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
What is the SF-36?
Contains 36 items that assess HRQoL grouped into 8 dimensions
Responses to questions are scored
Scores of each dimension are added together to give a score between 0-100
Dimension scores are not added together to give an overall score - could make interpretation difficult in some cases
Advantages of SF-36?
Acceptable to people
Takes 5-10 minutes to complete
Good reliability
Responsive to change
What are the five dimensions of EuroQoL EQ-5D?
Mobility Self care Usual activities Pain/discomfort Anxiety/depression
What are the three levels of each dimension in the EuroQoL?
No problems
Some/moderate problems
Extreme problems
Advantages of EuroQoL EQ-5D?
Widely used
Good population data available
Well validated and tested for reliability
Particularly suitable for use in economic evaluations
What are the types of specific instruments?
Disease specific
Site specific
Dimension specific (pain, depression)
Advantages of specific instruments?
Relevant content
Sensitive to change
Acceptable to patients
Disadvantages of specific instruments?
Can’t be used on people without disease
Comparison is limited
May not detect unexpressed effects
What points should be used to assess the suitability and value of HRQoL instruments?
Is there published work showing established validity and reliability?
Is there other published work showing successful use of the instrument?
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?
