Economic Evaluation of Health
and Social Care Interventions
Policy Research Unit
Development of a brief generic mental health recovery patient reported outcome
measure (MH-ROM)
The Policy Research Unit in Economic Evaluation of Health and Care Interventions (EEPRU) at the University of
Sheffield and the University of York has been commissioned by the Department of Health to develop a brief generic
mental health recovery (patient reported) outcome measure (MH-ROM).
1. Why is a generic MH Recovery PROM needed?
The Department of Health is committed to increasing the use of outcome measures in the NHS to improve the care
in people with mental health problems. First, the NHS Outcomes framework aims to incorporate indicators to
promote a greater focus on outcomes that matter most to patients. Second, with the introduction of Payment by
Results in mental health, the collection of a PROM is necessary. It has been recognised that the main generic
measure, the EQ-5D, is not appropriate in many areas of mental health. A generic measure needs to be: short;
preference-based (i.e. can be used in cost-effectiveness analyses); applicable to all the clusters and; to encompass
the main domains for measuring recovery outcomes in mental health as reported by Boardman et al. (2013). There is
no off-the-shelf preference measure that can be satisfactorily used, necessitating the development of a new generic
preference based measure in the area of mental health.
2. What will the project entail?
There are 5 stages in this project and are described briefly below.
Stages
Stage 1: Development
of dimensions
Stage 2: Generation of
items
Stage 3: Testing face
and content validity
with service users and
clinicians
Stage 4: Psychometric
testing and further
refinement
Stage 5: Valuation
Description
The key components of this stage are to agree on the domains for the measure
drawing on the Boardman review (2013) and the thematic analysis of qualitative
research into the impact of mental health on the quality of people’s lives and
interviews with service users conducted by Connell et al. (2013).
Items will be generated for each domain agreed in stage 1. These items will include
both positive and negative aspects for several of the domains from existing
measures which among others include WEMWEBS, Affectometer 2, CORE-OM, GHQ28, AQOL-8D and other recovery measures. Alternative sources include analysis of
transcripts from the work of Connell and colleagues picking out the language used to
describe the concepts (Brazier et al., 2013).
A draft set of items will be tested with mental health service users to examine the
items face and content validity. This will involve face to face interviews where users
who will be are asked to complete items and taken through a cognitive de-briefing
exercise to examine the meaning of the items and the extent to which they seem to
cover the things that matter in their lives. A sample of users will also be asked to
complete an instrument to test the face validity of items. A sample of clinicians will
also be asked to review the items.
This stage will examine the classical psychometric properties of practicality,
reliability, validity and responsiveness. A factor analysis will also be conducted to
confirm the dimensionality of the scales and a Rasch analysis will be performed to
inform the process of selecting the final set of items and the way positive and
negative items are combined.
The aim of this phase of the project will be to obtain values from the general
population on the zero to one Quality Adjusted Life Year (QALY) scale for health
states defined by the health state classification derived from the new measure.
3. Who is involved in the project?
The questionnaire will be developed by a scientific group supported by researchers from EEPRU and chaired by John
Brazier. The group will include psychometric experts from mental health, clinicians and service users. It will meet at
least 5 times during the project to review evidence and to make key decisions at each stage regarding content.
An advisory group will consist of both international and national scientists who will also be asked to contribute at
various stages of the project.
A stakeholders’ group will be established to comment on all stages of the work and to ensure the work meets its
aims and objectives. Key stakeholders include, among others DH policy makers, NHS England, CPPP, users and
professional groups.
4. Timeline of the project
The project will start in February 2014 and a final instrument will be available for use within 15 months. A further 5
months have been added for the valuation of the instrument and a final study report to be published.
Feb – Apr
14
May – Jul
14
Aug –
Oct 14
Nov 14 –
Apr 15
May 15
June –
Aug 15
Oct 15
Stage 1: Confirmation of themes
Stage 2: Generating items
Stage 3: Face and content validation
Stage 4: Psychometric testing of
final version of questionnaire
Interim report
Stage 5: Valuation
Final report
5. References
Boardman J, Slade M, Shepherd G. Assessing recovery: seeking agreement about the key domains. Report for the
Department of health. 9 March 2013.
Brazier J. Is the EQ-5D fit for purpose in mental health? British Journal of Psychiatry 2010, 197: 348-349.
Brazier JE, Connell J, Papaioannou D, Mukuria C, Mulhern B, O’Cathain A, Barkham M, Knapp M, Byford S,
Gilbody S, Parry G. Validating generic preference-based measures of health in mental health populations and
estimating mapping functions for widely used specific measures. Health Technology Assessment (in press)
Connell, J., Brazier, J.E., O'Cathain, A., Lloyd-Jones, M. and Paisley S. Quality of life of people with mental health
problems: a synthesis of qualitative research. Health and Quality of Life Outcomes 2012, 10:138.
DOI: 10.1186/1477-7525-10-138. URL: http://www.hqlo.com/content/10/1/138
For more information on the development of this measure, please contact Anju Keetharuth
on d.keetharuth@sheffield.ac.uk ( Tel: 0114 222 0884) or John Brazier on
j.e.brazier@sheffield.ac.uk
Visit our webpage: www.eepru.org.uk/MH-ROM