Economic and Humanistic Outcomes Self-Assessment
Terms in this set (33)
1. Proponents of outcomes research believe that which
one of the following is true?
A. Outcomes research is synonymous with
B We should measure not only the clinical and cost
impacts of health care, but also the outcomes that
take the patients perspective into account.
C. Only clinical effects, and not functional status or
well-being, should be included as outcomes.
D. All outcomes research is pharmacoeconomic
1. Answer: B
Pharmacoeconomics is part of the larger area of research
known as outcomes research. The two are not synonymous;
therefore, Answer A is incorrect. Proponents of outcomes research
include clinical, economic, and humanistic variables
as dependent or as the outcome variables. Outcomes research
includes clinical assessments, the patient's perspective about
2. The economic, clinical, and humanistic outcomes
(ECHO) model recognizes the existence of intermediate
outcomes. Which one of the following is an example of
an intermediate outcome?
A. A patient's physical functioning or mental
B. A specific laboratory value.
C. The total cost of hospitalization.
D. Adherence to a drug regimen.
2. Answer: D
The economic, clinical, and humanistic outcomes (ECHO)
model represents economic, clinical, and humanistic outcomes.
Each of these endpoints involves intermediate steps
or intermediate outcomes. Humanistic intermediaries can
include specific behaviors of an individual or a group of
people. The behaviors themselves are not outcomes in this
model. One example is the behavior of patients' adherence
to their drug regimen. Compliance can be affected by nonbehavioral
factors also, such as the cost of the drug or the patient's
belief system, or attitude toward taking drugs. All of
these influences can have an impact on the outcome and the
patients assessment of the outcome. In a statistical model,
adherence to drug regimens is considered both a dependent
and an independent variable. As an independent variable,
adherence can be evaluated for its effect on the dependent
variable of humanistic outcomes. In this way, it is an intermediary,
or an intermediate step.
3. Which one of the following statements best describes
A. The direct, indirect, and intangible costs compared
with the consequences of medical treatment
B. The medical events that occur as a result of a
disease or treatment.
C. The consequences of a disease or treatment on a
patient's functional status or quality of life.
D. The cost-savings associated with a disease or
3. Answer: A
Economic outcomes have been defined as the total costs of
medical care associated with treatment alternatives balanced
against clinical or humanistic outcomes (see Reference 13).
Clinical outcomes are defined as medical events that occur
as a result of a disease or treatment (Answer B). Humanistic
outcomes are defined as the consequences of disease or treatment
on patient functional status or quality of life (Answer
C). Researchers have proposed that the evaluation of pharmaceutical
products should include an assessment of each of
these three outcome types.
4. Which one of the following best represents a direct
D. Medical professional time.
4. Answer: D
Direct medical costs are the costs incurred for medical products
and services used for the prevention, detection, and
treatment of a disease, such as transportation. Examples of
other direct costs include drugs, supplies, and hospitalizations.
Pain (Answer A) is an example of an intangible cost.
Mortality (Answer C) is a direct nonmedical cost. Medical
professional time is an example of an indirect cost.
5. Lost productivity is an example of which one of the
following cost categories?
A. Direct medical cost.
B. Direct nonmedical cost.
C. Indirect cost.
D. Intangible cost.
5. Answer: C
Indirect costs are those costs resulting from morbidity and
mortality. They are costs valued as real money that are not
directly paid for the treatment of an illness or disease, such
as transportation. Morbidity costs are incurred from missing
work (lost productivity), whereas mortality costs are the
costs incurred due to premature death.
6. Which one of the following statements regarding the
perspective of economic evaluations is true?
A. Economic evaluations are valid only if conducted
from a single perspective.
B. Economic evaluations can be conducted from
C. Economic evaluations should only be conducted
from the perspective of the patient.
D. Society is the only valid perspective for economic
6. Answer: B
Economic evaluations can be conducted from single (Answer
A) or multiple perspectives, as long as it is clear what
the perspective(s) is and the costs and consequences are relevant
to the perspective(s) chosen. Popular perspectives for
conducting economic evaluations include the patient (Answer
C), provider, payer, and society. In countries with nationalized
medicine, society is the predominate perspective;
however, it is not the only valid perspective (Answer D).
7. From the perspective of a provider, which one of the
following is a direct cost of health care?
