Health-related Quality Of Life Flashcards
What are some commonly used measures of health?
Morbidity
Mortality
Patient-based outcomes
Pros and cons of using mortality?
Pros
-easily defined
Cons
- not always recorded accurately
- not a good way of assessing outcomes and quality of care
Pros and cons of morbidity?
Pros
-routinely collected eg disease registers, hospital stats
Cons
- collection not always reliable or accurate
- tells us nothing about patient experience
- not always easy to use in evaluation
What are patient-reported outcome measures (PROMs)?
Measures of health that come directly from the patient
Work by comparing scores before and after treatment or over long periods.
How can patient based outcomes be used?
Clinically To access benefits in relation to costs In a clinical audit Measure health status of populations Compare interventions in a clinical trial Used as a measure of service quality
Why have patient-based outcomes?
Increase in conditions where aim is managing rather than curing
Biomedical tests just one part of the picture
These focus on patient’s concerns
Need to pay attention to iatrogenic effects of care
What happens to the data of PROMs?
Published by health and social care information centre
Comparisons can be made between trusts
Why are PROMs of interests to commissioners?
Indicates quality of care provided
Why are PROMs of interest to patients?
Can make comparisons to inform their decision making
What are the challenges with PROMs?
Minimise time and cost of collection
Analysis and presentation of data
Need high rates of patient participation
Provide appropriate output to different audiences
Avoid PROMs misuse
Define quality of life
Functional effect of an illness and its consequent therapy upon a patient, as perceived by the patient
What are the dimensions looked at in HRQoL?
Physical function Symptoms Global judgements of health Psychological well-being Social well-being Personal constructs Satisfaction with care
What things are looked at in physical function?
Mobility Dexterity Range of movement Physical activity ADL
What factors are looked at in psychological well being?
Anxiety Depression Coping Positive well-being Sense of control Self esteem
What factors come under social well-being?
Family and intimate relations Social contact Integration Opportunities Sexual activity Satisfaction
What are personal constructs?
Body image
Stigma
Life satisfaction
Spirituality
Pros and cons of using qualitative methods to measure HRQoL?
Pros
- gives access to parts other methods don’t reach
- good for initial look at dimensions of HRQoL - informing development of quantitative instruments.
Cons
- very resource hungry
- not easy to use in evaluation
Why measure health?
Indication of the need for healthcare
Target resources where they are most needed
Assess effectiveness of health interventions
Evaluate quality of health services
Use evaluations effectively so better value for money
Monitor patient’s progress
What do quantitative methods rely on?
Questionnaires as instruments/scales
What do PROMs need to be?
Reliable: is the instrument accurate over time? Internally consistent ie if no change in health, score should be the same
Valid: measures what it is meant to (may only be assessing pain and not social aspects)
What are features of generic instruments to measure HRQoL?
Can be used with any population including healthy people
Generally cover perceptions of overall health
Also has questions on social, emotional and physical functioning, pain and self-care
Advantages of generic instruments?
Advantages
- can be used for a broad range of health problems
- can be used if there is no disease-specific instrument
- enables comparisons across treatment groups
- used to detect unexpressed positive/negative effects of an intervention
- assess health of populations
Disadvantages of generic instruments?
Less detailed die to generic nature
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
Give two examples of generic instruments
Short form 36-item questionnaire (SF-36)
EuroQoL EQ-5D
