What Does ‘Clinical Significance’ Mean in the Context of the Health of the Nation Outcome Scales?

Abstract

Objective: The aim of this paper was to improve understanding of what ‘clinical significance’ means in relation to the Health of the Nation Outcome Scales (HoNOS) and its older persons and child/adolescent equivalents (the HoNOS65+ and HoNOSCA). Method: An anonymous, web-based survey was completed by 94 outcome measurement experts, most of whom had clinical responsibilities. Respondents were asked to indicate for acute inpatient and ambulatory settings: the rating on each item which represented a clinically significant problem; the relative importance of each item in determining overall clinical severity; and the items which would not be expected to improve between admission and review, admission and discharge, review and review, and review and discharge. Results: A score of 2 (‘mild problem but definitely present’) on each HoNOS/HoNOS65+/HoNOSCA item resonates with experts as being evidence of a clinically significant problem that requires active monitoring or intervention. In the main, all items on these instruments are viewed as equally important in making an overall judgement of clinical severity. The items making up the impairment and, to a lesser extent, social subscales are least likely to demonstrate change during the course of an episode of care, according to expert opinion. Generally, these findings apply across instruments and service settings. Conclusions: Overall, the findings provide support for the content validity and clinical utility of the HoNOS/HoNOS65+/HoNOSCA. Further exploration of the question of clinical significance as reflected in these instruments could take a number of forms.