A. The amount paid out-of-pocket by patients directly
to their physicians for a clinic visit.
B. The patient charge for a visit to an emergency
C. The prescription cost of insulin at the community
D. The salary of the clinical pharmacist who monitors
a patient's therapy.
7. Answer: D
Direct costs of importance to providers are expenses paid
by the provider to care for patients. The amount paid out-ofpocket
by patients directly to their physicians for a clinic visit
is a direct expense to patients (Answer A). Patient charges
for visits to an emergency department (Answer B) and the
prescription cost of insulin at the community pharmacy (Answer
C) both are direct expenses to third-party payers and
to patients (for the amount of their co-payment). Salaries of
clinical pharmacists who monitor patients' therapies are direct
expenses from the perspective of the provider.
8. From the perspective of an employer, indirect costs are
best described by which one of the following?
A. Hospitalization costs borne by the patient.
B. Drug effects on patient functioning.
C. Loss of patient income associated with missed
D. Family caregiving costs.
8. Answer: B
Indirect costs are composed of costs due to work loss and decreased
productivity due to illness. From the perspective of
an employer, costs related to lost days of work and decreased
functioning of employees are pertinent indirect costs. A drug
that reduces an employee's ability to function certainly falls
into this category. Loss of income (Answer C) is an indirect
cost from the perspective of the patient, whereas family caregiving
expenses (Answer D) are direct nonmedical costs.
The patient's share of hospitalization costs (Answer A) are a
direct cost from the patient perspective.
9. The costs and consequences of health care can be
different depending on the perspective of the evaluation.Costs from a patient's perspective are best described as
which one of the following?
A. Essentially, what patients are charged for a product
B. Essentially, the true cost of providing a product or
service, regardless of the charge.
C. Essentially, the charges allowed for a health care
product or service.
D. Essentially, the cost of giving and receiving
medical care, including patient morbidity and
9. Answer: A
Costs from a patient's perspective are essentially the uninsured
portion of what they pay, or are charged, for a product
or service. The provider's perspective is represented by
the true cost of providing a service (Answer B). The charges
allowed for a health care product or service (Answer C)
represent cost from the perspective of a payer. Cost from a
societal perspective includes the cost of giving and receiving
medical care, including morbidity and mortality (Answer D).
10. Which one of the following constitutes a full economic
A. Two antibiotics are compared and relative cure
rates are determined.
B. The costs for treatment of hypertension by general
practice physicians, versus pharmacists, are
considered in light of the blood pressure control
C. The costs and efficiency of treatment of hypercholesterolemia
with a new HMG-CoA reductase
inhibitor are determined.
D. The acquisition costs of two therapeutically
equivalent antihypertensive agents are compared.
10. Answer: B
A full economic evaluation is one that encompasses two
basic characteristics: 1) a comparison of two or more treatment
alternatives is made; and 2) both the costs and the consequences
of the alternatives are examined (see Reference
7). A partial economic evaluation encompasses only one of
these characteristics. A complete evaluation should identify,
measure, and compare the costs and consequences associated
with competing programs or treatment alternatives.
11. Which one of the following is an example of a partial
A. A comparison of the costs and consequences of
B. A cost-utility analysis.
C. A comparison of the costs of two equally effective
D. A quality of life comparison of multiple treatment
11. Answer: D
A partial economic evaluation provides a descriptive assessment
of resource use or outcome. By definition, partial
evaluations do not provide both a comprehensive assessment
and comparison of the costs and consequences of competing
alternatives; therefore, Answer A is incorrect. A simple cost
comparison without regard for outcomes, as well as comparison
of only outcomes without regard for costs, are both
examples of partial economic assessments. A third example
of partial economic assessment is the description of costs
and outcomes for a single treatment alternative.
12. Which one of the following is true of partial economic
A. Partial evaluations should be performed as
components of full economic evaluations.
B. Partial evaluations assess all important components
necessary for a complete economic analysis.
C. Partial evaluations may provide a description
of the costs, or consequences, of competing
D. Partial evaluations compare the costs and
consequences of two treatments.
12. Answer: C
Although partial economic evaluations may serve as a useful
starting point in outlining or describing the costs or consequences
of drug therapy, they are not a component of a
full assessment (Answer A). A full economic assessment necessitates
evaluation of both the costs and consequences of
competing alternatives. In the absence of a full evaluation, a
partial evaluation may provide some insight into important
cost and outcome parameters for a given disease state, but
should never serve as the basis for selection of an alternative.
