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![1 Equality and Equity. The left image shows equal supports for all three people, but the function is not the same. The right image shows different supports that allow all three people to watch the game. Equity might also be systemically incorporated by making the fence transparent at all levels. (Image: [2])](publication/365947424/figure/fig1/AS:11431281104255902@1669987018036/Equality-and-Equity-The-left-image-shows-equal-supports-for-all-three-people-but-the.png)
1 Equality and Equity. The left image shows equal supports for all three people, but the function is not the same. The right image shows different supports that allow all three people to watch the game. Equity might also be systemically incorporated by making the fence transparent at all levels. (Image: [2])
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Measurement choices play a critical role in improving healthcare systems. As this book describes, improved measurement can promote excellence in person-centered outcomes through health policy, methodology, theory, and clinical practice. This chapter focuses on measurement choices within clinical practice that can guide decision-making for improved...
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... The person separation is likely affected by the circumstances of the sample, where the length of the test is moderate, the sample ability is moderate, and the categories per item are restricted. These results conform with the pragmatic focus on the role of theory in motivating item composition and in evaluating empirical results advocated by Wright and Stone (1979) and adopted by others (Allen & Pak, 2023;Massof & Bradley, 2023). ...
... 2) Establishing metrological standards is essential for maximizing the value of the widespread use of a PROM. COSMIN standards for the validity of measurements include criteria that can be met only if the PROM has been developed using additive conjoint measurement modeling and so demonstrates validity in a wider context than that available using ordinal measurement methods (Churruca et al., 2021;Derriennic et al., 2019;Hobart et al., 2007Hobart et al., , 2010Prinsen et al., 2018;Snyder & Brundage, 2010;Fisher, 2023;Allen & Pak, 2023;Massof & Bradley, 2023). This is a desirable long-term strategy that needs to be endorsed by all stakeholders. ...
... There is a need for standardized assessments of the psychometric properties and validities of PROMs so that information provided is sensitive, relevant, and specific to various contexts. Provisionally resolving the tensions between standardization and personalization (Fisher, 2023;Allen & Pak, 2023;Massof & Bradley, 2023;Lipscomb et al., 2007;Mallinson, 2024) via meaningful scaling and individualized reporting is essential for generalized improvements in deciding the superiority or inferiority of surgical approaches or policies (Massof & Bradley, 2023). 2) There is a need to improve the comparability of PRO measurements and data across different healthcare settings, countries, and cultures, which poses challenging but not intractable problems (Lipscomb et al., 2007;Mallinson, 2024). ...
... Investment is required when establishing platforms for data collection and optimizing the flow and analysis of the data but may pay remarkable returns when systems are well-designed (Snyder & Brundage, 2010). 4) Data needs to be presented in forms usable to all the stakeholders at all levels (Snyder & Brundage, 2010) with clear information on what, if anything, small changes to the scores actually mean clinically (Fisher, 2023;Allen & Pak, 2023); anything less can risk leading to clinician disengagement (Bitton et al., 2014). Measurements should provide information on quality indicators; PROM data has been used to this effect in the UK in national audits covering the index orthopedic procedures (Williams et al., 2016). ...
... For instance, it may happen that experiments provisionally omitting observations associated with mean square fit statistics exceeding a desired limit result in no change outside the bounds of the estimated uncertainty to either the estimated ability measurements or the item difficulties. Given the lack of a difference that makes a difference, the anomalous observations should be retained and fed back end users, since the unexpected responses may convey information valuable in the formulation of interventions, treatments, or decisions (Allen & Pak, 2023;Bohlig et al., 1998;Massof & Bradley, 2023;Wilson & Gochyyev, 2020). When considering the big picture, as shown in the Wright map in Figure 3.2, while the LLMs are relatively more like each other than prompts are, there are significant differences between them. ...
