Health status assessment outcome measures

For many pharmacists, their first encounter with the terminology quality of life was in the 1986 New England Journal of Medicine article by Croog et alJ entitled The effects of hypertensive therapy on the quality of life. The authors found that antihypertensive agents had different effects on the quality of life and that these differences can be meaningfully assessed with available psychosocial measures. Currently, the clinical community is more aware of patient-based measures and the potential uses of health status assessments. Curriculum of many schools of pharmacy now includes some information on outcomes of patient care beyond just the traditional biological measures. 

Modern test theory offers the potential for individualized, comparable assessments for the careful examination and application of different health status measures. One such theory is item response theory (IRT). Researchers report that IRT has a number of potential advantages over the currently employed classical test theory in assessing self-reported health outcomes. Applications of the IRT models are ideally suited for implementing computer adaptive testing. IRT methods are also reported to be helpful in developing better health outcome measures and in assessing change over time. ° ... 

Quality of life includes many issues occurring in a person s life, such as health status, job satisfaction, family issues, and overall well-being.Since these are nonspecific, this measurement may not be the best indicator of positive or negative pharmacotherapeutic interventions made by a clinical pharmacist. Health-related quality-of-life assesses those aspects of a patient s life specifically related to physical and mental well-being. Hard data such as treadmill time in patients with heart failure may be of interest to clinicians, but is of little value to the patients. Frequently, hard data correlate poorly with the patient s actual functional status. An additional reason to add HRQL instruments to clinical outcomes measurements pertains to the phenomenon that patients with the same medical condition often respond differently to therapy. HRQL is a complementary method of meas-... 

HRQOL has been defined as the assessment of the functional effects of illness and its consequent therapy as perceived by the patient. These effects often are displayed as physical, emotional, and social effects on the patient. Measurement of HRQOL usually is achieved through the use of patient-completed questionnaires. Many questionnaires are available, and most are either disease-specific or generic measures of health status. Various overviews on HRQOL and its application to pharmacy have been published. " For further discussion on health outcomes and HRQOL, refer to Chapter 2. 

According to the CDC, every health care visit, regardless of its purpose, should be viewed as an opportunity to review a patient s immunization status and to administer needed vaccines. Immunization is perhaps the most cost-effective medical practice available. Each visit should encompass assessment of individuals vaccine needs, administration of indicated agents, and documentation of immunization histories. The outcome measurement of what percentage of patients in a particular practice site is completely immunized is extremely important because the benefits of optimal vaccine use extend beyond the individual patient to the public as a whole. 

Research should assess the effects of foods on the health status of human subjects. That is, the outcome measure in clinical or other human studies should be an improvement in some indicator of well-being or the lessening of some disease. 

Stroke outcomes are measured based on the neurologic status and functioning of the patient after the acute event. The National Institutes of Health Stroke Scale (NIHSS) is a measure of daily functioning and is used to assess patient status following a stroke. 

Analytic or individual-level studies have been directed either at the effect of air pollution exposure on respiratory health generally, or on the status of persons with conditions (e.g., asthma) that make them more susceptible to air pollution than the population in general. The Six-Cities Study, a prospective cohort study, and the 24-Cities Study, a cross-sectional study, were of the general design. The panel study, a short-term cohort study involving relatively intensive assessment of outcome, has been used to assess the effects of air pollution on susceptible persons. Typically, a panel of participants is enrolled and asked to maintain a diary of symptom status and medication use, and physiological measurements, such as peak expiratory flow rate (PEFR) may be made. New methods for data analysis have also made this design more informative than previously (7,8). 

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