13. Which one of the following statements is not true about
A. Cost-minimization analysis is a tool used to
compare the costs of two or more treatment
B. Cost-minimization analysis shows only a costsavings
of one treatment alternative over another.
C. Cost-minimization analysis measures costs of
treatment alternatives in dollars and a assumes
D. Cost-minimization analysis is a method to be used
when no evidence exists to support the therapeutic
equivalence of two or more treatment alternatives.
13. Answer: D
Cost-minimization analysis should not be used if there is any
doubt regarding the therapeutic equivalence of two or more
treatment alternatives being compared. This methodology
does not take into account differences in clinical outcomes
between agents. The appropriate use of this method could
be to compare agents in the same therapeutic class with
documented equivalence in safety and efficacy. Although
the costs of these agents would be identified, measured, and
compared, the analysis should extend beyond drug acquisition
costs, and include all relevant costs incurred for administering,
monitoring, and preparing the agent.
14. When conducting a cost-benefit analysis (CBA), the
results are best expressed as which one of the following?
A. Cost-benefit ratio.
B. Average cost per utility.
D. Incremental cost ratio.
14. Answer: A
The results of a cost-benefit analysis are typically expressed
as either a cost-benefit ratio, or as net cost or net benefit.
When comparing two or more treatment alternatives, the alternative
with the greatest cost-benefit ratio, or net benefit,
is considered the most efficient use of resources. However, caution must be exercised when using cost-benefit ratios.
The values can be misleading; therefore, the relative magnitude
of the cost-benefit ratio must be considered. The net
benefit associated with a program or treatment alternative is
often the preferred expression of study results.
15. When quantifying the value of a clinical pharmacy
service, which one of the following economic evaluation
methods is the best to use?
A. Cost-benefit analysis.
B. Cost-effectiveness analysis.
C. Cost-minimization analysis.
D. Cost-utility analysis.
15. Answer: A
A cost-benefit analysis is the best economic evaluation method
to compare two or more programs when it is best to translate
benefits into a dollar value. For example, if quantifying
the value of a new pharmacy service, such as a Therapeutic
Drug Monitoring Service, the cost of implementing and
managing the program (the pharmacist's salary, laboratory
tests), and the benefit of the program (decreased drug costs,
decreased patient lengths of stay), can both be translated into
16. Which one of the following statements does not
describe a cost-effective treatment alternative?
A. Less expensive and less effective, where the lost
benefit was worth the extra cost.
B. Less expensive and at least as effective.
C. More expensive with an additional benefit worth
the additional cost.
D. Less expensive and less effective, where the extra
benefit is not worth the extra cost.
16. Answer: A
A product or service may be considered cost-effective compared
to a competing alternative when any of the following
three conditions are met: 1) the alternative is less expensive
and at least as effective as the comparator; 2) the alternative
is more expensive and provides an additional benefit that is
worth the additional cost; or 3) the alternative is less expensive
and less effective and the lost benefit was not worth the
extra cost of the comparator. Cost-effectiveness analysis attempts
to determine the optimal alternative, which is not always
the least expensive alternative, for obtaining a desired
17. A cost-effectiveness analysis would be best applied to
which one of the following situations?
A. When comparing two or more treatment
alternatives that differ in clinical outcome.
B. When comparing two or more treatment
alternatives that are equal in clinical outcome.
C. When comparing two or more treatment
alternatives that differ in humanistic outcome.
D. When comparing two or more treatment
alternatives that differ in cost.
17. Answer: A
Cost-effectiveness analysis is the best economic evaluation
method to apply when two or more treatment alternatives
have different efficacy and safety profiles. An appropriate
application of this method could be to compare treatment
alternatives from different therapeutic categories that are
used to treat the same disease. A complete evaluation would
identify, measure, and compare all of the costs and consequences
relative to the perspective(s) chosen. Relevant costs
assessed in this evaluation should extend beyond drug treatment
costs, and include the costs of treatment failures and
adverse drug reactions.
18. Which one of the following statements best describes
an incremental cost-effectiveness ratio?
A. A summary measurement of efficiency.
B. The cost per benefit of a new strategy, independent
of other treatment alternatives.
C. The cost to obtain an extra benefit realized when
switching from one strategy to another.
