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HaDSoc > 5: patient reported outcomes > Flashcards

5: patient reported outcomes Flashcards

1
Q

why measure health?

A
  • 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
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2
Q

commonly used measures of health?

A
  • Mortality
  • Morbidity
  • Patient-based outcomes
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3
Q

pros of using mortality as a measure of health?

A

• Easily defined

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4
Q

cons of using mortality as a measure of health?

A
  • not always recorded accurately

* Not a very good way of assessing outcomes and quality of care

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5
Q

pros of using morbidity as a measure of health?

A

• Routinely collected e.g. disease registers, hospital episode statistics

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6
Q

cons of using morbidity as a measure of health?

A
  • Collection not always reliable/accurate
  • Tells us nothing about patients’ experiences
  • Not always easy to use in evaluation
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7
Q

patient based outcome as a measure of health?

A

• Attempt to assess well-being from the patient’s point of
view
• e.g. health-related quality of life (HRQoL), health status, functional abilities
• Patient-reported outcome measures (PROMs) = measures of health that come directly from patients

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8
Q

how does patient based outcome as a measure of health work?

A

by comparing scores before and after treatment or over longer-periods

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9
Q

why use patient based outcome?

A

• Increase in conditions where aim is managing rather than curing
• Biomedical tests just one part of picture
• Need to focus on patient’s concerns (patient-centred
care)
• Need to pay attention to iatrogenic effects of care

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10
Q

pros of using patient based outcome? Can…

A
  • Can be used clinically
  • Can be used to assess benefits in relation to cost
  • Can be used in clinical audit
  • Can be used to measure health status of populations
  • Can be used to compare interventions in a clinical trial
  • Can be used as a measure of service quality
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11
Q

why use PROMS (patient-related outcome measures)?

A

• Improve clinical management of patients
(informed, shared decision-making)
• Comparison of providers (hospitals)
– increase productivity through demand management
– improve quality through patient choice, purchasing

Results published to help patient’s decision making

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12
Q

challenges of using PROMS?

A
  • Minimising the time and cost of collection, analysis, and presentation of data
  • Difficult to achieve high rates of patient participation
  • Providing appropriate output to different audiences
  • PROMs can be misused
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13
Q

what is health-related quality of life (HRQoL)?

A

Quality of life in clinical medicine represents the
functional effect of an illness and its consequent therapy
upon a patient, as perceived by the patient

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14
Q

what are the multi-dimension factors of HRQoL?

A 
physical function
symptoms
global judgements of health
psychological well-being
social wellbeing
cognitive functioning
personal constructs
satisfaction with care
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15
Q

what is the physical function dimension of HRQoL?

A

Mobility, dexterity, range of movement, physical activity, activities of daily living (e.g. ability to eat, wash, dress)

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16
Q

what are the symptoms dimension of HRQoL?

A

Pain, nausea, appetite, energy, vitality, fatigue, sleep, rest

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17
Q

what is the psychological well-being of health dimension of HRQoL?

A

Psychological illness: anxiety, depression, coping, positive well-being and adjustment, sense of control, self-esteem

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18
Q

what is the social well-being of health dimension of HRQoL?

A

Family and intimate relations, social contact, integration, social opportunities, leisure activities, sexual activity and satisfaction

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19
Q

what is the cognitive functioning within health dimension of HRQoL?

A

Cognition, alertness, concentration, memory, confusion, ability to communicate

20
Q

what is the person construct within health dimension of HRQoL?

A

Satisfaction with bodily appearance, stigma, life satisfaction, spirituality

21
Q

How do we measure HRQoL?

A

Two main choices:

  1. Qualitative methods
  2. Quantitative methods (Specific vs generic instruments)
22
Q

Pros of qualitative measures of HRQoL?

A
  • Very appropriate in some cases
  • Gives you access to parts other methods don’t reach
  • Good for initial look at dimensions of HRQoL – informing development of quantitative instruments
23
Q

cons of qualitative measures of HRQoL?

