Validation aspects of the health of the nation outcome scales

Abstract

BackgroundThe purpose of the current study was the psychometric evaluation of the Health of the Nation Outcome Scales (HoNOS), an instrument developed to meet the necessity of a clinically acceptable outcome scale for routine use in mental illness services.MethodsThe study participants included 2,162 outpatients and residential inpatients (rated on the HoNOS on three occasions during the year 2000) with a range of mental illnesses in different diagnostic groups from ten Mental Health Departments, located in the area of Milan (Italy). Principal Component Analysis, Confirmatory Factor Analysis, Discriminant Analysis and Partial Credit Rasch Model were used to assess two sources of validity: the internal structure and the relationships with other variables.ResultsThe results of the 12-item HoNOS demonstrate a significant departure from uni-dimensionality, confirmed by the Rasch analysis (which identified three misfitting items). However, HoNOS scores demonstrate stability and precision of item difficulties over time. Discriminant analysis showed that HoNOS scores have an acceptable level of discriminatory power in predicting the severity of patients' conditions (as represented by setting).ConclusionsIt was concluded that the Italian version of the HoNOS does not measure a single, underlying construct of mental health status. The internal structure validity analysis recommends a note of caution to use a summary index of the HoNOS scores, given the presence of multidimensionality and misfit. Nonetheless, the finding that the instrument is more multidimensional than unidimensional does not preclude the use of the HoNOS as a clinically valid tool for routine outcome assessment. In fact, item scores have demonstrated sufficient reliability (over diagnostic groups and care settings) and high precision in time, indicating that HoNOS items can be utilized as valid measurement instruments in longitudinal analyses.

Role of Patient and Practice Characteristics in Variance of Treatment Quality in Type 2 Diabetes between General Practices

“…The pseudo R 2 measure was used to estimate what part of the variance at practice level could be explained by including patient and general practice characteristics [25, 26]. For this, the percentages reduction in pseudo R 2 were calculated for each model compared to the empty model, expressing the part of the practice level variance that can be explained by the included characteristics.…”

Utility of the Health of the Nation Outcome Scales (HoNOS) in Predicting Mental Health Service Costs for Patients with Common Mental Health Problems: Historical Cohort Study

“…These concerns are compounded by the lack of robust evidence from other studies for associations of HoNOS scores with costs,[17–19,21–23] operationalisation and validity issues [28,29], and the fact that the HoNOS were designed to measure clinical outcome rather than need for care. [49]…”

“…[28] Rasch analyses demonstrate the absence of an underlying construct in the composite scale. [26,29] Analyses involving individual HoNOS items have been undertaken in many studies. [16,17,30] There is no universal agreement regarding operationalisation of the HoNOS.…”

Pharmacotherapy in bipolar disorders during hospitalization and at discharge predicts clinical and psychosocial functioning at follow‐up

“…Some authors indicated a four‐factor structure for the scale (Pirkis et al , ): 1) Behavior (items 1 to 3), Impairment (items 4 to 5), Symptoms (items 6 to 8), and Social (items 9 to 12). However, not all subsequent research has replicated this structure (Trauer, ; McClelland et al , ; Preston, ; Newnham et al , ; Lovaglio and Monzani, ) and, in Italy, Lovaglio and Monzani () proposed a six‐item one‐dimensional version for routine use in community‐oriented mental health services. The HoNOS‐6 demonstrated a solid factor structure (strong loadings and communalities), and acceptable model fit (Lovaglio and Monzani, ).…”