D. The cost per quality-adjusted life-year (QALY)
18. Answer: C
The incremental cost-effectiveness ratio represents the incremental
or additional cost required to obtain an incremental
or additional benefit when comparing a treatment alternative
to the next most intensive or expensive treatment option.
Summary measurements of efficiency (Answer A) typically
describe cost-effectiveness ratios. The cost per benefit of a
new strategy independent of other alternatives (Answer B)
describes the classic average cost-effectiveness ratio, where the average cost to obtain a specific therapeutic objective is spread over a large population. The cost per quality-adjusted ife-year gained (Answer D) is a description of a cost-utility ratio.
19. When comparing treatment alternatives, which one of
the following is the most correct application for costutility
A. Alternatives that are life-extending with serious
B. Alternatives that differ in cost.
C. Alternatives that differ in efficacy and safety.
D. Alternatives that are similar in clinical and
19. Answer: A
Cost-utility analyses can compare cost, quality, and quantity
of patient-years. Thus, when evaluating treatment alternatives
that are life-extending with serious side effects, such
as cancer chemotherapy, is the best economic evaluation
technique. Cost-utility analysis is also an appropriate methodology
to use when evaluating alternatives that produce reductions
in morbidity instead of mortality, such as arthritis
20. Which one of the following statements about discounting
is not true?
A. When costs and consequences of a treatment
alternative occur in the future, they should be
reduced to reflect current fiscal value.
B. Discounting is the process of adjusting for
C. There is one standard discount rate that should be
used in pharmacoeconomic analyses.
D. Comparisons of programs or treatment alternatives
should be made at the same time.
20. Answer: C
The primary role of discounting in economic evaluation is
to incorporate the effects of differential timing into the decision
process. Whenever a cost or benefit is realized more
than 1 year into the future, discounting should be performed.
There is no standard discount rate to use, although 5 percent
is commonly used.
21. Which one of the following statements regarding
discounting is true?
A. Researchers should always use a 5 percent
B. Costs incurred today to initiate a new program
should be discounted.
C. Discounting can be useful when comparing acute
and long-term treatment strategies.
D. Benefits should not be discounted.
21. Answer: C
There is no one standard discount rate for use in pharmacoeconomic
analyses. Many investigators recommend that
costs should be discounted to their present value using a rate
of 3-8 percent per annum. However, a commonly used rate
in recently published evaluations is 5 percent.
22. The primary reason to perform a sensitivity analysis is
to accomplish which one of the following?
A. Test the robustness of the economic evaluation
B. Reveal sensitive variables of the economic
C. Uncover the range of plausible values.
D. Allow for a meaningful comparison of treatment
22. Answer: A
Sensitivity analysis is a standard approach to manage uncertainty
in an economic evaluation. Due to the almost universal
need to make assumptions when conducting economic
evaluations, it is critical to perform sensitivity analyses. By
varying sensitive variables over a range of plausible results,
one can test the robustness of the study conclusions.
23. Which one of the following statements is not true
regarding the application of pharmacoeconomics to
A. Pharmacoeconomics can be a powerful tool for
determining the most efficient use of drugs.
B. Pharmacoeconomics can assist pharmacy and
therapeutics committees in incorporating clinical,
economic, and humanistic outcomes of drug
therapy into formulary management decisions.
C. Pharmacoeconomics can provide data to support
individual patient treatment and resource allocation
D. Use of pharmacoeconomic data ensures that
organizational drug-use policies will influence
physician prescribing patterns.
23. Answer: D
No one single factor can absolutely ensure that drug-use
policies will have a positive effect on prescribing patterns.
However, having pharmacoeconomic data to support the appropriate
and cost-effective use of a pharmaceutical product
typically increases its acceptance by health care providers
and society. Strategic implementation of strategies using
verbal, written, and on-line communication, based on sound
pharmacoeconomic data, will also enhance the success of
these policies in a health care organization.