A
  • Very resource-hungry (need expert training, time)
  • Not easy to use in evaluation, esp RCTs

(good for initial look, but very resource hungry and not easy to evaluate)

24
Q

Quantitative measures of HRQoL?

A
  • relies on use of questionnaires: known as ‘instruments’ or ‘scales’
  • Should fulfil certain criteria

(have to be reliable and valid)

25
Q

what are two important properties of PROMs?

A

reliability

validity

26
Q

what is reliability within PROMs?

A

is the instrument accurate over time and internally CONSISTENT? (if the patient has no change in health, she should get the same score each time on the measure)

27
Q

what is validity within PROMs?

A

does the instrument actually measure what it is INTENDED to measure? (a measure might be accessing only pain, and neglecting social aspects of illness)

28
Q

what are the 2 quality of life measures?

A

generic instruments

specific instruments

29
Q

what are the criterias for generic instruments in measuring QoL?

A

• Can be used with any population (inc healthy people)
• Generally cover perceptions of overall health
• Also questions on social, emotional and physical
functioning, pain and self-care

30
Q

what are the criterias for Specific instruments in measuring QoL?

A

Evaluates a series of health dimensions specific to a

disease, site or dimension

31
Q

advantages of generic instruments in measuring QoL?

A

• 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

32
Q

disadvantages of generic instruments in measuring QoL?

A
  • Generic nature means inherently less detailed
  • Loss of relevance – too general?
  • Can be less sensitive to changes that occur as a result of an intervention
  • May be less acceptable to patients
33
Q

examples of generic measures of QoL?

A
  • The Short-Form 36-item questionnaire (SF-36)

* The EuroQol EQ-5D

34
Q

what is the SF-36? (recall period)

A
  • Standard version uses 4 week recall period (can be used every 4 weeks)
  • Acute version uses 1 week recall period
35
Q

pros of SF-36?

A
  • Adapted and tested for British populations
  • Reliable
  • Valid
  • Widely used in research (several thousand citations)
36
Q

what does the SF-36 contain?

A 
• Contains 36 items which can also be grouped into 8
dimensions:
– Physical functioning
– Social functioning
– Role functioning (physical)
– Role functioning (emotional)
– Bodily pain
– Vitality
– General health
– Mental health
37
Q

scoring of SF-36?

A

• Responses to questions are scored
• Scores for items within each dimension are added
together
• This score is transformed to give each respondent’s
score for each dimension (0-100)
• You are NOT allowed to add up the dimensions to give
an overall score – can make interpretation difficult in
some cases

38
Q

advantages of using SF-36? (performance)

A
  • Acceptable to people
  • 5-10 mins for completion
  • Internal consistency good
  • Test retest high
  • Responsive to change
  • Population data available
39
Q

types of specific instruments?

A
  • Disease specific
  • Site specific
  • Dimension specific
40
Q

examples of disease specific instruments?

A

Asthma Quality of Life Questionnaire

Arthritis Impact Measurement Scale (AIMS)

41
Q

examples of site specific instruments?

A

Oxford Hip Score

Shoulder Disability Questionnaire

42
Q

examples of dimension specific instruments?

A

Beck Depression Inventory

McGill Pain Questionnaire

43
Q

advantages of specific instruments in measuring HRQoL?

A
  • Very RELEVANT content
  • SENSITIVE to change
  • ACCEPTABLE to patients
44
Q

disadvantages of specific instruments in measuring HRQoL?

A
  • Can’t use them with people who don’t have the disease
  • Comparison is limited
  • May not detect unexpected effects
45
Q

how do you select the appropriate HRQoL in a range of circumstances?

A
  • Is there PUBLISHED work showing established reliability and validity?
  • Have there been OTHER published studies that have used this instrument successfully?
  • Is it SUITABLE for your area of interest?
  • Does it adequately REFLECT patients’ concerns in this area?
  • Is the instrument acceptable to patients?
  • Is it SENSITIVE to change?
  • Is it EASY to administer and analyse?

HaDSoc (9 decks)

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