Skip to main content
SpringerLink
Log in

Subjective outcome measurement_a primer

  • Published:
Pharmacy World and Science Aims and scope Submit manuscript

Abstract

There is a growing recognition within both the practice and research communities in pharmacy that serious attention must be given to the systematic study of the outcomes of pharmacy services, especially those outcomes that are focused on the patient. Research has tended to focus too strongly on the measurement of structure and process, with the unspoken assumption that if these are of good quality, the outcome will automatically be similar. However, the literature on outcome measurement instruments is vast and practitioners moving into this area for the first time may find themselves lost in a morass of conflicting definitions and different methods of measurement. This review considers the outcome measures or 'measurement instruments' that are used to assess subjective health status. Two commonly used taxonomies are described that concern the conceptual content (functional status, general health perceptions, quality of life and health‐related quality of life) and the breadth of coverage of the instruments (generic, disease specific, domain or dimensions specific and patient‐centred instruments). Specific attention is paid to the newest of these groups, the patient‐centred instruments, which are very different in style and content to the other three and reflect a change in direction in instrument development, to address limitations of commonly used 'fixed' outcome instruments. Detail is given on what makes a quality instrument in particular circumstances (validity, reliability, sensitivity to change, multidimensional construct, practicality and applicability), to help pharmacists develop the necessary skills to select appropriate instruments in the burgeoning field of outcomes measurement.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Donabedian A. Evaluating the quality of medical care. Milbank Q 1966;44:166-203.

    Google Scholar 

  2. Donabedian A. The quality of care. How can it be assessed? JAMA 1988;260:1743-8.

    Google Scholar 

  3. Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm 1990;47:533-43.

    Google Scholar 

  4. Federation Internationale Pharmaceutique. Good Pharmacy Practice in Community and Hospital Pharmacy Settings Tokyo: Federation Internationale Pharmaceutique, 1993.

    Google Scholar 

  5. Van Mil FWF, Hepler CD. Primary Pharmaceutical Care. In: Hepler CD, ed. Primary Pharmaceutical Care and Self Care. Proceedings of the section of community pharmacists. Stockholm: International Pharmaceutical Federation, 1995;23-37.

    Google Scholar 

  6. Tully MP, Hassell K, Noyce PR. Advice-giving in Community Pharmacies in the United Kingdom. Journal of Health Service Research and Policy 1997;2:38-50.

    Google Scholar 

  7. Evans SW, John DN, Bloor M, Luscombe DK. Utilisation of the advice offered by community pharmacists to clients presenting with symptoms. Pharm J 1995;255:R29.

    Google Scholar 

  8. Ghalamkari HH, Rees JE, Saltrese-Taylor A. Clients' responses to health promotion advice given by community pharmacists. Pharm J 1995;255:R19.

    Google Scholar 

  9. Holdford DA, Smith S. Improving the quality of outcomes research involving pharmaceutical services. Am J Health-Syst Pharm 1997;54:1434-42.

    Google Scholar 

  10. Hanlon JT, Weinberger M, Samsa GP, et al. A randomized, controlled trial of a clinical pharmacist intervention to improve inappropriate prescribing in elderly outpatients with polypharmacy. Amer J Med 1997;100:428-37.

    Google Scholar 

  11. Kennie NR, Schuster BG, Einarson TR. Critical analysis of the pharmaceutical care research literature. Ann Pharmacother 1998;32:17-26.

    Google Scholar 

  12. Kozma CM, Reeder CE, Schulz RM. Economic, clinical, and humanistic outcomes: a planning model for pharmacoeconomic research. Clin Ther 1993;15:1121-32.

    Google Scholar 

  13. Kirshner B, Guyatt G. A methodological framework for assessing health indices. J Chronic Dis 1985;38:27-36.

    Google Scholar 

  14. Brooks RG. Health status measurement: a perspective on change. London: Macmillan, 1995.

    Google Scholar 

  15. Bowling A. Measuring Disease. Buckingham: Open University Press, 1995.

    Google Scholar 

  16. World Health Organisation. Official Records of the World Health Organisation. vol. 2. Geneva: WHO, 1948.

    Google Scholar 

  17. McDowell I, Newell C. Measuring health: a guide to rating scales and questionnaires. New York: Oxford University Press, 1987.

    Google Scholar 

  18. Fitzpatrick R. A pragmatic defence of health status measures. Health Care Analysis 1996;4:192.1-192.8.

    Google Scholar 

  19. Albrecht GL, Fitzpatrick R. A sociological perspective on health-related quality of life research. Adv Med Sociol 1994;5:1-21.

