Measuring Health-Related Quality of Life – ppt video online download

Presentation on theme: “Measuring Health-Related Quality of Life”— Presentation transcript:

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Measuring Health-Related Quality of Life
Ron D. Hays, Ph.D. UCLA Department of Medicine UCLA School of Public Health RAND Health Program May 13, 2015, 8-9:50am (M218, ) 1

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Students Aryana Amoon, Epidemiology Shannon Dunlap, Social Welfare
Nancy Guerrero-Llamas, Comm. Health Sci. Aryun Hahm, Social Welfare Melissa Johnson, Nursing Neha Srivastava, Social Welfare Leslie Thomas, Community Health Sciences Lumo Tserling, Visiting student from Tibet

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U.S. Health Care Issues Access to care Costs of care
~ 50 million people without health insurance Costs of care Expenditures ~ $ 2.7 Trillion Effectiveness (quality) of care

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How Do We Know If Care Is Effective?
Effective care maximizes probability of desired health outcomes Health outcome measures indicate whether care is effective Cost ↓ Effectiveness ↑

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Signs and Symptoms of Disease
Indicators of Health Signs and Symptoms of Disease

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Signs and Symptoms of Disease
Indicators of Health Signs and Symptoms of Disease Functioning Well-Being

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Health-Related Quality of Life (HRQOL)
How the person FEELs (well-being) Emotional well-being Pain Energy What the person can DO (functioning) Self-care Role Social

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Signs and Symptoms of Disease
Indicators of Health Signs and Symptoms of Disease Functioning Well-Being

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KDQOL Symptoms/Problems
During the past 4 weeks, to what extent were you bothered by each of the following? Soreness in your muscles? Chest pain? Itchy skin? Shortness of breath? Faintness or dizziness?

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Health-Related Quality of Life (HRQOL)
Quality of environment Type of housing Level of income Social Support

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Determinants of Health
Quality Of Care Health Characteristics Behavior Environment Chronic Conditions

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Patient-Reported Measures (PRMs)
Mediators Health behaviors (adherence) Health Care Process Reports about care (e.g., communication) Outcomes (PROs) Patient satisfaction with care Health-Related Quality of Life (HRQOL)

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Type of HRQOL Scores Multiple Scores (Profile) Single Score
Generic (SF-36) How much of the time during the past 4 weeks have you been happy? (None of the time  All of the time) Targeted (“Disease specific”) KDQOL-36 My kidney disease interferes too much with my life. Single Score Preference-based (EQ-5D, HUI, SF-6D) Combinations of above

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HRQOL Scoring Options 0-100 possible range
T-scores (mean = 50, SD = 10) (10 * z-score) + 50 z-score = (score – mean)/SD 0 (dead) to 1 (perfect health)

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HRQOL in HIV Compared to other
Chronic Illnesses and General Population T-score metric Hays et al. (2000), American Journal of Medicine

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HRQOL in HIV Compared to other
Chronic Illnesses and General Population T-score metric Hays et al. (2000), American Journal of Medicine

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HRQOL in HIV Compared to other
Chronic Illnesses and General Population T-score metric Hays et al. (2000), American Journal of Medicine

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HRQOL in HIV Compared to other
Chronic Illnesses and General Population T-score metric Hays et al. (2000), American Journal of Medicine

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Item Responses and Trait Levels
Person 1 Person 2 Person 3 Trait Continuum

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In general, how would you rate your health?
Excellent Very Good Good Fair Poor

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In general, how would you rate your health?
62 = Excellent 54 = Very Good 47 = Good 38 = Fair 29 = Poor Reliability = 0.52 (compared to 0.81 for 4-item scale).

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Reliability Target for Use of Measures with Individuals
Reliability ranges from 0-1 0.90 or above is goal SE = SD (1- reliability)1/2 Reliability = 1 – (SE/10)2 Reliability = 0.90 when SE = 3.2 95% CI = true score +/ x SE T = z*

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In the past 7 days … I was grouchy [1st question]
Never [39] Rarely [48] Sometimes [56] Often [64] Always [72] Estimated Anger = 56.1 SE = 5.7 (rel. = 0.68) Never: 39 Rarely: 48 Sometimes = 56 Often = 64 Always = 72

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In the past 7 days … I felt like I was ready to explode [2nd question]
Never Rarely Sometimes Often Always Estimated Anger = 51.9 SE = 4.8 (rel. = 0.77)

