Essentials of Outcome Assessment (Essentials of Mental Health Practice)

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The results from outcome measures may also be grouped for aggregated analysis focused on determining quality of care. When outcome measures are used in an aggregated data situation to compare results, a risk adjustment process is required to fairly compare results. Self-report measures are typically captured in the form of a questionnaire. The questionnaires are scored by applying a predetermined point system to the patient's responses. Although self-report measures seem subjective in nature, self-report measures objectify a patient's perception.


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Historically, the questionnaires required that either a therapist interviewed the patient or the patient independently completed the questionnaire. Self-report outcome measures that use paper and pencil for completion are considered a fixed-form questionnaire. Computer based or electronic self-report measures are available. Electronic measures may be fixed-form or adaptive. Computerized adaptive testing is a method of testing that determines the questions for a response based on the patient's previous responses. Performance-based measures require the patient to perform a set of movements or tasks.

Scores for performance-based measures can be based on either an objective measurement e. Performance-based measures and patient reported measures both capture a current status. These measures do not typically equate with each other.

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Performance-based measures tend to bring to light physiologic factors. Observer-reported measures are measurements completed by a parent, caregiver or someone who regularly observes the patient on a daily basis. Clinician-reported measures are measurements that are completed by a health care professional.

The professional uses clinical judgement and reports on patient behaviors or signs that are observed by the professional. Important features of an outcome measure that need to be taken into account when using an outcome measure are its psychometric properties.

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Psychometric properties are the intrinsic properties of an outcome measure. Ideally, the psychometric properties of an outcome measure used in practice should have been developed and tested through a series of research studies.

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These properties include validity, inter-rater reliability, intra-rater reliability, responsiveness, ceiling effects, floor effects and minimal clinically important difference. Validity refers to the how accurately the test actually measures what it is supposed to measure. High validity means the measure is consistently stable in its ability to measure its intended focus. Inter-rater reliability takes into consideration the consistency of the results of the measure when two different people are evaluating the results of a common subject.

With performance-based measures, if two physiotherapists scored the performance, high inter-rater reliability would mean that both determined similar scores on the performance evaluated. For patient reported outcome measures, a high intra-rater reliability indicates that the patient consistently responds to attain the same results. This would be more relevant with serial testing and no intervention or change in status.

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Intra-rater reliability falls under test-retest reliability. Responsiveness refers to the ability for the measure to be able to capture change in status. Ceiling effect occurs when the majority of patients are able to complete the measure and score within the highest range of the measurement. The test is too easy and is not capturing their full capability. Floor effect occurs when the majority of the patients score within the lowest range of the measurement. The test is too hard and does not have enough easier items to distinguish varying levels of status.

Linder JC: Outcome measurement: Compliance tool or strategic initiative?

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Outcome Measures

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Psychological Assessment ; — Cronbach, LJ: Coefficient alpha and the internal structure of tests. Psychometrica ; —

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