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PubMed2001

General health status measures for people with cognitive impairment: learning disability and acquired brain injury.

BACKGROUND: Currently there is a wide range of health status measures that aim to assess general health status in people with cognitive impairment. However, the validity and/or applicability to this patient group are largely unknown. This has implications for the assessment of treatment outcomes and rehabilitation, for prognostic purposes, for planning services, and for determining the benefits and adverse effects of health technologies targeted at these patient groups. OBJECTIVES: (1) To identify the general health status measures that have been validated in patients with cognitive impairment. (2) To assess the extent to which these measures have been validated. (3) To draw out the implications of the findings for the use of existing measures and for future primary research in this area. METHODS. SELECTION CRITERIA: Studies that assessed general health status in people with cognitive impairment due to acquired brain injury (traumatic brain injury, cerebro-vascular accident or multiple sclerosis (MS)) or learning disability (LD) were included in the review. Studies that used general health status instruments measuring only one general health dimension, and studies that only featured participants with cognitive impairment due to dementia were excluded. METHODS. SEARCH STRATEGY: A wide range of relevant databases were searched for studies on cognitive impairment, general health status measures, and validation of health status measures. A handsearch of general health status bibliographies was also conducted. Data were collected on the general health status measure used, the population characteristics, aims of the study, validity details, and conclusions. RESULTS: The review includes data from 71 studies, reported in 83 separate publications. In total 34 different general health status measures were described in the 83 publications, with the Sickness Impact Profile (SIP) and the Short Form-36 (SF-36) the most frequently used measures (20 and 19 studies, respectively). These studies included a total of 98 instrument validations, 52 of which definitely or probably included people with cognitive impairment. Six measures were extensively validated (quality scores ranged from 0.25 to 0.5, on a scale from 0 to 1) in studies in which more than 50% of the respondents were people with cognitive impairment. A further three measures were also validated in studies in which more than 50% of the respondents were people with cognitive impairment, but their level of validation was more limited (quality scores ranged from 0.1 to 0.2). Five measures were validated in studies in which 20-50% of the respondents were cognitively impaired, which may limit their relevance to participants with cognitive impairment (quality scores ranged from 0.1 to 0.6). The SF-36 was also validated in two studies in which 20-50% of the respondents were cognitively impaired and the quality score was 0.3. Finally, nine of the measures were only validated in studies in which less than 20% of the respondents were cognitively impaired. For these measures it was unclear whether the findings applied to people with cognitive impairment. CONCLUSIONS: Very few measures have been validated specifically for cognitively impaired respondents. Studies where at least 50% of the respondents were cognitively impaired generally showed poorer validity results compared with studies with fewer cognitively impaired persons, indicating that general health status measures designed for the general population are not automatically suitable for people with cognitive impairment. The few measures that were specifically developed for people with cognitive impairment also reported poor validity results. Therefore, there are no validated instruments available for use in cognitively impaired respondents; existing measures, specifically designed for use in these populations, should be used with caution. The most promising measure is the MS-Quality of Life Interview (MS-QLI) for MS patients. The MS-QLI was thoroughly validated in 300 MS patients and the results were good, except for the 'social function' subscale. However, only 20-50% of the respondents in this study had cognitive impairment. Most information on the validity of general health status measures was found in studies among people with LD. For these patients, six measures were found that have been validated in a populations where more than 50% of the respondents were cognitively impaired LD patients. CONCLUSIONS: (1) Existing general health status measures should be used with caution in individuals with cognitive impairments. (2) There is no evidence to indicate the most suitable general health status measure for use in economic evaluations of cognitive impairment. (3) There is little evidence to support the validity of proxy assessments in cognitively impaired populations. (ABSTRACT TRUNCATED)

Brain Injuries↗
PubMed2001

Utilisation of private care by public primary care clinic attenders with diabetes: relationship to health status and social factors.

