4.1.1 First, establishing a single metric standard with a defined range and unit will arrest the burgeoning proliferation of new scale-dependent metrics.

4.1.2 Second, the communication of the information pertaining to patient status represented by these measures (physical, cognitive, and psychosocial health status, quality of life, satisfaction with services, etc.) will be simplified.

4.1.3 Third, common standards of data quality will be used to evaluate and improve instrument performance. The vast majority of test and survey data quality is currently almost completely unknown, and when quality is evaluated, it is via many different methods that are often insufficient to the task, misapplied, misinterpreted, or even contradictory in their aims.

4.1.4 Fourth, currently unavailable economic benefits will accrue from the implementation of measurement methods based on quality-assessed data and widely accepted reference standard metrics. The potential magnitude of these benefits can be seen in an assessment of 12 different metrological improvement studies conducted by the National Science and Technology Council (Subcommittee on Research, 1996). The average return on investment associated with these twelve studies was 147?%. Is there any reason to suppose that similar instrument improvement efforts in the psychosocial sciences will result in markedly lower returns?

4.2.1 For instance, payors may want to know outcome information that tells them what percentage of patients discharged can function independently at home. A hospital manager, referral source, or accreditor might want to know more detail, such as percentages of patients discharged who can dress, bathe, walk, and eat independently. Clinicians will want to know still more detail about amounts of independence, such as whether there are safety issues, needs for assistive devices, or specific areas in which functionality could be improved. Researchers may seek even more detail yet, as they evaluate differences in outcomes across treatment programs, diagnostic groups, facilities, levels of care, etc.

4.4.1 The use of measures, not scores, in all capture of data from the EHR for statistical comparisons;

4.4.2 The reporting of both the traditional reliability statistics (Cronbach's alpha or the KR20) and the additive, linear separation statistics (Wright & Masters, 1982), along with their error and variation components, for both the measures and the calibrations;

4.4.3 A qualitative elaboration of the variable defined by the order of the survey questions or test items on the measurement continuum, preferably in association with a figure displaying the variable;

4.4.4 Reporting of means and standard deviations for each of the three essential measurement statistics, the measure, the error, and the model fit;

4.4.5 Statement of the full text of at least a significant sample of the questions included on the instrument;

4.4.6 Specification of the mathematical model employed, with a justification for its use;

4.4.7 Specification of the error estimation and model fit estimation algorithms employed, with mathematical details and justification provided when they differ from those routinely used;

4.4.8 Evaluation of overall model fit, elaborated in a report on the details of one or more of the least and most consistent response patterns observed;

4.4.9 Graphical comparison of at least two calibrations of new instruments from different samples of the same population to establish the invariance of the item calibration order across samples;

4.4.10 Graphical comparison of measures produced by at least two subsets of items on new instruments to establish the invariance of the person measure order across scales (collections of items);

4.4.11 Graphical comparison of new instrument calibrations with the calibrations produced by other instruments intended to measure the same variable in the same population, to establish the potential for sample-free equating of the instruments and establishment of reference standards;

4.4.12 At least a useable prototype of the instrument employed, with the worksheet laid out to produce informative quantitative measures (not summed scores) as soon as it is filled out; and

4.4.13 Graphical presentation of the treatment and control groups' measurement distributions, for the purpose of facilitating a substantive interpretations of differences' significance.