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Linking Scores with Patient-Reported Health Outcome Instruments: A Validation Study and Comparison of Three Linking Methods

Published online by Cambridge University Press:  01 January 2025

Benjamin D. Schalet Open the ORCID record for Benjamin D. Schalet [Opens in a new window] ,
Sangdon Lim Open the ORCID record for Sangdon Lim [Opens in a new window] ,
David Cella  and
Seung W. Choi Open the ORCID record for Seung W. Choi [Opens in a new window]
Benjamin D. Schalet*
Affiliation:
Northwestern University, Feinberg School of Medicine
Sangdon Lim
Affiliation:
The University of Texas at Austin
David Cella
Affiliation:
Northwestern University, Feinberg School of Medicine
Seung W. Choi
Affiliation:
The University of Texas at Austin
*
Correspondence should be made to Benjamin D. Schalet, Department of Medical Social Sciences, North–western University, Feinberg School of Medicine, 625 N Michigan Ave, 21st Floor, Chicago, IL60611, USA. Email: [email protected]
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Abstract

The psychometric process used to establish a relationship between the scores of two (or more) instruments is generically referred to as linking. When two instruments with the same content and statistical test specifications are linked, these instruments are said to be equated. Linking and equating procedures have long been used for practical benefit in educational testing. In recent years, health outcome researchers have increasingly applied linking techniques to patient-reported outcome (PRO) data. However, these applications have some noteworthy purposes and associated methodological questions. Purposes for linking health outcomes include the harmonization of data across studies or settings (enabling increased power in hypothesis testing), the aggregation of summed score data by means of score crosswalk tables, and score conversion in clinical settings where new instruments are introduced, but an interpretable connection to historical data is needed. When two PRO instruments are linked, assumptions for equating are typically not met and the extent to which those assumptions are violated becomes a decision point around how (and whether) to proceed with linking. We demonstrate multiple linking procedures—equipercentile, unidimensional IRT calibration, and calibrated projection—with the Patient-Reported Outcomes Measurement Information System Depression bank and the Patient Health Questionnaire-9. We validate this link across two samples and simulate different instrument correlation levels to provide guidance around which linking method is preferred. Finally, we discuss some remaining issues and directions for psychometric research in linking PRO instruments.

Keywords

patient-reported outcomeslinkingscale alignmentdepressionPROMISPHQ-9calibrated projection
Type
Application Reviews and Case Studies
Information
Psychometrika , Volume 86 , Issue 3: Special Section: Advancing Methods to Assess Patient-Reported Outcomes: Lessons Learned from the Patient-Reported Outcomes Measurement Information System® (PROMIS®) Initiative , September 2021 , pp. 717 - 746
Copyright
Copyright © 2021 The Psychometric Society

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