5) Chronic Illness and Health-Related Quality of Life Flashcards
Why should we measure health?
- Indication of the need for healthcare
- Target resources where they are most needed
- Assess the effectiveness of health interventions
- Evaluate the quality of health services
- To use evaluations of effectiveness to get better value for money
- To monitor patients’ progress
What ways do we have to measure health?
- Mortality
- Morbidity
- Patient-based outcomes
What are the advantages and disadvantages of using mortality to measure health?
-Easily defined, but, not always recorded
accurately
-Not a very good way of assessing outcomes and quality of care
What are the advantages and disadvantages of using morbidity to measure health?
- Routinely collected e.g. disease registers, hospital episode statistics
- Collection not always reliable/accurate
- Tells us nothing about patients’ experiences
- Not always easy to use in evaluation
Suggest some possible uses of the data from patient based outcomes.
- Used to assess benefits in relation to cost
- Used in a clinical audit
- Used to measure health status of populations
- Used to compare interventions in a clinical trial
- Used as a measure of service quality
Define health-related quality of life.
The functional effect of an illness and its consequent therapy upon a patient, as perceived by the patient
Suggest some things that are included in the idea of the patient’s perspective on their health-related quality of life?
- Physical function (what can they/what can’t they do)
- Symptoms (effect of symptoms on life)
- Global judgements on health
- Psychological wellbeing (anxiety, depression)
- Social wellbeing (relationships)
- Cognitive functioning (alertness, thinking)
- Personal constructs (body image)
- Satisfaction with care
What are the two main properties of PROMs?
- Reliability (should keep giving the same score over time if nothing changes)
- Validity (is it measuring what you want it to measure)
What is the relationship between health-related quality of life (HRQoL) and PROMs?
PROMs are a measure of health-related quality of life (HRQoL)
Suggest some benefits of the SF-36.
- Acceptable to people
- Only takes 5-10 minutes to complete
- Has good reliability
- Responsive to change
Why might the EQ-5D be a better tool than SF-36?
It groups all the dimensions to come to a single answer as opposed to the many dimensional answers.
What are the two main generic instruments for the measurement of HRQoL?
- SF-36
- EQ-5D
Suggest some benefits of the EQ-5D.
- Good population data is available
- Well validated and tested for reliability
Briefly describe the EQ-5D.
-Five dimensions (Mobility, self-care, usual activities, pain/discomfort, anxiety/depression)
-Three levels for each dimension:
+No problems
+Some/moderate problems
+Extreme problems
Suggest some of the advantages of using specific instruments for the measurement of HRQoL?
- Very relevant content
- Sensitive to change
- Acceptable to patients
Suggest some of the disadvantages of using specific instruments for the measurement of HRQoL?
- Cannot be used with people who don’t have the disease
- Comparison is limited
- May not detect unexpected effects
What are the three main types of specific instruments that can be used for the measurement of HRQoL?
- Disease specific (asthma quality of life questionnaire, arthritis impact measurement scale (AIMS)
- Site specific (oxford hip score, shoulder disability questionnaire)
- Dimension specific (Beck depression inventory, McGill pain questionnaire)
Why might patient based outcomes in healthcare be on the rise?
- Increase in conditions where the aim of treatment is management rather than curing
- Mid-Staff (and others) failing
- Iatrogenic effects of care
Compare and contrast the use of qualitative and quantitative methods to measure HRQoL?
- Qualitative methods are good really good for a first look at HRQoL. However, they are resource hungry and not easy to evaluate
- On the other hand, quantitative measures give much more specific answers. (they can be split into generic and specific)
What are the two groups of instruments that can be used in a quantitative method of measuring HRQoL?
- Generic instruments
- Specific instruments
Suggest some of the advantages of using generic instruments when carrying out a quantitative method of measuring HRQoL?
- Can be used for broad range of health problems
- Can be used if no disease-specific instrument
- Enable comparisons across treatment groups
- Can be used to detect unexpected positive/negative effects of an intervention
- Can be used to assess health of populations (don’t need to have disease)
- Questions on social, emotional and physical functioning, pain and self-care
Suggest some of the disadvantages of using generic instruments when carrying out a quantitative method of measuring HRQoL?
- Generic nature means inherently less detailed
- Loss of relevance (too general/many false positives)
- Can be less sensitive to changes that occur as a result of an intervention (needs a big change for
- May be less acceptable to patients
When might SF-36 be used?
- Measure of general health
- Population surveys
- Patient management
- Resource allocation
- Audit tool
- Clinical tool
Briefly describe the SF-36.
Contains 36 items which can also be grouped into 8 dimensions (4 physical and 4 mental). Scores within each dimension are added together to give a score (0-100)
N.b. each dimensional score is taken as a separate piece, NOT added together.
