Session 5 - Part II Flashcards
(24 cards)
Why do we measure health?
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
What are the commonly used measures of health?
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)
What does PROM stand for?
Patient Reported Outcome Measure
Why were PROMs introduced?
To improve the clinical management of patients
To compare hospitals - Increase productivity through demand management
What are the challenges associated with PROMs?
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
Define Health-related quality of life
The functional effect of an illness and its consequent therapy upon a patient as perceived by the patient
What is assessed as part of Health-related quality of life?
Physical function
Symptoms
Global judgments of health (What patient think their life would be like if they weren’t ill)
Psychological wellbeing
What are the 2 main ways of measuring health related quality of life?
Qualitative methods
Quantitative methods
What are the evaluative points of Qualitative methods?
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
What is the benefit of using Published instruments?
The Reliability and Validity is already established
Can be used to compare across different groups of patients
However, can be used inappropriately
What are Generic instruments?
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
What are specific instruments?
Evaluates a series of health dimensions specific to a disease, site or dimension
What are the advantages of Generic instruments?
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
What are the disadvantages of Generic instruments?
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
What are 2 examples of Generic measures?
SF-36
EuroQol EQ-5D
What is the SF-36?
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
What are some of the suggested uses for SF-36?
Measurement of general health Population surveys Patient management Resource allocation Audit tool Clinical tool
What are the 8 dimensions to the SF-36?
Physical functioning Social functioning Role functioning (Physical) Role functioning (Emotional) Bodily pain Vitality General health Mental health
How is the SF-36 scored?
Scores for items within each dimension are added together
Get a score per dimension
Do NOT get one overall score
What is the performance of the SF-36?
Acceptable to people 5-10 minutes for completion Internal consistency good Test retest high Responsive to change Population data is available (Allows comparison
What are the dimensions for the EQ-5D?
Mobility Self care Usual activities Pain/Discomfort Anxiety/Depression
What are the types of specific instruments?
Disease specific
Site specific
Dimension specific
e.g. Oxford hip score
What are the advantages of specific instruments?
Very relevant
Sensitive to change as so focused
Acceptable to patients
What are the disadvantages of specific instruments?
Can’t use them for people who don’t have the disease
Comparison is limited
May not detect unexpected effects as so specific
