Week 8- Preference-based, Co-morbidity and Disease Specific Instruments

Question 1

What are preference-based measures?

Answer 1

• 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

Question 2

Quality-adjusted life years

Answer 2

Generic measure of disease burden that includes quality and quantity of life lived

Question 3

Short Form 6 Dimensions SF-6D

Answer 3

multi-attribute utility instrument derived from the Short-Form 36 and is used to calculate quality-adjusted life

Question 4

SF-6D: 6 Dimensions

Answer 4

• Energy
• Mental health
• Pain
• Physical functioning
• Role limitation
• Social functioning

Question 5

EuroQOL (EQ-5D) -> What 3 things can it be used for?

Answer 5

• Clinical trials
• Population health surveys
• Routine outcome measurement

Question 6

EuroQOL (EQ-5D): 5 Dimensions

Answer 6

• Anxiety/depression
• Mobility
• Pain/discomfort
• Self-care
• Usual activities
• Each dimension has 3 levels
• no problems
• some problems
• extreme problems

Question 7

Health Utilities Index (HUI) Version 3

Answer 7

• 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

Question 8

HUI Scoring

Answer 8

• 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

Question 9

Health Utilities Index Domains

Answer 9

• vision
• hearing
• speech
• ambulation
• dexterity
• emotion
• cognition
• pain

Question 10

American Association of Anesthetists Physical Status Classification System (ASA)

Answer 10

• 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

Question 11

Issues with the ASA

Answer 11

• definitions are based on the severity of disease and may result in inconsistent application
• “systemic” in ASA classification creates confusion

Question 12

ASA I Criteria

Answer 12

A normal healthy patient

Question 13

ASA II Criteria

Answer 13

A patient with mild systemic disease
Adult: Mild diseases only without substantive functional limitations. Current smoker, social alcohol drinker, pregnancy, obesity (30

Question 14

ASA I Adult

Answer 14

Healthy, non-smoking, no or minimal alcohol use

Question 15

ASA I Pediatric

Answer 15

Healthy (no acute or chronic disease), normal BMI percentile for age

Question 16

ASA II Adult

Answer 16

Mild diseases only without substantive functional limitations. Current smoker, social alcohol drinker, pregnancy, obesity (30

Question 17

ASA II Pediatric

Answer 17

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

Question 18

ASA III Criteria

Answer 18

A patient with severe systemic disease

Question 19

ASA III Adult

Answer 19

Substantive functional limitations; One or more moderate to severe diseases.

Question 20

ASA III Pediatric

Answer 20

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.

Question 21

ASA IV Criteria

Answer 21

A patient with severe systemic disease that is a constant threat to life

Question 22

ASA IV Adult

Answer 22

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

Question 23

ASA IV Pediatric

Answer 23

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.

Question 24

ASA V Criteria

Answer 24

A moribund patient who is not expected to survive without the operation

Question 25

ASA V Adult

Answer 25

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.

Question 26

ASA V Pediatric

Answer 26

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.

Question 27

ASA VI Criteria

Answer 27

A declared brain-dead patient whose organs are being removed for donor purposes

Question 28

Functional Co-morbidity Index

Answer 28

- 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

Question 29

ASQOL for Ankylosing Spondylitis Domains

Answer 29

- activities of daily living and pain - sleep disturbance and activity limitation - emotion - fatigue

Question 30

ASQOL Impact: Grading Criteria

Answer 30

- 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)

Question 31

ASQOL Impact: When is AS Diagnosed?

Answer 31

- 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)

Question 32

ASQOL Impact: Critiques

Answer 32

- 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

Question 33

PSAQOL for Psoriatic Arthritis Looks At...

Answer 33

- daily activities - work or school activities - personal relationships - leisure - treatment

Question 34

PDI (Psoriasis Disability Index)

Answer 34

- 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.

Question 35

RAQOL for Rheumatoid Arthritis

Answer 35

- 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)