    Google Scholar 

  20. Fitzpatrick R, Fletcher A, Gore S, et al. Quality of life measures in health care. I: Applications and issues in assessment. BMJ 1992;305:1074-7.

    Google Scholar 

  21. O'Boyle CA, McGee H, Hickey A, et al. Individual quality of life in patients undergoing hip replacement. Lancet 1992;339:1088-91.

    Google Scholar 

  22. Leplège A, Hunt S. The problem of quality of life in medicine. JAMA 1997;278:47-50.

    Google Scholar 

  23. Wilson IB, Cleary PD. Linking clinical variables with healthrelated quality of life. JAMA 1995;273:59-65.

    Google Scholar 

  24. Mahoney FI, Barthel DW. Functional evaluation: the Barthel Index. Maryland State Medical Journal 1965;14:61-65.

    Google Scholar 

  25. Meenan RF. The AIMS approach to health status measurement: conceptual background and measurement properties. J Rheumatol 1982;9:785-8.

    Google Scholar 

  26. Fries J, Spitz P, Young D. The dimensions of health outcomes: the Health Assessment Questionnaire disability and pain scales. J Rheumatol 1982;9:789-93.

    Google Scholar 

  27. Applegate WB, Blass JP, Williams TF. Instruments for the functional assessment of older patients. N Engl J Med 1990;322:1207-14.

    Google Scholar 

  28. Symmons D. Measuring outcome in rheumatoid arthritis – which measures are suitable for routine clinical use? Br J Rheumatol 1995;34:802-4.

    Google Scholar 

  29. Ziebland S, Fitzpatrick R, Jenkinson C. Tacit models of disability underlying health status instruments. Soc Sci Med 1993;37:69-75.

    Google Scholar 

  30. Ziebland S. Measuring changes in health status. In: Jenkinson C, ed. Measuring health and medical outcomes. London: UCL Press, 1994:42-53.

    Google Scholar 

  31. Davies AR. Patient defined outcomes. Qual Health Care 1994;3Suppl:S6-9.

    Google Scholar 

  32. Cleary PD, Wilson IB, Fowler FJ. A theoretical framework for assessing and analyzing health-related quality of life. Adv Med Sociol 1994;5:23-41.

    Google Scholar 

  33. Rowan K. Global questions and scores. In: Jenkinson C, ed. Measuring health and medical outcomes. London: UCL Press, 1994:54-76.

    Google Scholar 

  34. Idler EL, Kasl S. Health perceptions and survival: do global evaluations of health status really predict mortality? J Gerontol 1991;46:S55-S65.

    Google Scholar 

  35. Farquhar M. Elderly people's definitions of quality of life. Soc Sci Med 1995;41:1439-46.

    Google Scholar 

  36. Hopkins A. How might measures of quality of life be useful to me as a clinician? In: Hopkins A, ed. Measures of the quality of life and the uses to which such measures may be put. London: Royal College of Physicians of London, 1992:1-13.

    Google Scholar 

  37. Tennant A. Quality of life – a measure too far? Ann Rheum Dis 1995;54:439-40.

    Google Scholar 

  38. Ware JE. SF-36 Health Survey. Manual and interpretation guide. Boston: The Health Institute, 1993.

    Google Scholar 

  39. Bergner M, Bobbitt RA, Dressel S, et al. The sickness impact profile: conceptual formulation and methodology for the development of a health status measure. Int J Health Serv 1976;6:393-15.

    Google Scholar 

  40. Fletcher A, Gore S, Jones D, et al. Quality of life measures in health care. II: Design, analysis, and interpretation. BMJ 1992;305:1145-8.

    Google Scholar 

  41. Guyatt GH, Bombardier C, Tugwell PX. Measuring disease-specific quality of life in clinical trials. Can Med Assoc J 1986;134:889-95.

    Google Scholar 

  42. Fitzpatrick R, Ziebland S, Jenkinson C, et al. A comparison of the sensitivity to change of several health status instruments in rheumatoid arthritis. J Rheumatol 1993;20:429-36.

    Google Scholar 

  43. Guyatt GH, Walter S, Norman G. Measuring change over time: assessing the usefulness of evaluative instruments. J Chronic Dis 1987;40:171-8.

    Google Scholar 

  44. Fries JF, Spitz P, Kraines RG, Holman HR. Measurement of patient outcome in arthritis. Arthritis Rheum 1980;23:137-45.

    Google Scholar 

  45. Tugwell P, Bombardier C, Buchanan WW, et al. Methotrexate in rheumatoid arthritis. Impact on quality of life assessed by traditional standard-item and individualized patient preference health status questionnaires. Arch Intern Med 1990;150:59-62.