Private health care provision is important in most middle-income countries but factors influencing the demand for private care have not been well defined. This paper evaluated the relationships of health status and socio-economic variables with utilisation of private care by public primary care clinic attenders. The sample included 2117 randomly selected subjects with clinical diabetes attending 35 government health centres in Trinidad and Tobago. Measures included attendance at a private doctor, the type 2 Diabetes Symptom Checklist, the SF36 questionnaire, and indicators of socio-economic status. Of the sample, 1256 (59%) reported attending a private doctor, 577 (27%) attended a private doctor for diabetes, and 378 (18%) attended a private doctor regularly. Attendance at a private doctor was associated with lower SF36 scores. The odds ratio for a 10 unit increase in SF36 physical component score was 0.81, 95% confidence interval 0.72-0.91. After adjusting for demographic and social factors the relative odds were 0.89, 0.80 to 1.00. After allowing for differences in health status, the relative odds of attending for private care for those without a pipe borne water supply in the home, compared with those with water in the home, were 0.77, 0.63-0.94. Those living alone were less likely to attend a private doctor than those living with their children and partner (odds ratio 0.60, 0.43-0.83). Among people attending public clinics, the decision to utilise private care is sensitive to health status. After adjusting for health status, there was evidence for horizontal inequity in access to private care in relation to household amenities and composition.

Adult↗
PubMed1998

Patient perceived health status, hospital length of stay, and readmission after coronary artery bypass surgery.

This study evaluates the effect of length of stay and baseline health status on health status and readmission rates 3 months after coronary artery bypass graft surgery. Baseline health status showed a trend toward worse scores for patients who were readmitted. Readmitted patients had longer lengths of stay, and worse 3-month health status scores, and women and patients with heart failure had higher readmission rates. It may be possible to identify patients at risk for readmission using clinical variables, length of stay, and health status. If a predictive model can be developed, then interventions can be developed and tested to decrease the rate of unplanned readmissions.

Adult↗
PubMed1999

Treatment of osteonecrosis of the femoral head by free vascularized fibular grafting: an analysis of surgical outcome and patient health status.

OBJECTIVE: To evaluate the limb-specific outcome and general health status of patients with osteonecrosis of the femoral head treated with vascularized fibular grafting. DESIGN: A retrospective review. SETTING: A single tertiary care centre. PATIENTS: Fifty-five consecutive patients with osteonecrosis of the femoral head who underwent fibular grafting (8 bilaterally). INTERVENTION: Vascularized fibular grafting. OUTCOME MEASURES: Limb-specific scores (Harris Hip Score, St. Michael's Hospital Hip Score), general health status (Nottingham Health Profile, SF-36 health status survey) and radiographic outcome measures (Steinberg stage). RESULTS: Patients were young (mean age 34 years, range from 18 to 52 years) and 80% had advanced osteonecrosis (Steinberg stages IV and V). Fifty-nine hips were followed up for an average of 50 months (range from 24 to 117 months) after vascularized fibular grafting. Sixteen hips (27%) were converted to total hip arthroplasty (THA). To date, 73% of hips treated with vascularized fibular grafting have required no further surgery. Preoperative and postoperative Harris Hip Scores were 57.3 and 83.6 respectively (p < 0.001). As measured by patient-oriented health status questionnaires (SF-36, Nottingham Health Profile) and compared with population controls, patients had normal mental health scores and only slight decreases in physical component scores. CONCLUSIONS: Free vascularized fibular grafting for osteonecrosis of the femoral head provides satisfactory pain relief, functional improvement and general health status and halts the progression of symptomatic disease.

Adolescent↗
PubMed2004

Use of clinical services compared with patients' perceptions of and satisfaction with oral health status.