... -Physical measurements of length and distance, mass, and density expressed in SI units have been reproduced from ordinal observations via the application of probabilistic conjoint measurement models (Choi, 1998;Moulton, 1993;Pelton & Bunderson, 2003;Stephanou & Fisher, 2013). -The reproducibility of patterns of concrete observations from abstract measurements and formal theory is never perfect, of course, so data displays revealing failures of invariance pertinent to end user interests in improved outcomes are of value in bringing out qualitative exceptions to the rule (Allen & Pak, 2023;Chien et al., 2011Chien et al., , 2018Fisher, Oon, & Benson, 2021;Wright & Stone, 1979;Wright et al., 1980). -Substantive integrations of qualitative and quantitative data and methods in formative assessments delineate learning progressions and map variation to locate individuals or groups relative to where they have been, where they want to go, and what to do next (Black et al., 2011;Duckor & Holmberg, 2019;Morell et al., 2017). ...
... Over the course of those years, the inferential advantages and meaningful comparability provided by this logic and these methods (Andrich, 2010;Embretson, 1996;Rasch, 1977;Narens & Luce, 1986;Wilson, 2005Wilson, , 2013bWright, 1977Wright, , 1997Wright & Masters, 1982;Wright & Stone, 1979) led to their adoption across wide ranges of research and practice (Alagumalai et al., 2005) involving everything from educational (Confrey et al., 2021;Connolly et al., 1971Connolly et al., /2007Green, 1986;Masters & Keeves, 1999;Wilson, 2018;Wright, 1977Wright, , 1997, psychological (Commons et al., 2014;Dawson, 2004;K. Fischer & Dawson, 2002), and health care outcomes (Allen & Pak, 2023;Belvedere & de Morton 2010;Bezruczko, 2005;Cano et al., 2009;Christensen et al., 2013;A. Fisher, 1997;Massof & Bradley, 2023) to clinical chemistry (Fisher & Burton, 2010), climate-neutral environmental policies (Fisher, Melin, & Möller, 2021), human resources (Barney & Fisher, 2016), sociology (Duncan, 1984a/b/c), and the psychophysics of vision (Brown et al., 2014;Karakus et al., 2018;Massof et al., 2024;Powers & Fisher, 2021), and to measurements of the outcomes of spiritual care (Snowden et al., 2022;Pugliese et al., 1993) and mindfulness practices (Medvedev et al., 2016;Solloway & Fisher, 2007). ...
... Metrology contributes to the struggles of decolonization and liberation by facilitating entry into the global technical culture and by doing so in ways that are rooted in each distinctive culture's past (Allen & Pak, 2023;Mallinson, 2024;Massof & Bradley, 2023;Sul, 2024). Postmodern deconstructions of modern metaphysics have led to unmodern conceptions of intensely personalized custom-tailored measurements reconciled with technological universals. ...
... People-centered practice that considers all aspects of a person's life, and not only their role as a client, has emerged as a critical principle underlying best practice in health care [3]. People-centered outcome metrics aim to measure what matters to the person both within and outside of the clinical setting, which is key for improving quality of care as well as for setting health system policy priorities [4]. ...
... The groups of respondents in the study were program staff, providers, PLHIV advocates, [3] and PLHIV. Program staff consisted of the health facility directors, the provincial HIV manager, and senior ECHO program staff, all of whom may potentially use the indicator data to inform how they structure and manage HIV programs and supervise providers. ...
Achieving the global HIV/AIDS 95-95-95 targets requires monitoring clinical outcomes as well as the experience of people living with HIV (PLHIV). A qualitative exploratory study was conducted with program staff, providers, PLHIV and PLHIV advocates at two government HIV clinics in Tete Province, Mozambique. The purpose was to explore how newly developed, people-centered outcome metrics for HIV could be used in monitoring and improving the management and provision of care. Focus group discussions and 40 semi-structured interviews explored respondents’ perceptions of the acceptability, feasibility, integrability and relevance of the indicators. Respondents noted the importance of issues raised by these indicators—such as physical symptoms, mental and emotional problems, discrimination, lack of family support, financial burden, and satisfaction with HIV services—for improving the patient experience and health outcomes. PLHIV generally said they would share information on these issues with their clinician if asked, especially if it would help improve their care. Program staff and providers shared ideas about how they might use data on these issues to improve delivery of care, though they recognized that the capacity of program staff and existing clinic systems to address the broad range of individual and social issues recorded by these metrics was a major challenge. Results of this study point to the importance of continuing to pursue efforts to examine how integration of one or more of the people-centered metrics in routine HIV care and monitoring could lead to improved clinical outcomes and client quality of life.
