title: Measuring agreement between healthcare survey instruments using mutual information.
abstract: Healthcare researchers often use multiple healthcare survey instruments to examine a particular patient symptom. The use of multiple instruments can pose some interesting research questions, such as whether the outcomes produced by the different instruments are in agreement. We tackle this problem using information theory, focusing on mutual information to compare outcomes from multiple healthcare survey instruments.
  
  
  
  We review existing methods of measuring agreement/disagreement between the instruments and suggest a procedure that utilizes mutual information to quantitatively measure the amount of information shared by outcomes from multiple healthcare survey instruments. We also include worked examples to explain the approach.
  
  
  
  As a case study, we employ the suggested procedure to analyze multiple healthcare survey instruments used for detecting delirium superimposed on dementia (DSD) in community-dwelling older adults. In addition, several examples are used to assess the mutual information technique in comparison with other measures, such as odds ratio and Cohen's kappa.
  
  
  
  Analysis of mutual information can be useful in explaining agreement/disagreement between multiple instruments. The suggested approach provides new insights into and potential improvements for the application of healthcare survey instruments.
authors.affiliation: Department of Industrial Engineering, Hongik University, Seoul, 04066, Republic of Korea. yckang@hongik.ac.kr.
authors.forename: Yuncheol
authors.initials: Y
authors.lastname: Kang
authors.affiliation: Orlando Veterans' Administration Medical Center, Viera, Florida, USA.
authors.forename: Melinda R
authors.initials: MR
authors.lastname: Steis
authors.affiliation: College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Kolanowski
authors.affiliation: College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA.
authors.forename: Donna
authors.initials: D
authors.lastname: Fick
authors.affiliation: Department of Industrial and Manufacturing Engineering, Pennsylvania State University, University Park, Pennsylvania, USA.
authors.forename: Vittaldas V
authors.initials: VV
authors.lastname: Prabhu
mesh_terms: D003693:Delirium / Q000175:diagnosis; D019538:Health Care Surveys / Q000592:standards*; D006801:Humans; D011569:Psychiatric Status Rating Scales / Q000592:standards*; D011594:Psychometrics / Q000379:methods*
keywords: Agreement; Delirium superimposed on dementia; Healthcare survey instrument; Mutual information