OBJECTIVES: To examine the relationship between rates of clinical service use and self-reported perception of and satisfaction with oral health status. METHODS: Dental services provision rates were calculated using health maintenance organization electronic data for members 55 years of age and older with at least four years of eligibility between 1990 and 2000. A mail survey yielded 986 responses (response rate = 65.7%). Poisson regression was used to examine the relationship between service utilization rates and self-reported perception of and satisfaction with oral health status, controlling for age, education, sex, and marital status. RESULTS: Perceptions of oral health status and levels of satisfaction with oral health status generally were closely associated. Greater dissatisfaction with oral health status and perception of poorer oral health status were associated with higher usage of nonpreventive dental services. Less satisfaction with oral health status was associated with higher restorative services usage and lower preventive services usage and slightly associated with periodontal service usage. Perception of a less favorable oral health status was strongly associated with higher restorative and periodontal services usage, but had only a weak association with preventive services usage. CONCLUSIONS: Dental plan members' service use is associated with their perception of their oral health status and their level of satisfaction with it. Future work should seek to clarify whether opinions on oral health status and satisfaction are a result of clinical experiences over time or whether the behavior and the values associated with seeking and obtaining care instead shape opinions on status and satisfaction.

Age Factors↗
PubMed1979

Measuring components of children's health status.

Measures of physical, mental and social components of health status and general health ratings were studied for children ages 0-4 (N = 679) and 5-13 (N = 1473). Questionnaires were completed by adult proxies (usually mothers) in three generally healthy populations. Hypothesized multi-item scales were tested; reliability was estimated and preliminary attempts at validation were undertaken. Items in ten scales pertaining to mental health (Anxiety, Depression, Positive Well-Being, Mental Health Index), social health (Social Relations), general health ratings (Current Health, Prior Health, Resistance/Susceptibility to Illness, General Health Rating Index), as well as parental satisfaction with child development satisfied Likert-type and discriminant validity criteria. Because functional limitation items were endorsed for very few children, scales to measure physical health could not be tested. Almost all scales were sufficiently reliable for group comparisons; reliability coefficients were lower in the most disadvantaged population. Interrelationships among scales and validity variables generally supported their construct validity and supported a multi-component model of children's health status.

Analysis of Variance↗
PubMed1996

Switching Swiss enrollees from indemnity health insurance to managed care: the effect on health status and stisfaction with care.

OBJECTIVES: In 1992, most members of a Swiss indemnity health insurance plan were automatically transferred into a newly created managed care organization. This study examined whether this semivoluntary change affected enrollees' health status and satisfaction with care. METHODS: Three groups of enrollees were compared: 332 plan members who accepted the switch (managed care joiners); 186 plan members who opted to maintain indemnity coverage (non-joiners); and 296 persons continuosly enrolled in another indemnity plan (indemnity plan members). Health status, health related behaviors, and satisfaction with care received in the previous year were surveyed at baseline and 1 year later. RESULTS: Health status remained unchanged in all three groups. Smoking prevalence decreased among managed care joiners but remained constant in the other groups. Satisfaction with insurance coverage increased between baseline and follow-up in managed care joiners, but decreased in nonjoiners and indemnity plan members. The latter groups had higher satisfaction with health care, particularly with continuity of care. CONCLUSIONS: A semivoluntary switch from indemnity health insurance to managed care reduced satisfaction with health care but increased satisfaction with insurance coverage. There were no changes in self-perceived health status.

Adult↗
PubMed1997

The impact of asthma on the health status of adolescents.

