Basic Concepts of Health Outcomes

What are “health outcomes”, how are they measured, and why are they important and useful?

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  1. What are “health outcomes”?

  2. How are health outcomes measured?

  3. So what are “health-related quality-of-life measures”?

  4. How are health-related quality-of-life measures used?

  1. What are “health outcomes”?

    The term refers to the impact healthcare activities have on people — on their symptoms, ability to do what they want to do, and ultimately on whether they live or die. Health outcomes include whether a given disease process gets better or worse, what the costs of care are, and how satisfied patients are with the care they receive. It focuses not on what is done for patients but what results from what is done.

  2. How are health outcomes measured?

    That depends on the outcome. Patient satisfaction is usually measured by surveys. Costs are calculated from financial studies. Life/death results are calculated from death certificates filed at coroners offices. “Functional status” — how well someone can do what they want to do given their symptoms — is measured through health-related quality-of-life measures.

  3. So what are “health-related quality-of-life measures”?

    These are special questionnaires that are quite different from the informal opinion polls you’ve probably been asked to complete. Health-related quality-of-life (HRQOL) “instruments” are designed to cover specific “domains” of patient experience and then are validated against known measures. For instance, the Seattle Angina Questionnaire (SAQ) was constructed around particular features important in assessing people with coronary heart problems and then was tested against other regular clinical tests like exercise treadmill tests.

    The result of this is that health-related quality-of-life questionnaires can provide the same kinds of assessment of how a patient is doing — simply by asking questions — that can be performed by more complicated, expensive, or dangerous tests.

    In short, health-related quality-of-life instruments like the SAQ are clinical tests conducted simply by asking patients carefully-designed questions that produce results about patients that are as reliable and predictive as much more complicated, invasive, and potentially dangerous tests.

  4. How are health-related quality-of-life measures used?

    There are two main ways:

    1. To follow specific patients over time
    2. To compare different groups of patients

    Both types of use are important, but the first one is the most common use, and it is what we focus on here at MyHealthOutcomes. Patients complete a HRQOL questionnaire regularly — most commonly once a month. Changes in the calculated scale scores from one study to the next reveal changes in how a patient is doing.

    For each scale there is a level of change that we know is “clinically significant”. Below that level, we know that the patient is essentially the same. This is particularly helpful for helping determine when patients need to be seen back in clinic. If their scores are stable, then we know that they’re doing OK and can be safely watched from afar.

    But if the change is greater than that minimal level, then we know that something is going on. If the scores are deteriorating, this means that a patient may be developing worse or new problems that are showing up in these sensitive tests before they’re bad enough to cause an obvious crisis. Scores that are trending down mean that a patient should be seen by her doctor. If the scores are improving, this means that something is going right — perhaps because the patient’s new medication is working or a recent procedure has worked.

    The second form of use compares groups of patients. This use is more commonly part of a clinical trial of a medication or a procedure, and it’s also used in “quality assessment and improvement” projects within clinical practices or health delivery systems. In order to compare groups of patients — or specific patients against groups — it’s necessary to know more information about the patients such as their age, gender, diagnoses, medications, etc. This information is how patients are matched against each other, as it obviously makes no sense to compare thirty year old patients to seventy year old patients.

    We offer patients the opportunity to save in their MyHealthOutcomes accounts specific types of additional clinical information that can make these comparisons — so that they can find other patients similar to them to discuss their cases and care. Over time, if enough MyHealthOutcomes patients decide to store this kind of information, we may begin to build group-comparison results into the other reports we provide.