Session 5 - Part II

Question 1

Why do we measure health?

Answer 1

Indication for health care needed
Target resources to where they are most needed
Assess the effectiveness of health interventions
Evaluate quality of health services
Evaluation of effectiveness to get better value for money
Monitor patient’s progress

Question 2

What are the commonly used measures of health?

Answer 2

Mortality (Can be hard to know why they died, not good for assessing the quality of care, not always recorded accurately)
Morbidity (Routinely collected, but not always reliably)
Patient based outcomes (Measured using PROMs, compare scores before and after treatment)

Question 3

What does PROM stand for?

Answer 3

Patient Reported Outcome Measure

Question 4

Why were PROMs introduced?

Answer 4

To improve the clinical management of patients

To compare hospitals - Increase productivity through demand management

Question 5

What are the challenges associated with PROMs?

Answer 5

The wrong PROM be used to measure something different
Patients may not want to participate
Takes a lot of time and resources to collect and analyse

Question 6

Define Health-related quality of life

Answer 6

The functional effect of an illness and its consequent therapy upon a patient as perceived by the patient

Question 7

What is assessed as part of Health-related quality of life?

Answer 7

Physical function
Symptoms
Global judgments of health (What patient think their life would be like if they weren’t ill)
Psychological wellbeing

Question 8

What are the 2 main ways of measuring health related quality of life?

Answer 8

Qualitative methods

Quantitative methods

Question 9

What are the evaluative points of Qualitative methods?

Answer 9

Can be very appropriate
Access to information other research cannot reach
Good for initial look at dimensions of HRQoL
Uses a lot of resources
Hard to use in evaluations

Question 10

What is the benefit of using Published instruments?

Answer 10

The Reliability and Validity is already established
Can be used to compare across different groups of patients
However, can be used inappropriately

Question 11

What are Generic instruments?

Answer 11

Can be used with any population
Generally cover perceptions of overall health
Also have questions on social, emotional and physical functioning, pain and self care

Question 12

What are specific instruments?

Answer 12

Evaluates a series of health dimensions specific to a disease, site or dimension

Question 13

What are the advantages of Generic instruments?

Answer 13

Can be used for a broad range of health problems
Can be used if no disease specific instrument is available
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

Question 14

What are the disadvantages of Generic instruments?

Answer 14

Less detail
May have a loss of relevance
Can be less sensitive to changes that occur as a result of an intervention
May be less acceptable to patients

Question 15

What are 2 examples of Generic measures?

Answer 15

SF-36

EuroQol EQ-5D

Question 16

What is the SF-36?

Answer 16

Standard version uses a 4 week recall period
Acute version uses a 1 week recall period
Reliable and valid, widely used in research
Has 36 questions

Question 17

What are some of the suggested uses for SF-36?

Answer 17

Measurement of general health
Population surveys
Patient management
Resource allocation
Audit tool
Clinical tool

Question 18

What are the 8 dimensions to the SF-36?

Answer 18

Physical functioning
Social functioning
Role functioning (Physical)
Role functioning (Emotional)
Bodily pain
Vitality
General health
Mental health

Question 19

How is the SF-36 scored?

Answer 19

Scores for items within each dimension are added together
Get a score per dimension
Do NOT get one overall score

Question 20

What is the performance of the SF-36?

Answer 20

Acceptable to people
5-10 minutes for completion
Internal consistency good
Test retest high
Responsive to change
Population data is available (Allows comparison

Question 21

What are the dimensions for the EQ-5D?

Answer 21

Mobility
Self care
Usual activities
Pain/Discomfort
Anxiety/Depression

Question 22

What are the types of specific instruments?

Answer 22

Disease specific
Site specific
Dimension specific
e.g. Oxford hip score

Question 23

What are the advantages of specific instruments?

Answer 23

Very relevant
Sensitive to change as so focused
Acceptable to patients

Question 24

What are the disadvantages of specific instruments?

Answer 24

Can’t use them for people who don’t have the disease
Comparison is limited
May not detect unexpected effects as so specific