During the course of instrument development, investigators are faced with the challenge of developing a psychometrically sound instrument that has a minimal number of items or components. Although instrument developers may encounter specific problems in relation to different types of tests, there are three areas of concern that are frequently encountered. These concerns relate to (a) instrument length, (b) scale homogeneity, and (c) instrument sensitivity. The purpose of this article is to discuss selected aspects of item analysis in relationship to these three commonly encountered and interrelated areas of concern.

The quality health outcomes model is sufficiently broad (a) to guide development of databases for quality improvement and outcomes management, (b) to suggest key variables in clinical intervention research, and (c) to provide a framework for outcomes research and outcomes management that compares not only treatment options, but organizational or system level interventions. The model also has several policy implications.

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Fetal attachment of four groups of expectant parents were studied during the 24th to 34th weeks of pregnancy: 153 high-risk women hospitalized for a complication, 75 high-risk women's mates, 218 low-risk women, and 147 low-risk women's mates. No differences in fetal attachment scores were observed between high- or low-risk women or their mates; women scored significantly higher than their mates. Very little variance (7% to 14%) in fetal attachment was explained by the test of causal models except for high-risk women's mates for whom 31% of the variance was explained.