    Google Scholar 

  46. Guyatt GH, Naylor CD, Juniper E, et al. Users' guides to the medical literature. XII. How to use articles about healthrelated quality of life. JAMA 1997;277:1232-7.

    Google Scholar 

  47. Bowling A. Measuring Health. A review of quality of life measurement scales. Milton Keynes: Open University Press, 1991.

    Google Scholar 

  48. Wilkin D, Hallam L, Doggett M-A. Measures of need and outcome for primary health care. revised ed. Oxford: Oxford University Press, 1993.

    Google Scholar 

  49. Lawton MP. The Philadelphia Geriatric Center Morale Scale: a revision. J Gerontol 1975;30:85-90.

    Google Scholar 

  50. Melzack R. The McGill Pain Questionnaire: major properties and scoring methods. Pain 1975;1:277-99.

    Google Scholar 

  51. Streiner DL, Norman GR. Health Measurement Scales. A practical guide to their development and use. 2nd ed. Oxford: Oxford Medical Publications, 1995.

    Google Scholar 

  52. Gill TM, Feinstein AR. A critical appraisal of the quality of quality of life measurements. JAMA 1994;272:619-26.

    Google Scholar 

  53. Tugwell P. Bombardier C, Buchanan WW, et al. The MACTAR patient preference disability questionnaire – an individualized priority approach for assessing improvement in physical disability in clinical trials in rheumatoid arthritis. J Rheumatol 1987;14:446-51.

    Google Scholar 

  54. Tugwell P, Bombardier C, Buchanan WW, et al. The ability of the MACTAR disability questionnaire to detect sensitivity to change in rheumatoid arthritis (abstract). Clin Res 1983;31:239A.

    Google Scholar 

  55. Tugwell P, Bombardier C, Bell M, et al. Current quality-of-life research challenges in arthritis relevant to the issue of clinical significance. Control Clin Trials 1991;12:217S-225S.

    Google Scholar 

  56. Peloso PM, Ibanez D, Bombardier C. Quality of life in RA: disease specific or generic instruments? Arthritis Rheum 1994;37:S225.

    Google Scholar 

  57. Buchbinder R, Bombardier C, Yeung M, Tugwell P. Which outcome measures should be used in rheumatoid arthritis clinical trials? Clinical and quality-of-life measures' responsiveness to treatment in a randomized controlled trial. Arthritis Rheum 1995;38:1568-80.

    Google Scholar 

  58. Juniper EF, Guyatt GH, Epstein RS, et al. Evaluation of impairment of health related quality of life in asthma: development of a questionnaire for use in clinical trials. Thorax 1992;47:76-83.

    Google Scholar 

  59. Guyatt GH, Berman LB, Townsend M, et al. A measure of quality of life for clinical trials in chronic lung disease. Thorax 1987;42:773-8.

    Google Scholar 

  60. Juniper EF, Guyatt GH. Development and testing of a new measure of health status for clinical trials in rhinoconjunctivitis. Clin Exp Allergy 1991;21:77-83.

    Google Scholar 

  61. Guyatt GH, Eagle DJ, Sackett B, et al. Measuring quality of life in the frail elderly. J Clin Epidemiol 1993;46:1433-44.

    Google Scholar 

  62. McGee HM, O'Boyle CA, Hickey A, et al. Assessing the quality of life of the individual: the SEIQoL with a healthy and a gastroenterology unit population. Psychol Med 1991;21:749-59.

    Google Scholar 

  63. Ruta DA, Garratt AM. Health status to quality of life measurement. In: Jenkinson C, ed. Measuring health and medical outcome. London: UCL Press, 1994:138-59.

    Google Scholar 

  64. Browne JP, O'Boyle CA, McGee HM, et al. Individual quality of life in the healthy elderly. Qual Life Res 1994;3:235-44.

    Google Scholar 

  65. Browne JP, O'Boyle CA, McGee HM, et al. Development of a direct weighting procedure for quality of life domains. Qual Life Res 1997;6:301-9.

    Google Scholar 

  66. Hickey AM, Bury G, O'Boyle CA, et al. A new short form individual quality of life measure (SEIQoL-DW): application in a cohort of individuals with HIV/AIDS. BMJ 1996;313:29-33.

    Google Scholar 

  67. Ruta DA, Garratt AM, Leng M, et al. A new approach to the measurement of quality of life. The patient generated index. Med Care 1994;32:1109-26.

