Practical and philosophical issues surrounding a national item bank: if we build it will they come?

Item response theory (IRT), item banking and computer adaptive testing (CAT) methods have the potential to provide novel platforms for the collection, analysis and dissemination of patient data on health status and well-being. There are considerable challenges associated with building and maintaining a national item bank and it is uncertain whether there is sufficient interest among key stakeholders for IRT-based and CAT measures. The most convincing activity is demonstrating that the approach is feasible, psychometrically sound and useful in different specific applications. Demonstrated success opens up the possibility of more widespread acceptability and application. As part of the development effort, there needs to be continued meetings and discussion with psychometricians, instrument developers, clinical researchers, the FDA, pharmaceutical industry researchers and a managed care organizations about the advantages and disadvantages of a national item bank.