Measuring Health Flashcards
Compare mortality and morbidity data collection.
MORTALITY MORBIDITY
Easily defined Routinely collected
Not always recorded accurately Not always recorded
accurately or reliably
Not a good way of assessing Tells us nothing about
outcomes & QoL patients' experiences
Not always easy to use in evaluation
Why should we measure health?
- indication of need for healthcare
- target resources
- assess effectiveness of health intervention
- evaluate quality of health services —> better value for money
- monitor patients’ progress
What are patient-reported outcomes? What can they be used for?
Attempts to assess well-being from patients’ point of view
Pays attention to the iatrogenic effects of care
Patient-reported outcome measures (PROMs) = come directly from patients (compare scores before and after treatment/over long periods)
Used to compare providers to increase productivity and quality (through patient choice)
- assess benefits in relation to cost
- clinical audit
- measure health status of populations
- compare interventions in a clinical trial
- measure of service quality
What are some of the challenges of using patient-reported outcome measures?
- minimising time and cost
- achieving high rates of patient participation
- appropriate output to different audiences
- avoiding misuse
- expanding to other areas
What is the definition of quality of life?
Individual’s perception of their position in life in the context of the culture and value system in which they live, and in relation to their goals, expectations, standards, and concerns
OR: individual’s sense of social, emotional, and physical well-being which influences the extent to which they can achieve personal satisfaction with their life circumstances
What is the idea of health-related quality of life?
Quality of life represents the functional effect of an illness and its consequent therapy upon the patient, as perceived by the patient
- physical function e.g. mobility
- symptoms e.g. pain
- global judgement of health
- psychological wellbeing e.g. anxiety
- social wellbeing e.g. social contact
- cognitive functioning e.g. memory
- personal constructs e.g. stigma
- satisfaction with care
Compare the qualitative and quantitative measures of health-related quality of life.
QUALITATIVE =
- good for initial look at dimensions of health-related quality of life (informs development for quantitative measures)
- resource-hungry (time & training)
- not easy to use in evaluation e.g. RCTs
QUANTITATIVE =
- relies on use of questionnaires (“instruments” or “scales”)
- should be reliable and valid
Compare generic and specific measurements for health-related quality of life.
GENERIC = e.g. Short Form-36, EuroQol EQ-SD
- used with any population (inc. healthy people)
- covers perception of overall health
- also questions social, emotional, and physical functioning (as well as pain and self-care)
Advantages:
- can be used for a broad range of health problems
- can be used if no disease-specific instrument exists
- enables comparisons across treatment groups
- can be used to detect unexpected positive/negative effects of an intervention
- can be used to assess health of populations
Disadvantages:
- inherently less detailed —> loss of relevance?
- less sensitive to changes that occur due to an intervention
- may be less acceptable to patients
SPECIFIC = e.g. Oxford Hip score
evaluates a series of health dimensions specific to a disease, site, or dimension
Advantages:
- very relevant content
- sensitive to change
- acceptable to patients
Disadvantages:
- can’t use with people who don’t have disease
- limited comparisons
- may not detect unexpected effects
Describe some of the features of the Short-Form 36 questionnaire.
Derived from larger questionnaires of patient-assessed outcomes. Responses to questions are scored and added together within each dimension (not an overall score)
Score transformed into 0-100 for each dimension
- usually 4 week recall period
- widely used in research
- adapted and tested for British populations
- reliable & valid
- responsive to change
- approx. 5-10min
- internally consistent
- population data available
Describe some of the features of the EuroQol EQ-SD questionnaire.
Simple descriptive profile
Single index value for health status on which full health = 1 and
death = 0
5 dimensions with 3 levels each
- increasingly used as a stand-alone measure
- widely used
- good population data available
- good validity & reliability
- particularly good for economic evaluations
What are some points to consider when deciding how to measure quality of life?
- published work demonstrating reliability & validity?
- other published studies used instrument in question successfully?
- suitable for area of interest?
- adequately reflects patients’ concerns?
- instrument acceptable to patients?
- sensitive to change?
- easy to administer/analyse?