    Google Scholar 

  68. Guyatt GH, Townsend M, Pugsley SO, et al. Bronchodilators in chronic air-flow limitation. Effects on airway function, exercise capacity and quality of life. Am Rev Respir Dis 1987;135:1069-74.

    Google Scholar 

  69. Hoinville G. The priority evaluator method. Methodological Working Paper 3. London: Department of Social and Community Planning and Research, London University, 1977.

    Google Scholar 

  70. Herd RM, Tidman MJ, Ruta DA, Hunter JAA. Measurement of quality of life in atopic dermatitis: correlation and validation of two different methods. Br J Dermatol 1997;136:502-7.

    Google Scholar 

  71. Tully MP. Developing outcome measures: the validity and reliability of the modified patient generated index [Thesis]. University of Manchester, 1997.

  72. McDowell I, Jenkinson C. Development standards for health measures. J Health Serv Res Policy 1996;1:238-46.

    Google Scholar 

  73. Jenkinson C. Evaluating the efficacy of medical treatment: possibilities and limitations. Soc Sci Med 1995;41:1396-1401.

    Google Scholar 

  74. Thorndike RL. Applied Psychometrics. Boston: Houghton Mifflin Company, 1982.

    Google Scholar 

  75. Kazis LE, Anderson JJ, Meenan RF. Effect sizes for interpreting changes in health status. Med Care 1989;27Suppl:S178-S189.

    Google Scholar 

  76. Jaeschke R, Singer J, Guyatt GH. Measurement of health status. Ascertaining the minimal clinically important difference. Control Clin Trials 1989;10:407-11.

    Google Scholar 

  77. McHorney CA, Tarlov AR. Individual-patient monitoring in clinical practice: are available health status surveys adequate? Qual Life Res 1995;4:293-307.

    Google Scholar 

  78. Nelson EC, Landgraf JM, Hays RD, et al. The COOP function charts: a system to measure patient function in physicians' offices. In: Lipkin M. ed. Functional status measurement in primary care. New York: Springer-Verlag, 1990:97-131.

    Google Scholar 

  79. Guyatt GH, Feeny DH, Patrick DL. Measuring health-related quality of life. Ann Intern Med 1993;118:622-9.

    Google Scholar 

  80. Slevin ML, Plant H, Lynch D, et al. Who should measure quality of life, the doctor or the patient? Br J Cancer 1988;57:109-12.

    Google Scholar 

  81. Rothwell PM, McDowell Z, Wong CK, Dorman PJ. Doctors and patients don't agree: cross sectional study of patients' and doctors' perceptions and assessments of disability in multiple sclerosis. BMJ 1997;314:1580-3.

    Google Scholar 

  82. Epstein AM, Hall JA, Tognettie J, et al. Using proxies to evaluate quality of life. Can they provide valid information about patients' health status and satisfaction with medical care? Med Care 1989;27:S91-8.

    Google Scholar 

  83. Gurel L, Linn MW, Linn BS. Physical and mental impairment-of-function evaluation in the aged: the PAMIE Scale. J Gerontol 1972;27:83-90.

    Google Scholar 

  84. Hill S, Harries U. The outcomes process: some reflections from research with people in their 60s and 70s. Crit Pub Health 1993;4:21-8.

    Google Scholar 

  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;28:1111-26.

    Google Scholar 

  86. MacKeigan ID, Pathak DS. Overview of health-related quality-of-life measures. Am J Hosp Pharm 1992;49:2236-45.

    Google Scholar 

  87. Street RL, Gold WR, McDowell T. Using health status surveys in medical consultations. Med Care 1994;32:732-44.

    Google Scholar 

  88. Calman KC. Quality of life in cancer patients – a hypothesis. J Med Ethics 1984;10:124-7.

    Google Scholar 

  89. WHOQOL group. Study protocol for the World Health Organisation project to develop a quality of life assessment instrument. Quality Life Research 2. Geneva: World Health Organisation, 1993.

    Google Scholar 

  90. Engström B, Nordeson A. What neurological patients regard as quality of life. J Clin Nurs 1995;4:177-83.

    Google Scholar 

  91. Fletcher A. Quality-of-life measurements in the evaluation of treatment: proposed guidelines. Brit J Clin Pharmacol 1995;39:217-22.

    Google Scholar 

Download references

Authors
  1. Mary Patricia Tully
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Judith A. Cantrill
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tully, M.P., Cantrill, J.A. Subjective outcome measurement_a primer. Pharm World Sci 21, 101–109 (1999). https://doi.org/10.1023/A:1008694522700

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1008694522700

Search

Navigation