Health status assessment Research

Now that we briefly reviewed the history of some of the origins of health status assessment research and a few of the important stimuli, we proceed with a brief discussion of some of the underlying theories and assumptions. 

This article discusses selected milestones in the evolution of health status assessments, the health status/ quality of life conceptual framework(s), an introduction to the scientific basis and evaluation of patient health status self-assessment questions, and potential future research and application of health status measures to patient care, with special emphasis on its role in clinical pharmacy practice. 

One study used quality-adjusted life years to capture the range of health-related dimensions that may affect the quality of life of patients. This measure also provides an estimate of the value or preferences for changes in health status (Neumann et al, 1999). The study used the Health Utility Index Mark II in a sample of patients and carers, which is a generic measure of the value of health-related quality of life. However, it is clear that further research is needed to explore (a) the key determinants or dimensions of quality of life that are important to people with dementia and their carers (b) whether existing instmments to measure and value health-related quality of life are able to detect differences in quality of life that are important to people with cognitive disability and their carers and (c) whether the assessment and... 

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. ° ... 

As mentioned earlier, one of the essential elements of outcomes research is the assessment of patient health-related quality of life. However, there is no consensus on the definition of quality of life (QOL) or its overall conceptual framework. In the literature, the term quality of life has been used in a variety of ways. It has been proposed that studies of health outcomes use the term health-related quality of life (HRQOL) to distinguish health effects from the effects of standard of living, family life, friendships, job satisfaction, and other factors on overall quality of life. Only health outcomes are discussed in this chapter, so quality of life and health-related quality of life are used interchangeably, along with health status. 

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. 

Deficiency syndromes of Zn, Cu, Cr, Se and Mo have occurred in patients on total parenteral nutrition (TPN). There is still much research to be done in assessing the nutritional status of many elements and understanding their metabolism, so that normal dietary intake may be supplemented for health benefits. Table 2 is a summary of the amounts required, the functions and the nutritional (usually dietary) imbalances in humans, where known, of the essential trace elements.31-33 (Note that this summary does not attempt to include imbalances related to environmental toxicology and occupational hazards.) Several trace elements have important functions in the immune system. Some are associated with nucleic acid. Others have structural roles, such as Si in cartilage, F and Zn in bone. They may be parts of vitamins, such as Co in vitamin B12, or hormones, such as iodine in thyroid hormones, Zn and Cr have a role in the synthesis and action of insulin.31-33... 

Health systems researchers and public health experts need to address the requirement for rapid assessments of health care infrastructure that quickly identifies the status of the critical assets for providing care (facilities, medical supplies, and the workforce) during a disaster. Natural disasters are not predictable and there are rarely more than a few days warning of an impending event. Time does not allow for testing and retesting of tools or analysis of definitions and measures, and therefore they must be established in advance. Because needs assessments should be done as rapidly as possible it leaves little time for refining the processes. Further, the uniqueness of each disaster complicates research because of the variable populations, socioeconomic status, health care availability, and environmental conditions in every community. 

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