Effectiveness and Outcomes in Health Care Proceedings of an Invitational Conference (1990) / Chapter Skim
Currently Skimming:
15 Measuring Patient Function and Well-Being: Some Lessons from the Medical Outcomes Study
15 Measuring Patient Function and Well-Being: Some Lessons from the Medical Outcomes Study
Pages 107-119
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 107... ...
Included are data bases used to compare costs and benefits of various financial and organizational aspects of health care services, by organizational managers who try to provide the best value for health care dollars, by clinical investigators who evaluate new treatments and technologies, and by practicing physicians and other providers who try to achieve the best possible outcomes for their patients. The primary source of this information will be from standardized patient surveys that have served research well over the past decade.
|
From page 108... ...
Further, these measures of biologic phenomena cannot be used to characterize human phenomena. There simply are not good algorithms for combining diverse biologic information to predict functioning, and such algorithms are doomed to leave too much about quality of life unexplained.
|
From page 109... ...
The record and provider judgments are not valid proxies for patient ratings of functioning, well-being, or other aspects of the quality of life. We should not always expect assessments of different health components or clinical versus generic measures to agree, and often they do not.
|
From page 110... ...
We should not underestimate the power of a data base that includes clinical measurements familiar to medical providers, measurements that they believe in because they have clinical validity, in parallel with other measures, such as measures of generic health concepts, not typically linked with such measures in clinical practice or research. This is the most powerful strategy for analyzing and understanding outcomes and for diffusing recent advances in methods for assessing patient outcomes.
|
From page 111... ...
THE MEDICAL OUTCOMES STUDY A hallmark of the Medical Outcomes Study (MOS) is its reliance on a broad array of outcome measures, including parallel assessments of diseasespecific clinical endpoints traditionally measured by clinicians (biologic functioning in Figure 1)
|
From page 112... ...
Again, one of our primary interests has been to work towards advancing the state-of-the-art in outcome assessment methods. One lesson we have learned is that it is feasible to create the new data base defined above and to add to it routinely on a rather large scale in very diverse health care settings.
|
From page 113... ...
This experience has made me more enthusiastic than I had been after the Health Insurance Experiment (and I was enthusiastic then) about the feasibility of standardized surveys and self-administration as a primary data collection strategy for monitoring patient outcomes.
|
From page 114... ...
Thus, with centralized data collection and standardized forms and methods, the completeness and quality of the database need not vary by practice setting. This leads to the notion of centralized health assessment laboratories.
|
From page 115... ...
If 80 percent of the people earn the highest possible score on a physical health index (as they did in the Health Insurance Experiment) , and we randomly assign them to free care, we do not have much chance of determining, using that particular measure, whether there is any benefit of free care.
|
From page 116... ...
Dotted line indicates patients win no chronic conditions; GI, gastrointestinal disorder; MI, myocardial infarction. Relative to available full-length research instruments, including our own, this short-form has one-fifth to one-tenth the number of questionnaire items.
|
From page 117... ...
With my recent move to the New England Medical Center, I have had occasion to contrast my own background and training with the needs of the next era of health assessment. I was trained in measurement theory and methods and for the prior 15 years I had been in a full-time research setting where we evaluated measures in traditional psychometric terms and used them for purposes of research.
|
From page 118... ...
Audrey Burnam, Maureen Carney, Allyson Ross Davis, Sheldon Greenfield, Ron D Hays, Elizabeth McGlynn, Eugene C
|
From page 119... ...
A Studying Outcomes for Patients with Depression: Initial Findings from the Medical Outcomes Study.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.