OBJECTIVE: To identify a characteristic pattern of health and illness for adolescents with asthma, we compared the health status of teenagers with asthma to those without asthma using a recently developed generic health status instrument, the Child Health and Illness Profile, Adolescent Edition (CHIP-AE). METHODS: This was a cross-sectional survey using a school sample of 3109 teenagers. Participants completed the CHIP-AE during school in northern Baltimore City, rural western Maryland, and rural Arkansas. The health and functioning scores of teens without asthma ("well" group) were compared with those with asthma with and without recent wheezing. RESULTS: Of the 12% who reported that a physician had ever told them they had asthma, 50% had problems with wheezing in the past 28 days. Compared with well teenagers, those with asthma and recent wheezing had lower perceived well-being, more physical and emotional symptoms, greater limitations in activity, more comorbidities, and more negative behaviors that threaten social development. These findings held true in multivariable regression models that controlled for sociodemographics and sites of data collection. Teenagers with asthma without recent wheezing reported a greater number of comorbidities than well teens and showed similar trends in health status as those with recently symptomatic asthma. CONCLUSIONS: Multiple aspects of adolescent health status are affected by asthma, particularly if it is recently symptomatic. These results argue for incorporating a generic health status instrument, such as the CHIP-AE, in studies that document the health needs or outcomes of medical care for populations of teenagers with asthma.

Adolescent↗
PubMed1986

A comparison of the effects of sociodemographic factors and health status on use of outpatient mental health services in HMO and fee-for-service plans.

The authors compared the effects of age, sex, socioeconomic status, and mental and physical health status on the use of outpatient mental health services in one well-established health maintenance organization (HMO) and in fee-for-service plans. In the Seattle site of the Rand Health Insurance Study (HIS), families were randomly assigned to HMO or fee-for-service coverage. Adults incur much greater expense for outpatient mental health services than children in both an HMO and a fee-for-service plan with identical coverage (i.e., free care). However, the difference in use between adults and children is significantly greater for the fee-for-service plan than the HMO (P less than 0.01). Similarly, education has significantly greater effects on use for the fee-for-service than the HMO plan. Increased income has a significant negative effect on use in both the HMO and fee-for-service plans. Mental and physical health status have similar large effects on use in both fee-for-service and HMO plans.

Adult↗
PubMed2003

Quality of life after hip fracture: a comparison of four health status measures in 208 patients.

OBJECTIVES: We compared four health status measures for the evaluation of quality of life after hip fracture. METHODS: Two hundred and eight elderly hip fracture patients were followed up to 4 months after hospital admission. We used two interviewer-administered instruments (the Rehabilitation Activities Profile (RAP) and the Barthel Index (BI)) that focus on functional status, and two self-assessment instruments (the Nottingham Health Profile (NHP) and the COOP/WONCA charts) that additionally include psychological and social health domains. The score distribution, internal consistency, construct validity, and sensitivity to change were investigated. RESULTS: At 4 months only 18% of surviving patients had reached the same level of functioning as before the fracture and, compared with reference values, lower scores of health status were found in the areas of physical mobility and emotional reactions. The number of comorbidities at hospital admission was the most important prognostic factor for recovery of health status at 4 months. The RAP and the BI both performed well in the assessment of functional status in regard to score distribution, internal consistency and construct validity. In contrast to the BI, the RAP also assessed instrumental activities of daily living and perceived problems with existing disabilities. The generic health status measures produced no added value in the assessment of functional status. The NHP covered a wider range of psychological health dimensions (emotion, pain, energy, and sleep) and had better psychometric properties than COOP/WONCA. None of the four instruments performed well in assessing social functioning. CONCLUSIONS: To assess health status after hip fracture, we recommend the RAP for functional status and the NHP for changes in emotion, pain, and energy. These instruments detected poor recovery in functional and emotional status at 4 months after fracture.

Activities of Daily Living↗
PubMed2005

Paternal involvement in the management of pediatric chronic diseases: associations with adherence, quality of life, and health status.

OBJECTIVES: This article reports associations among paternal involvement in pediatric chronic disease management and child outcomes. METHODS: The Dads' Active Disease Support scale (DADS) and measures of treatment adherence, quality of life, health status, and health care utilization were obtained for youths with six chronic diseases, with complete data sets obtained from 190 couples. RESULTS: Paternal involvement was not associated with these outcomes among younger children. Among adolescents, mother-reported and father-reported DADS scores indicating more paternal involvement were associated with maintenance, rather than deterioration, of treatment adherence and more favorable quality of life. Youths' health status and health care utilization were not related significantly to paternal involvement. CONCLUSIONS: More paternal involvement was associated with more favorable adherence and quality of life among adolescents but not associated with health status or health care utilization. Longitudinal studies could verify whether paternal involvement merits clinical intervention.