24. Which one of the following formulary decision options
would be least influenced by the inclusion of pharmacoeconomic
A. Inclusion or exclusion of newly marketed agents.
B. Inclusion with restriction of newly marketed
C. Deletion of drugs from the formulary.
D. Determination of the least expensive to purchase
24. Answer: D
For formulary management, the best uses of pharmacoeconomic
data are for formulary decisions regarding the inclusion or exclusion of treatment options. Although a
formulary is often viewed as a cost-containment tool, a formulary
should not be a list of the cheapest alternatives. The
purpose of today's formulary should be to optimize therapeutic
outcomes while controlling the cost of pharmaceutical
products. Contemporary formulary management decisions
have begun to extend beyond an evaluation of only safety
and efficacy, or only cost, and include an assessment of the
pharmacoeconomic value of pharmaceutical products and
25. Which one of the following is true regarding health and
quality of life?
A. Quality of life is encompassed by a person's
lifestyle, including work and economic status.
B. Health or HRQOL refers only to those aspects
of life dominated, or significantly influenced, by
personal health or activities performed to maintain
C. Quality of life is divided into physical and mental
dimensions of functioning and well-being.
D. The concept of health includes marital status,
education, and religious beliefs.
25. Answer: B
Health-related quality of life refers to those aspects of life
dominated, or significantly influenced, by personal health
and activities performed to maintain health. Health is only
one aspect of quality of life. Quality of life encompasses
more than a person's lifestyle (Answer A). There are 12
different domains of life proposed in the literature. Marital
status, education, and religious beliefs more accurately describe
quality of life, rather than health; therefore, Answer
D is incorrect.
26. Which one of the following activities is a dimension of
general health status measurement?
A. Carrying a bag of groceries.
B. Physical functioning.
C. Playing sports.
D. Bathing or dressing.
26. Answer: B
Only physical functioning is a dimension of health. Activities
such as the ability to carry a bag of groceries (Answer
A), playing sports (Answer C), and bathing and dressing
(Answer D), are all items used to inquire about a degree or
state of physical functioning. Knowing that a patient has no
limitations in bathing or dressing, but has some limitations in
playing sports, gives one information to describe a range of
physical functions that the person can perform.
27. Which one of the following pairs illustrates two opposite
extremes of mental well-being? These two attributes can
be used to describe the range of a mental health continuum.
A. Psychological distress and physical distress.
B. Physical distress and psychological well-being.
C. Psychological well-being and psychological distress.
D. High physical energy and physical weariness.
27. Answer: C
Distress and well-being describe two extreme points, or
boundaries, in the range of mental health states. To be complete,
it is recommended that the dimensions included within
health status questionnaires go beyond the absence of the
negative health state. For example, a patient who experiences
relief of his psychological distress would not necessarily
have achieved his ultimate health goal unless he achieved an
experience of psychological well-being, or was happy, and not just not sad.
28. Which one of the following features could be described
as one of the most striking differences between
traditional clinical measures of a patient's health and
measures of health status?
A. The source of the data is patient self-administered
B. The collection of data from patients is a new
phenomenon, whereas collection of laboratory data
dates back many years.
C. Clinicians can use the clinical data, but not health
status data, in decision-making.
D. Clinical data are "hard data", whereas, health
status data are not as scientifically rigorous in their
standards of measurement.
28. Answer: A
Traditional means of collecting clinical data, such as laboratory
tests, radiographs, and physical examinations, are usually
performed by a technician, a machine, or a clinician.
Health status assessments, as described in this module, are
patient self-administered questionnaires. Collection of information
from patients is not a new phenomenon; what is new
are the attempts to standardize the collection of this information;
therefore, Answer B is incorrect. Clinicians can use the information from health status assessments in clinical decision-
making; therefore, Answer C is incorrect. Although
there is some controversy surrounding the application of the
results of the questionnaires, the results are being used. The
methods of assessing health status use the discipline of psychometrics,
enabling one to assess objectively the subjective
aspects of health. Thus, an argument can be made that health
status measures are also "hard data;" therefore, Answer D is
29. The following are characteristics of a good scale for
measuring health status. Which one of the following is
true of generic/general health status measures, but not
true of disease specific measures?
A. The concepts can be measured in patients of all
ages, races, and socio-demographic characteristics.
B. The concepts being measured include all possible
dimensions of health for a patient population.
C. The measurement framework extends across
the entire range of a dimension, from disease to
D. The measurement must be sensitive to change over
time to be used in clinical practice.
29. Answer: A
Measurement of health status across the spectrum of patient
age, race, and socio-demographics is unique when using generic
measures. If generic status measurements were applied
to a disease population, the measurement would be too burdensome
to the patient and include concepts that were not
applicable to some patients in the population. The dimensions
of health addressed in the measurement definitely need
to be comprehensive, but cannot contain too many questions
that would overburden the patient. Measurement frameworks
(Answer C) should extend across the entire range of a
dimension for both general and disease-specific assessments.
