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Health Status and HRQOL Assessment

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Quality

Abstract

Should indicators of health status be included in a HRQOL assessment? To answer this question I first need to understand what the term health means in the phrase health status. Since the term disorder is also used to characterize a person’s health state, I also have to discuss what it means. I discuss both these topics, but also how health status can be assessed, reviewing its historic dependence on operations research approaches. The relationship between health status and quality of care is also discussed, with a particular emphasis on Donabedian’s definition of quality (of care). This is followed by a discussion of patient satisfaction and its usefulness as an indicator of quality (of care). A final section deals with using health status as an indicator of HRQOL. In this section, I make explicit the components of a HRQOL assessment, and review examples of its application in different HRQOL assessments. I also review “Quality Adjusted Life Years” estimates, as an application of HRQOL assessments. I end my discussion concluding that health status, especially when expressed abstractly, is of limited usefulness as an element of a HRQOL assessment.

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Notes

  1. 1.

    Lillienfeld and Marino (1999; p. 400) included this quote at the beginning of their paper, and it seemed appropriate to use at the start of this chapter, since the issue of the inferences we draw from the terms we use will repeatedly come up here.

  2. 2.

    Of course, this same argument can be made about why there can never be a universal definition of quality of life or HRQOL.

  3. 3.

    I will discuss Parson’s notions about health in greater detail in Chapter 9, which deals with whether functional status is an appropriate domain of a health domain.

  4. 4.

    One approach is to use fuzzy logic to decide what state a person is in.

  5. 5.

    To get a sense of the richness of the issues being discussed here, the reader is encouraged to read the papers published in the Journal of Abnormal Psychology, Volume 108, No. 3, 1999 (pages 371–472). This issue includes the two papers discussed here and nine comments that deal with how well each of these perspectives has dealt with the topic of what is meant by a disorder (with a particular emphasis on the meaning of “mental disorder” or “mental disease”). I will review only a limited amount of this material here, but it should also be noted that many of the issues discussed in these papers are relevant for my discussion concerning the definition and measurement of HRQOL.

  6. 6.

    “A value statement” is being and will be used as a general category that includes measures of values, preferences, and utilities.

  7. 7.

    The hybrid construct that Wakefield (1999a) uses is the same basic model previously cited as providing a unique definition of a quality-of-life assessment. There are other examples of this paradigm, each of which attests to the universality of this model.

  8. 8.

    The distinction being made here should remind the reader of our previous discussion of the difference between logical positivism and empirical constructionalism (Chap. 2, p. 31).

  9. 9.

    See a book by Wegner, The Illusion of Conscious Will (MIT Press, 2002), which addresses issues similar to the discussion here.

  10. 10.

    Dr. Penny Erickson in a personal communication suggested this association (December 3, 2004).

  11. 11.

    The reader is encouraged to read the Mallon (2000) book for a complete description of the cartoon and its consequences on Codman.

  12. 12.

    These assessments include, for example, the Bergner et al.’s (1981) Sickness Impact Profile; Kaplan and Anderson’s (1990) Index of Well-being; and Torrance’s (1995) Health Utility Index.

  13. 13.

    This is a particularly relevant issue for HRQOL assessment, since many assessments are not administered with a fixed time for completion. Thus, someone who is partially compromised may take longer to complete the task than someone who is not, and yet both may have similar response patterns. The question is whether these two individuals are providing the same information, and how this can be judged.

  14. 14.

    See Michalos (2004, p. 59), who also gives examples where this is not so.

Abbreviations

BCE:

Before the Common Era

BCQ:

Breast cancer questionnaire (Levine et al. 1988)

BFI:

Brief fatigue inventory (Mendoza et al. 1999)

CAHPS:

Consumer assessment of health plans

CARES:

CAncer Rehabilitation Evaluation System (Ganz et al. 1992)

CCM:

Chronic care model (Hung et al. 2008; Wagner et al. 2001)

EORTC-QLQ-C30:

European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire-Cancer specific-30 items (Aaronson et al. 1991)

EQ-5D:

EuroQol-5 dimensions (Brooks et al. 2003)

FACT:

Functional assessment of cancer therapy (B  =  Breast Cancer; BMT  =  Bone Marrow Transplantation; F  =  Fatigue; G  =  General; O  =  Ovarian)

FLIC:

Functional Living Index-Cancer (Shipper et al. 1984)

HALex:

Health and Activity Limitation Index (Erickson 1998)

HRQOL:

Health-related quality of life

HUI:

Health Utility Index (Torrance 1976)

IASP:

International association for the study of pain

JCAHO:

Joint Commission on Accreditation of Hospitals Organization

MOS-SF-36:

Medical Outcome Study-Short Form-36 (Ware et al. 1993)

QALY:

Quality adjusted life years

QOL:

Quality of life

QWB:

Quality of Well-being Scale (Kaplan and Bush 1982)

RSCL:

Rotterdam symptom check list (De Haes et al. 1990)

SEIQoL:

Schedule for the evaluation of individual quality of life (Hickey et al. 1999)

SF-6D:

Based on the MOS SF-36 or 12 (Brazier et al. 2002)

SIP:

Sickness impact profile (Bergner et al. 1981)

WHO:

World Health Organization

15D:

15 Dimensions (Sintonen 2001)

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    Ivan Barofsky

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Barofsky, I. (2012). Health Status and HRQOL Assessment. In: Quality. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-9819-4_8

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