It is fundamental to measure the individual value of different medical interventions in order to prioritise resources. Preference-based approaches can produce measures that allow comparisons of such values. This volume covers altruism within families, differences in risk attitudes, and estimation of health benefits of food safety.
Patient-reported outcomes (PROs) are measures of how patients feel or what they are able to do in the context of their health status; PROs are reports, usually on questionnaires, about a patient's health conditions, health behaviors, or experiences with health care that individuals report directly, without modification of responses by clinicians or others; thus, they directly reflect the voice of the patient. PROs cover domains such as physical health, mental and emotional health, functioning, symptoms and symptom burden, and health behaviors. They are relevant for many activities: helping patients and their clinicians make informed decisions about health care, monitoring the progress of care, setting policies for coverage and reimbursement of health services, improving the quality of health care services, and tracking or reporting on the performance of health care delivery organizations. We address the major methodological issues related to choosing, administering, and using PROs for these purposes, particularly in clinical practice settings. We include a framework for best practices in selecting PROs, focusing on choosing appropriate methods and modes for administering PRO measures to accommodate patients with diverse linguistic, cultural, educational, and functional skills, understanding measures developed through both classic and modern test theory, and addressing complex issues relating to scoring and analyzing PRO data.
The Measurement of Health and Health Status: Concepts, Methods and Applications from a Multidisciplinary Perspective presents a unifying perspective on how to select the best measurement framework for any situation. Serving as a one-stop shop that unifies material currently available in various locations, this book illuminates the intuition behind each method, explaining how each method has special purposes, what developments are occurring, and how new combinations among methods might be relevant to specific situations. It especially emphasizes the measurement of health and health states (quality-of-life), giving significant attention to newly developed methods. The book introduces technically complex, new methods for both introductory and technically-proficient readers. - Assumes that the best measure depends entirely on the situation - Covers preference-based methods, classical test theory, and item response theory - Features illustrations and animations drawn from diverse fields and disciplines
This dissertation aims at developing and testing a new method that can better capture preferences for multistate health profiles. The motivation arose from the failure of the QALY (Quality-Adjusted Life Year) model in adequately capturing preferences in multistate health profiles. The current QALY-based technique captures preferences for multistate health profiles by evaluating each health state in the profile independently of other states. As the past literature showed, this additive independence condition does not hold in practice and hence such approach is inadequate. To address this issue, this study proposes a novel approach to measure preferences for multistate health profiles by looking at two consecutive health states at a time. It hypothesizes that an evaluation of the future health state is dependent or "conditioned" on the level of the preceding, or current, health state. Characteristics of the current health state that are suspected to impact the resulting?conditional preference scores? for future health state are systematically explored in a carefully designed empirical study. The interested factors include duration of the current health state, direction of change and amplitude of change between the current and future health states. A 23 full factorial design with three replications is used to explore main effects and their interactions. In a subsequent experiment, this study tests whether the proposed technique, which assesses "conditional preference scores" for discrete health states, can better predict preference scores for an entire health profile than the current unconditional QALY-based technique. In this subsequent study, duration-weighted conditional preference scores, duration-weighted unconditional preference scores, and duration-weighted holistic preference scores are compared for 10 hypothetical health profiles. Visual analog scale is used as an elicitation technique throughout the experiment. The ultimate goal of this study is to enable more accurate cost-effectiveness analyses, which sequentially will lead to better healthcare resource allocation decisions. This dissertation concludes with the results and discussions of the effects of the current health state characteristics on the preference evaluation of future health state as well as the potential of the proposed technique in capturing preferences for multistate health profiles. Implications for other related fields and future research are also discussed.
Health literacy-the ability for individuals to obtain, process, and understand basic health information and services to facilitate appropriate health decisions-is increasingly recognized as an important facet of health care and health outcomes. Although research on health literacy has grown tremendously in the past decade, there is no widely agreed-upon framework for health literacy as a determinant of health outcomes. Most instruments focus on assessing an individual's health literacy, yet the scope of health literacy reaches far beyond an individual's skills and abilities. Health literacy occurs in the context of the health care system, and therefore measures of health literacy must also assess the demands and complexities of the health care systems with which patients interact. For example, measures are needed to determine how well the system has been organized so that it can be navigated by individuals with different levels of health literacy and how well health organizations are doing at making health information understandable and actionable. To examine what is known about measures of health literacy, the Institute of Medicine convened a workshop. The workshop, summarized in this volume, reviews the current status of measures of health literacy, including those used in the health care setting; discusses possible surrogate measures that might be used to assess health literacy; and explores ways in which health literacy measures can be used to assess patient-centered approaches to care.
The National Roundtable on Health Care Quality was established in 1995 by the Institute of Medicine. The Roundtable consists of experts formally appointed through procedures of the National Research Council (NRC) who represent both public and private-sector perspectives and appropriate areas of substantive expertise (not organizations). From the public sector, heads of appropriate Federal agencies serve. It offers a unique, nonadversarial environment to explore ongoing rapid changes in the medical marketplace and the implications of these changes for the quality of health and health care in this nation. The Roundtable has a liaison panel focused on quality of care in managed care organizations. The Roundtable convenes nationally prominent representatives of the private and public sector (regional, state and federal), academia, patients, and the health media to analyze unfolding issues concerning quality, to hold workshops and commission papers on significant topics, and when appropriate, to produce periodic statements for the nation on quality of care matters. By providing a structured opportunity for regular communication and interaction, the Roundtable fosters candid discussion among individuals who represent various sides of a given issue.
It has become trite to observe that increases in health care costs have become unsustainable. How best for policy to address these increases, however, depends in part on the degree to which they represent increases in the real quantity of medical services as opposed to increased unit prices of existing services. And an even more fundamental question is the degree to which the increased spending actually has purchased improved health. Accounting for Health and Health Care addresses both these issues. The government agencies responsible for measuring unit prices for medical services have taken steps in recent years that have greatly improved the accuracy of those measures. Nonetheless, this book has several recommendations aimed at further improving the price indices.
This User’s Guide is a resource for investigators and stakeholders who develop and review observational comparative effectiveness research protocols. It explains how to (1) identify key considerations and best practices for research design; (2) build a protocol based on these standards and best practices; and (3) judge the adequacy and completeness of a protocol. Eleven chapters cover all aspects of research design, including: developing study objectives, defining and refining study questions, addressing the heterogeneity of treatment effect, characterizing exposure, selecting a comparator, defining and measuring outcomes, and identifying optimal data sources. Checklists of guidance and key considerations for protocols are provided at the end of each chapter. The User’s Guide was created by researchers affiliated with AHRQ’s Effective Health Care Program, particularly those who participated in AHRQ’s DEcIDE (Developing Evidence to Inform Decisions About Effectiveness) program. Chapters were subject to multiple internal and external independent reviews. More more information, please consult the Agency website: www.effectivehealthcare.ahrq.gov)
A new edition of this practical guide for clinicians who are developing tools to measure subjective states, attitudes, or non-tangible outcomes in their patients, suitable for those who have no knowledge of statistics.
