What is howRU?

howRU is a short generic tool for measuring patient-reported outcomes (health status) in terms of how you feel physically and mentally, and how much you can do in terms of loss of function and dependence. It is very quick and easy to use and is designed for use in routine clinical care to deliver feedback to patients, clinicians, managers and payers.

The name, howRU, stems from the core question “How are you today?”.  We define today as being the previous 24 hours, to cover patients whose condition changes with the time of day or is worse at night.  

howRU

The howRU questionnaire has four items:

  • Pain or discomfort (short label: discomfort) covers physical symptoms
  • Feeling low or worried (distress) relates to emotional symptoms
  • Limited in what you can do (disability) may include work, home and leisure activities.
  • Dependent on others (dependence) covers lack of autonomy, self-care and other activities of daily living.  

The severity of each howRU item is rated using four levels:

  • none
  • a little
  • quite a lot
  • extreme

Each level may be indicated in mutually supporting ways to minimise cognitive effort, for face validity and to avoid the need for training: written labels: none, a little,a lot, and extreme; colour: green, yellow, orange and red; position: increasing in severity from left to right, and pictographs based on smiley faces. The combination of four items with four levels each creates a 4x4 matrix with 256 (44) different possible combinations.  This classification is generic (i.e. not condition- or domain-specific), can be used by all types of patients and citizens, except children and those in coma, and in all health settings.

The scoring system used in howRU is an aggregate score in which a higher score indicates better health. For analysis and reporting, each level is allocated a score on a 0-3 ordinal scale with low being bad and good being a high, with: extreme = 0, quite a lot = 1, a little = 2, and none = 3.  The overall howRU Score is calculated by adding the scores for each item, giving a range from the floor, 0 (4 x extreme), to the ceiling, 12 (4 x none). This scoring system is similar to that used by the Apgar, Glasgow Coma and Oxford Hip and Knee scores.  It is easy to understand and is transparent.  Unlike more complex schemes, the impact of changing a rating from one level to the next is always the same. The resulting scale has ordinal properties. 

Healthcare IT systems use codes to identify measures used.  howRU uses standard coding schemes such as LOINC, Read Codes Version 2, Clinical Terms Version 3 and SNOMED CT, which facilitate feedback at the point of care and linkage to case-mix and demographic data for longitudinal analysis. 

Reference:

Benson T, Sizmur S, Whatling J, Arikan S, McDonald D, Ingram D.  Evaluation of a new short generic measure of health status: howRu. Informatics in Primary Care 2010 Vol 18 No 2, 89-101. [Free Full Text Download]