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Allied Health: Articles of Interest Use of Quality of Life Assessment Tools in Healthcare The use of Quality of Life (QOL) measurements has become increasingly popular in the healthcare arena. The goal of using these tools is to quantify the more subjective factors associated with the concept of Quality of Life, such as perception of health, impact of symptoms and satisfaction with general health. And thus, ultimately aid in the provision of evidence-based outcome measurement to satisfy the scrutiny related to healthcare expenditures (Jenney & Campbell, 997). Typically, health-related QOL tools assess a person’s perception throughout several core domains, such as physical well being, psychosocial functioning, support systems, financial burden and general functioning. Quality of Life tools can be divided into two broad categories: generic tools and disease-specific tools. Generic QOL tools are designed to provide comparative information on a varied patient population, both healthy and unhealthy. Disease-specific tools, such as the many developed for asthma, are more sensitive to the subtle changes associated with the disease course and include domains and items that are more troublesome for each particular disease (Janssens, 2001). For example, asthma-specific tools measure the impact of cough at night or perceptions of sleep quality. Many clinicians choose to utilize both generic and disease-specific tools, however, the time it takes to administer both tools is usually a limiting factor. The usefulness of tools can be determined through the establishment of validity and reliability. Validity looks at the design of a tool—does it measure what it is supposed to, and how accurate are the resulting scores? Validity has several facets: face validity (logical), content validity (coverage of all the key areas needed to give accurate results), criterion validity (comparison of the findings to an established tool), and construct validity (wording and placement of the items). Reliability answers whether the tool measures consistently. Inter-rater reliability demonstrates the consistency of the tool when used by different data collectors on the same subjects. Reliability also assesses the stability of the tool—the ability to produce the same responses over time from the same participants. For a more comprehensive review of “Measurement Properties” see the excellent resource provided on the ATS Web site (www.atsqol.org). Clearly, there are constraints to the use of a QOL tool in pediatrics, due to questionable responses from children caused by variation in language skill, verbal comprehension, and poor perceptive ability (Annett, 2001). The simple solution of asking the parent or caregiver to respond for the child has, in some studies, shown a poor correlation between proxy scores (derived from parental responses on behalf of the child) and children’s scores. Nonetheless, the parents’ report of their child’s perception of QOL does give a clinician useful information. Another key constraint in pediatric use of QOL tools is cognitive maturity. A child’s perception of “health” changes with maturity; therefore the concepts regarding illness change from the concrete to the abstract as well (Jenney, 1997). Many tools have been developed to reliably capture these changes by using age-specific measurements. Healthcare providers can enhance many aspects of patient care through use of QOL measurement. Whether the results produce findings that are statistically or clinically significant, it is important to utilize findings to enhance the patient’s treatment plan, thus achieving optimal well being and functional independence. I encourage clinicians to incorporate QOL tools in their practice or research to document the tangible effects of their care in the lives of patients. Thanks to Lonnie Roy, PhD, Children’s Medical Center of Dallas, for his assistance. References: Annett, R. D. (2001). Assessment of health status and quality of life outcomes for children with asthma. Journal of Allergy and Clinical Immunology, 107(Suppl.), 473-481. Janssens, J. (2001). When and how to assess quality of life in chronic lung disease. Swiss Medical Weekly, 131, 623-629. Jenney, M. E. & Campbell, S. (1997) Measuring quality of life. Archives of Disease in Childhood, 77, 347-354. |
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