In addition, measurements must be sensitive to change over
time for both types of assessments; therefore, Answer D is
30. The categorization of structure, process, and outcome
published in the early 1960s (see Reference 5) was
designed to evaluate which one of the following?
A. Patients satisfaction with care.
B. The quality of health care.
C. Health policy changes.
D A patients self-assessment of the health care
30. Answer: B
Many articles on the evaluation of quality of care have been
published (see Reference 5). He proposed that quality could
be evaluated in areas of structure, process, and outcome. This
can be a confusing concept because one can achieve quality
in the structure of a care setting, in the process of care, or in
the outcome of care; however, Donnabedian proposed that to
achieve true quality of care, quality must be achieved in all
three areas. Although the categories are intimately related,
success in one area does not imply success in another. Until
the recent attention to outcomes assessment, the system had
focused on achieving quality in structure and process only.
Patient satisfaction with care (Answer A) is a component of
quality outcomes, as is patient self-assessment of the health
care system (Answer D). Although the information gained
from knowing about the structure, the process, and the outcomes
of a health care delivery system can give a representation
of the quality of care, it is really only a starting point for
changes in health policy (Answer C).
31. Which one of the following best describes a difference
between patient satisfaction and health status?
A. Patient satisfaction results are required for
accreditation by JCAHO; health status results are
B. Health status measurements of functioning and
well-being are required by law for drug approval;
patient satisfaction results are not.
C. Patient satisfaction is measured with a combination
of reports and ratings; health status doesn't use
D. Health status is measured using psychometric
techniques; patient satisfaction is not.
31. Answer: C
There are no national regulations for the use of patientbased
assessments. The Joint Commission on Accreditation
of Healthcare Organizations recommends patient satisfaction
be assessed for accreditation; however, it is not a mandate;
therefore, Answer A is incorrect. To date, there is no regulatory body that requires health-related quality-of-life
measures for drug approval (Answer B); however, manufacturers
must now provide evidence of scientifically valid conclusions
to make labeling claims about quality of life. Both
patient satisfaction and health status are measured using psychometric
techniques; therefore, Answer D is incorrect.
32. It has been proposed that one solution to increase
clinicians' information about the functional status,
well-being, and changes over time of their patients might
be to standardize these assessments in everyday medical
practice. Such routine assessments could be useful for all
except which one of the following purposes?
A. To replace the need for referral to specialists in
assessment of functional or emotional problems.
B. To detect, explain, and track changes in functional
capacity over time.
C. To make it possible to better consider the patients
total functioning when choosing among therapies.
D. As guidance for efficient use of community
resources and social services.
32. Answer: A
Ware has proposed that everyday use of health status assessments
could ensure that all important dimensions of functional
status and well-being are considered consistently to detect,
explain, and track changes over time (Answer B). Their use
would make it possible to better consider the patients total
functioning when choosing among therapies (Answer C).
Health status assessments also could guide the efficient use
of community resources and social services (Answer D), as
well as more accurately predict the course of chronic disease.
Although health status assessments have great potential
to improve care, they are not meant to serve as a replacement
for current, more detailed assessments of function, such as
that used by physical therapists, or of emotional well being,
such as is assessed by psychiatrists and social workers.
33. Which one of the following are not characteristics of
the measurement and use of individual level patient
self-reported health status information?
A. Standardized method of asking patients about
their functioning and well being can be efficiently
used in treatment decisions and as a monitoring
parameter for efficacy and toxicity of treatment.
B. Concerns have been raised about the reliability
and interpretation of the results from individual,
patient-level, health status information.
C. Modern psychometric test theory, such as Item
Response Theory, offers potential for individual
patient-level, health status assessment, and use in
D. Existing health outcome assessments drawn from
classic test theory can no longer be used.
33. Answer: D
Existing health outcome assessments drawn from classic test
theory, along with item response theory, offer exciting opportunities
for appreciably expanding applications of patient
based health assessments in biomedical and health services
research, clinical practice, and decision-making, and policy
developments. Answers A, B, and C all discuss true characteristics
of the measurement and use of individual level
patient self-reported health status information.