Adaptation, Psychological↗
PubMedDate not supplied

Health behaviors, health status, and access to and use of health care: a population-based study of lesbian, bisexual, and heterosexual women.

BACKGROUND: There is a dearth of validated information about lesbian and bisexual women's health. To better understand some of these issues, we used population-based data to assess variations in health behaviors, health status, and access to and use of health care based on sexual orientation. METHODS: Our study population was drawn from a population-based sample of women, the 1997 Los Angeles County Health Survey. Participants reported their sexual orientation and these analyses included 4697 women: 4610 heterosexual women, 51 lesbians, and 36 bisexual women. We calculated adjusted relative risks to assess the effect of sexual orientation on important health issues. RESULTS: Lesbians and bisexual women were more likely than heterosexual women to use tobacco products and to report any alcohol consumption, but only lesbians were significantly more likely than heterosexual women to drink heavily. Lesbians and bisexual women were less likely than heterosexual women to have health insurance, more likely to have been uninsured for health care during the preceding year, and more likely to have had difficulty obtaining needed medical care. During the preceding 2 years, lesbians, but not bisexual women, were less likely than heterosexual women to have had a Papanicolaou test and a clinical breast examination. CONCLUSIONS: In this first population-based study of lesbian and bisexual women's health, we found that lesbians and bisexual women were more likely than heterosexual women to have poor health behaviors and worse access to health care. These findings support our hypothesis that sexual orientation has an independent effect on health behaviors and receipt of care, and indicate the need for the increased systematic study of the relationship between sexual orientation and various aspects of health and health care. Arch Fam Med. 2000;9:1043-1051

Adult↗
PubMed2006

Measuring health status and decline in at-risk seniors residing in the community using the Health Utilities Index Mark 2.

PURPOSE: The purpose of this study was to assess the responsiveness of one measure of HRQL, the HUI Mark 2 (HUI2), to changes in health status over time in an older community-based population. METHODS: The sample consisted of 192 individuals age 65 and over residing in their homes and receiving health and support services in Calgary, Canada. Subjects received three assessments at 6-month intervals using the HUI2, to measure health-related quality of life (HRQL), and the Minimum Data Set for Home Care (MDS-HC) for demographic and health status information. Change scores were calculated as the difference between scores at the second and third assessments. The relationship between the HUI2 and other measures of health status were examined using t-tests and ANOVA. Associations between the magnitude of decline in HUI2 and declines on other measures were examined using multiple linear regression. RESULTS: Lower HUI2 scores were significantly associated with the presence of depressive symptoms, impairment in activities of daily living (ADL), and clinical instability at baseline. Over 6 months of follow-up, HUI2 decline was associated with worsening depressive symptoms, increase in the number of chronic conditions, and age 85 and over. CONCLUSION: The HUI2 measure of HRQL in older persons at risk for institutionalization appears to reflect health status at a point in time and to be responsive to changes in health status over time.

Activities of Daily Living↗
PubMed2006

Effect of motivational interviewing-based health coaching on employees' physical and mental health status.

Motivational Interviewing (MI) based health coaching is a relatively new behavioral intervention that has gained popularity in public health because of its ability to address multiple behaviors, health risks, and illness self-management. In this study, 276 employees at a medical center self-selected to participate in either a 3-month health coaching intervention or control group. The treatment group showed significant improvement in both SF-12 physical (p = .035) and mental (p = .0001) health status compared to controls. Because of concerns of selection bias, a matched case-control analysis was also performed, eliciting similar results. These findings suggest that MI-based health coaching is effective in improving both physical and mental health status in an occupational setting.

