structure of all of these domains and how they should be sampled for different populations, as well as their clinical, economic and social consequences. What is the comprehensive conceptual framework that can guide health measurement in the future? With the CAT measurement wave, we seem to have forgotten about the conceptualization of health and how to decide what to measure.
Regardless of how often CAT proves to be better than the electronic administration of “static” (pre-selected) survey items
(particularly those static forms that are based on the same IRT models that make CAT possible), IRT models are likely to
play a strategic role in the evaluation of the equivalence of language translations, as demonstrated during the IQOLA Project.9 Today, some health metrics have been translated well enough to enable their use in multinational clinical trials and population health surveys. At least as important going forward are comparisons of the effectiveness of different health policies for organizing and financing health care and the effectiveness of different treatment approaches within and between
countries, in terms of the health outcomes that matter most to patients.
A third development will be changes in technology. As evidenced by Google’s recent premium-priced offer to acquire Motorola Mobility, it seems likely that much of what we do with computers will be done with handhelds that serve many other purposes in addition to communications. Although we cannot guess what technology will be available in 20 years, any more than we could have envisioned today’s wireless world in 1991, the world of 2031 no doubt will be faster and smarter. The challenge for the PRO field will be to incorporate new technology into routine use, which is only being done on a limited basis today.
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