Week 8- Preference-based, Co-morbidity and Disease Specific Instruments Flashcards
What are preference-based measures?
- used to obtain the quality adjustment weight required to calculate the quality-adjusted life year in health economic models
- consist of a self-complete patient questionnaire, a health state classification system, and preference weights for all states defined by the classification system
Quality-adjusted life years
Generic measure of disease burden that includes quality and quantity of life lived
Short Form 6 Dimensions SF-6D
multi-attribute utility instrument derived from the Short-Form 36 and is used to calculate quality-adjusted life
SF-6D: 6 Dimensions
- Energy
- Mental health
- Pain
- Physical functioning
- Role limitation
- Social functioning
EuroQOL (EQ-5D) -> What 3 things can it be used for?
- Clinical trials
- Population health surveys
- Routine outcome measurement
EuroQOL (EQ-5D): 5 Dimensions
- Anxiety/depression
- Mobility
- Pain/discomfort
- Self-care
- Usual activities
- Each dimension has 3 levels
- no problems
- some problems
- extreme problems
Health Utilities Index (HUI) Version 3
- A family of generic preference-based systems for measuring comprehensive health status and health-related quality of life
- Health dimensions include vision, hearing, speech, ambulation/mobility, pain, dexterity, self-care, emotion and cognition
HUI Scoring
- interval scale properties
- Scores are on the conventional dead = 0.00 to perfect health = 1.00 scale and are appropriate for calculating quality-adjusted life years (QALYs) in cost-effectiveness and cost-utility analyses.
- A difference of 0.03 or more in HUI scores of HRQL is clearly clinically important
Health Utilities Index Domains
- vision
- hearing
- speech
- ambulation
- dexterity
- emotion
- cognition
- pain
American Association of Anesthetists Physical Status Classification System (ASA)
- purpose= assess and communicate a patient’s pre-anesthesia medical co-morbidities
- predicts perioperative risks
- predicts postoperative resource utilization and mortality in numerous surgical fields
Issues with the ASA
- definitions are based on the severity of disease and may result in inconsistent application
- “systemic” in ASA classification creates confusion
ASA I Criteria
A normal healthy patient
ASA II Criteria
A patient with mild systemic disease
Adult: Mild diseases only without substantive functional limitations. Current smoker, social alcohol drinker, pregnancy, obesity (30
ASA I Adult
Healthy, non-smoking, no or minimal alcohol use
ASA I Pediatric
Healthy (no acute or chronic disease), normal BMI percentile for age
ASA II Adult
Mild diseases only without substantive functional limitations. Current smoker, social alcohol drinker, pregnancy, obesity (30
ASA II Pediatric
Asymptomatic congenital cardiac disease, well-controlled dysrhythmias, asthma without exacerbation, well-controlled epilepsy, non-insulin-dependent diabetes mellitus, abnormal BMI percentile for age, mild/moderate obstructive sleep apnea, oncologic state in remission, autism with mild limitations
ASA III Criteria
A patient with severe systemic disease
ASA III Adult
Substantive functional limitations; One or more moderate to severe diseases.
ASA III Pediatric
Uncorrected stable congenital cardiac abnormality, asthma with exacerbation, poorly controlled epilepsy, insulin dependent diabetes mellitus, morbid obesity, malnutrition, severe OSA, oncologic state, renal failure, muscular dystrophy, cystic fibrosis, history of organ transplantation, brain/spinal cord malformation, symptomatic hydrocephalus, premature infant PCA <60 weeks, autism with severe limitations, metabolic disease, difficult airway, long term parenteral nutrition. Full term infants <6 weeks of age.
ASA IV Criteria
A patient with severe systemic disease that is a constant threat to life
ASA IV Adult
Recent (<3 months) MI, CVA, TIA or CAD/stents, ongoing cardiac ischemia or severe valve dysfunction, severe reduction of ejection fraction, shock, sepsis, DIC, ARD or ESRD not undergoing regularly scheduled dialysis
ASA IV Pediatric
Symptomatic congenital cardiac abnormality, congestive heart failure, active sequelae of prematurity, acute hypoxic-ischemic encephalopathy, shock, sepsis, disseminated intravascular coagulation, automatic implantable cardioverter-defibrillator, ventilator dependence, endocrinopathy, severe trauma, severe respiratory distress, advanced oncologic state.
ASA V Criteria
A moribund patient who is not expected to survive without the operation
ASA V Adult
Ruptured abdominal/thoracic aneurysm, massive trauma, intracranial bleed with mass effect, ischemic bowel in the face of significant cardiac pathology or multiple organ/system dysfunction.
ASA V Pediatric
Massive trauma, intracranial hemorrhage with mass effect, patient requiring ECMO, respiratory failure or arrest, malignant hypertension, decompensated congestive heart failure, hepatic encephalopathy, ischemic bowel or multiple organ/system dysfunction.
ASA VI Criteria
A declared brain-dead patient whose organs are being removed for donor purposes
Functional Co-morbidity Index
- Developed to predict physical function in acute lung injury patients using comorbidity data.
- Physical function is an important measure of success of many medical and surgical interventions and the FCI adjust for comorbid disease.
- Sum of 18 self-reported comorbid conditions with a score of 0 to 18
ASQOL for Ankylosing Spondylitis Domains
- activities of daily living and pain
- sleep disturbance and activity limitation
- emotion
- fatigue
ASQOL Impact: Grading Criteria
- grade 0: normal
- grade I: suspicious changes (some blurring of the joint margins)
- grade II: minimum abnormality (small localized areas with erosion or sclerosis, with no alteration in the joint width)
- grade III: unequivocal abnormality (moderate or advanced sacroiliitis with erosions, evidence of sclerosis, widening, narrowing, or partial ankylosis)
- grade IV: severe abnormality (complete ankylosis)
ASQOL Impact: When is AS Diagnosed?
- Bilateral grade 2-4 sacroiliitis, or; Unilateral 3-4 sacroiliitis
- Low back pain ≥ 3 months, improved by exercise and not relieved by rest
- Limitation of lumbar spine in sagittal and frontal planes
- Limitation of chest expansion (relative to normal values corrected for age and sex)
ASQOL Impact: Critiques
- based on plain radiographs
- vague and subjective
- indicates the individuals ability to engage in activities of daily living, their current pain levels, sleep quality, emotional state, ability to engage in activities and the impact on their energy levels
PSAQOL for Psoriatic Arthritis Looks At…
- daily activities
- work or school activities
- personal relationships
- leisure
- treatment
PDI (Psoriasis Disability Index)
- The Psoriasis Disability Index is calculated by summing the score of each of the 15 questions, resulting in a maximum of 45 and a minimum of 0.
- The higher the score, the more quality of life is impaired. The Psoriasis Disability Index can also be expressed as a percentage of the maximum possible score of 45.
RAQOL for Rheumatoid Arthritis
- RAQoL has 30 items with a ‘yes’/’no’ response format and takes approximately 6 min to complete
- developed from the experiences of RA patients
- specific to illness and is reliable, valid and responsive to change in QOL
- scores range from 0-30 (high score indicating poor QOL)