Adult↗
PubMed1992

Health status of the community becoming focus of MHS (Mercy Health Services) system. Interview by Donald E.L. Johnson.

Since hospitals exist to stabilize and improve the health of the people they serve, they should form community health care systems that offer the full spectrum of services in an organized way, says Edward J. Connors, president of Mercy Health Services, in the following interview with Donald E.L. Johnson, editor and publisher of Health Care Strategic Management. Skills in epidemiology are desperately needed to accomplish this, as well as skills in statistics, information systems and outcomes measurement. Connors believes that a consensus has formed on the core content of health status measurement. Hospitals should start building the information base needed to improve the health status of their target population.

Catchment Area, Health↗
PubMed1997

Prospective versus retrospective measurement of change in health status: a community based study in Geneva, Switzerland.

STUDY OBJECTIVES: To compare prospective and retrospective measurements of change in health status. DESIGN: Health status was measured using a French language version of the short form 36 (SF-36) health survey on two occasions one year apart--in 1992 and 1993. Differences in SF-36 scores measured prospectively were compared with the patients' single item retrospective evaluation of change in health (transition item). SETTING: This was a community based study among members of two health insurance plans in Geneva, Switzerland. PARTICIPANTS: Altogether 831 young adults (mean age 30 years at baseline). MAIN RESULTS: Health status remained stable on average during the study period. The retrospective rating correlated well with changes in health measured prospectively: those who said in 1993 that their current health was "much worse" than in 1992 experienced an average decrease of 1.06 SD on the eight SF-36 scales, while those who said that their health was "much better" recorded an average improvement of 0.43 SD. The associations between prospective and retrospective assessments of change were approximately linear for all scales but physical functioning. The transition item also discriminated between time periods: transition reported for 1991-92 did not correlate with changes recorded for 1992-93. Relative validity analyses indicated that the transition item was better suited to capture changes in general health than changes in purely physical or mental aspects of health. CONCLUSIONS: The concordance between retrospective and prospective measures of change in health suggests that both are sensitive, to some extent, to true changes in health status. Using both types of assessment may improve the reliability of measurements of change.

Adult↗
PubMed1989

The relationship between retrospective health insurance claims and a health risk appraisal-generated measure of health status.

This research examined the relationship between a measure of health status (defined as the health index--the difference between actual and appraised ages) derived from a health risk appraisal and retrospective health insurance claims taken from one cooperating work organization. A model was defined consisting of 3-year retrospective medical claims as the criterion and age and the health index as predictors. Using a cube-root transformation of medical claims, a significant inverse relationship for age and the health index was identified for men. No relationships were found for women. It was concluded that, for men when age is held constant, a negative relationship exists between retrospective medical claims and a health risk appraisal-generated health status indicator, the health index.

Adult↗
PubMed1996

Effects of dietary crude protein, breed, parity, and health status on the fertility of dairy cows.

A study was conducted to determine the impact of dietary CP (13% vs. 20%), parity (first vs. second lactation or later), and breed (Holstein vs. Jersey) on the reproductive efficiency of dairy cows. Sixty-four cows were blocked by parity and breed and assigned to one of two treatments. Cows were removed from treatments on d 100 or 120 depending on pregnancy status. Cows were categorized by health status based on the occurrence of postparturient disorders. Plasma urea N concentrations were influenced by diet (8.6 vs. 21 mg/dl, 13 and 20% CP, respectively), parity, and breed. Reproductive indices were not influenced by diet except that days to first estimated ovulation increased for cows fed the 20% CP diet when health status was added to the model. Days to first observed estrus, first AI service, and cumulative pregnancy rate were affected by health status. Regression analysis for survival showed an interaction of diet and health status for days open. High CP diets tended to increase days open when cows had major health problems; otherwise, a high CP diet decreased days open. The implementation of a strict reproductive management program allowed high reproductive efficiency goals to be achieved regardless of plasma urea N concentrations.

Animals↗