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In the past 7 days … I felt angry [3rd question]
Never Rarely Sometimes Often Always Estimated Anger = 50.5 SE = 3.9 (rel. = 0.85)

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In the past 7 days … I felt angrier than I thought I should [4th question] – Never Rarely Sometimes Often Always Estimated Anger = 48.8 SE = 3.6 (rel. = 0.87)

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In the past 7 days … I felt annoyed [5th question]
Never Rarely Sometimes Often Always Estimated Anger = 50.1 SE = 3.2 (rel. = 0.90)

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In the past 7 days … I made myself angry about something just by thinking about it. [6th question] Never Rarely Sometimes Often Always Estimated Anger = 50.2 SE = 2.8 (rel = 0.92)

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PROMIS Physical Functioning vs. “Legacy” Measures

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Is CAM Better than Standard Care (SC)?
Physical Health CAM > SC Mental Health SC > CAM

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Is Acupuncture Related to Worse HRQOL?
Subject Acupuncture General Health 1 No dead 2 No dead 3 No 50 4 No 60 5 No 70 6 Yes 40 7 Yes 50 8 Yes 50 9 Yes Yes 55 Group n HRQOL No Acupuncture Yes Acupuncture

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0.435

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HRQOL in SEER-Medicare Health Outcomes Study (n = 126,366)
Controlling for age, gender, race/ethnicity, education, income, and marital status.

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Physical Functioning and Emotional Well-Being at Baseline for 54 Patients at UCLA-Center for East West Medicine EWB Physical MS = multiple sclerois; ESRD = end-stage renal disease; GERD = gastroesophageal reflux disease. 37

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Significant Improvement in all but 1 of SF-36 Scales (Change is in T-score metric)
t-test prob. PF-10 1.7 2.38 .0208 RP-4 4.1 3.81 .0004 BP-2 3.6 2.59 .0125 GH-5 2.4 2.86 .0061 EN-4 5.1 4.33 .0001 SF-2 4.7 3.51 .0009 RE-3 1.5 0.96 .3400 EWB-5 4.3 3.20 .0023 PCS 2.8 3.23 .0021 MCS 3.9 2.82 .0067

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Effect Size (Follow-up – Baseline)/ SDbaseline Cohen’s Rule of Thumb:
ES = Small ES = Medium ES = Large

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Effect Sizes for Changes in SF-36 Scores
0.53 0.13 0.35 0.35 0.21 0.36 0.11 0.41 0.24 0.30 PFI = Physical Functioning; Role-P = Role-Physical; Pain = Bodily Pain; Gen H=General Health; Energy = Energy/Fatigue; Social = Social Functioning; Role-E = Role-Emotional; EWB = Emotional Well-being; PCS = Physical Component Summary; MCS =Mental Component Summary.

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Defining a Responder: Reliable Change Index (RCI)
Note: SDbl = standard deviation at baseline rxx = reliability

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Amount of Change in Observed Score Needed To be Statistically Significant
Note: SDbl = standard deviation at baseline and rxx = reliability

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Amount of Change in Observed Score Needed for Significant Individual Change
Scale RCI Effect size Cronbach’s alpha PF-10 8.4 0.67 0.94 RP-4 0.72 0.93 BP-2 10.4 1.01 0.87 GH-5 13.0 1.13 0.83 EN-4 12.8 1.33 0.77 SF-2 13.8 1.07 0.85 RE-3 9.7 0.71 EWB-5 13.4 1.26 0.79 PCS 7.1 0.62 MCS 0.73 43

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Amount of Change Needed for Significant Individual Change
Effect Size 1.33 0.67 0.72 1.01 1.13 1.07 0.71 1.26 0.62 0.73 PFI = Physical Functioning; Role-P = Role-Physical; Pain = Bodily Pain; Gen H=General Health; Energy = Energy/Fatigue; Social = Social Functioning; Role-E = Role-Emotional; EWB = Emotional Well-being; PCS = Physical Component Summary; MCS =Mental Component Summary.

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7-31% of People in Sample Improve Significantly
% Improving % Declining Difference PF-10 13% 2% + 11% RP-4 31% + 29% BP-2 22% 7% + 15% GH-5 0% + 7% EN-4 9% SF-2 17% 4% + 13% RE-3 15% EWB-5 19% PCS 24% + 17% MCS 11%

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Thank you. http://gim.med.ucla.edu/FacultyPages/Hays/
Powerpoint file at: 46

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