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Why a Global PROMIS® Can't Be Kept.

Jack Dowie1,2, Mette Kjer Kaltoft2

  • 1London School of Hygiene and Tropical Medicine, UK.

Studies in Health Technology and Informatics
|July 27, 2019
PubMed
Summary
This summary is machine-generated.

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Composite health measures like global mental and physical health are formative, not reflective. This preference-insensitivity can mislead clinical and policy decisions, as universal metrics are impossible without group-specific preferences.

Area of Science:

  • Psychometrics
  • Health Outcomes Research
  • Health Policy

Background:

  • Composite multi-dimensional constructs (e.g., global mental health, global physical health) are increasingly used in Patient-Reported Outcomes Measurement Information System (PROMIS) instruments and International Consortium for Health Outcomes Measurement (ICHOM) standard sets.
  • These constructs are often formative, meaning they are built from their indicators, rather than reflective, where indicators are caused by the underlying construct.

Purpose of the Study:

  • To critically evaluate the methodological appropriateness of using formative constructs in health outcome measurement.
  • To highlight the implications of preference-insensitivity in these composite measures for clinical practice and policy-making.
  • To challenge the notion of 'international gold standard metrics' for health outcomes.

Main Methods:

Keywords:
PROMISPatient Reported Outcome Measuresformativepreference-sensitivereflective

Related Experiment Videos

  • Conceptual analysis of measurement theory (formative vs. reflective models).
  • Critique of psychometric validation methods applied to formative constructs.
  • Examination of the role of patient and societal preferences in health outcome assessment.

Main Results:

  • Composite health constructs in PROMIS and ICHOM are formative, not reflective.
  • Preference-insensitivity of these formative constructs can lead to misleading interpretations in clinical and policy contexts.
  • Validation using reflective psychometric tests is methodologically inappropriate for formative measures.

Conclusions:

  • The widespread adoption of these instruments overlooks fundamental measurement issues.
  • The inherent need for group-specific preference bases ('tariffs') precludes the development of universal 'international gold standard metrics'.
  • Greater awareness among patients, clinicians, researchers, and policymakers is crucial regarding the limitations of current composite health measures.