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PubMed2000

Are patients at Veterans Affairs medical centers sicker? A comparative analysis of health status and medical resource use.

BACKGROUND: The Veterans Affairs (VA) health system has been criticized for being inefficient based on comparisons of VA care with non-VA care. Whether such comparisons are biased by differences between the VA patient population and the non-VA patient population is not known. Our objective is to determine if VA patients are different from non-VA patients in terms of health status and medical resource use. METHOD: We analyzed 128,099 records from the National Health Interview Survey for the years 1993 and 1994. We compared the VA patient population with the general patient population for self report on health status, number of medical conditions, number of outpatient physician visits, number of hospital admissions, and number of hospital days each year. RESULTS: The VA patient population had poorer health status (odds ratio [OR], 14.7; 95% confidence interval [CI], 10.7-20.2), more medical conditions (OR, 14; 95% CI, 10.5-18.7), and higher medical resource use compared with the general patient population (OR, 3.7 for 3 or more physician visits per year; OR 5.4 for 3 or more hospital admissions per year; OR, 7.7 for 21 or more days spent in a hospital per year). However, after controlling for health and sociodemographic differences, VA patients had similar resource use compared with the general patient population. CONCLUSION: Large differences in sociodemographic status, health status, and subsequent resource use exist between the VA and the general patient population. Therefore, comparisons of VA care with non-VA care need to take these differences into account. Furthermore, health care planning and resource allocation within the VA should not be based on data extrapolated from non-VA patient populations. Arch Intern Med. 2000;160:3252-3257.

Adult↗
PubMed1997

Evaluation of index and profile measures of health status in a randomized controlled trial. Comparison of the Medical Outcomes Study 36-Item Short Form Health Survey, EuroQol, and disease specific measures.

OBJECTIVES: The authors compare two generic measures of health status with disease-specific measures in a randomized controlled trial of transurethral resection of the prostate with laser vaporization prostatectomy for benign prostatic hypertrophy. METHODS: Patients entered into the trial completed the following questionnaires prior to treatment and at follow-up at 3 months and 1 year. The Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) is a generic measure that produces an eight-dimension profile as well as two summary measures of health status (the physical component score and the mental component score). The EuroQol provides two single index measures of health status; one intended to convey the utility (or lack of) that an individual derives from his or her own health state compared with alternative states and a second simple visual analog scale "thermometer" of health status. The American Urological Association symptom score and the Bothersome index are disease-specific indices of health status for use specifically with benign prostatic hypertrophy patients. RESULTS: The EuroQol indicates no statistically significant improvements with time for either arm of the trial. The SF-36 physical and general health perceptions domains indicates statistically significant improvements for the transurethral resection of the prostate arm alone at 3 months and 1 year, as do the physical summary score at the 3-month follow-up visit. The effect sizes of these improvements, however, are small, using standard criteria. In contrast, statistically significant differences are found with time for both transurethral resection of the prostate and laser prostatectomy on both disease-specific measures, which also indicate statistically significant superior outcome for the transurethral resection of the prostate arm compared with the laser arm. CONCLUSIONS: The results indicate that the disease-specific measures are more sensitive to change than the generic measures of outcome. Possible explanations for this are discussed.

Follow-Up Studies↗
PubMed1992

Identification of health status dimensions in a working-age population. An exploratory study.

With regard to health care there is a growing demand for comprehensive and reliable instruments of general health status measurement. In the Finnish Healthy Village Study, 427 men and 366 women of working age participated in a comprehensive health examination that included more than 120 physical, psychological, and social health status variables. On the basis of minimum correlation values, 37 health status variables were chosen for factor analytic study. Principal component factor analysis with varimax rotation identified six dimensions of health status: physical functioning, emotional state, perceived health, anthropometric state and blood pressure, social functioning, and biochemical state. These six factors accounted for 46% of the total variance of health status variables. Health profile analysis of both men and women revealed the same dimensions but in different order. Men ranked their self-rated general health more closely with their physical functioning, whereas women ranked it with perceived health. The identification of general health status dimensions has implications for planning health promotion programs and evaluating their outcomes.

Adult↗
PubMed2003

Adjustment for comorbidity in studies on health status in ESRD patients: which comorbidity index to use?

Health status can be an important outcome in studies on patients with end-stage renal disease (ESRD). In these studies, adjustment for prognostic factors, such as comorbidity, often has to be made. None of the comorbidity indices that are commonly used in research on ESRD patients has been validated for studies on health status. This study evaluated three existing indices (Khan, Davies, and Charlson) and four indices specifically developed for use in studies on health status. In a large prospective multi-center study (NECOSAD-2), new ESRD patients were included (n = 1041). Comorbidity was assessed at the start of dialysis. Health status was assessed with the physical and mental component summary score of the SF-36 (PCS and MCS), the symptoms dimension of the KDQOL-SF, and the Karnofsky Scale. Patient data were randomly allocated to a modeling or a testing set. The new indices were developed in the modeling set. The three existing indices explained about the same percentage of variance in the PCS (7 to 8%), MCS (1 to 3%), symptoms (2 to 4%), and Karnofsky (10 to 12%). The new indices performed better than the existing indices in the modeling population (13% PCS, 10% MCS, 10% symptoms, 18% Karnofsky), but not in the testing population (8% PCS, 1% MCS, 3% symptoms, 8% Karnofsky). Individual comorbidities explained more variance in PCS (10 to 15%), MCS (1 to 7%), symptoms (6 to 11%), and Karnofsky (11 to 18%) than comorbidity indices. The Khan, Davies, and the Charlson indices will adjust to the same extent for the potential confounding effect of comorbidity in studies with health status as an outcome. Separate comorbidity diagnoses will adjust best for comorbidity.

Aged↗
PubMed2000

Stages of disease severity and factors that affect the health status of patients with chronic obstructive pulmonary disease.

BACKGROUND: We hypothesized that the factors which may influence health status would differ in patients at different disease stages of chronic obstructive pulmonary disease (COPD). The present study investigated how impairments in health status were distributed in male patients at each disease stage according to the British Thoracic Society (BTS) guidelines, and analysed the contribution of the clinical indices, the dyspnoea rating and the psychological status to the health status of patients at the three disease stages of COPD. METHODS: A total of 218 consecutive male patients with stable COPD were recruited from our outpatient clinic. All eligible patients completed pulmonary function testing, progressive cycle ergometry, a dyspnoea rating [Medical Research Council (MRC) dyspnoea scale], an assessment of their anxiety and depression [Hospital Anxiety and Depression Scale (HADS)], and an assessment of their health status [the St. George's Respiratory Questionnaire (SGRQ)]. The patients were categorized into three groups: mild COPD with a FEV1 at 60-79% of the predicted value, moderate COPD at 40-59% of the predicted value, and severe COPD at below 40% of the predicted value. RESULTS: Twenty-five patients (11%) had mild COPD, 72 patients (33%) had moderate COPD, and 121 patients (56%) had severe COPD. Significant differences were observed for the total score and for three components on the SGRQ among patients at the three stages (one-way ANOVA, P<0.05). The scores for the total SGRQ and for the activity component were significantly higher for patients with severe COPD than for patients with moderate COPD [Fisher's least-significant-difference (LSD) method, P<0.05], and also significantly higher for moderate COPD patients than for mild COPD patients. The maximal oxygen uptake (VO2 max) correlated significantly with the total SGRQ score in the mild patients [Pearson's correlation coefficient (r) = -0.67], but not in the moderate or severe patients. The MRC dyspnoea scale had strong correlations with the SGRQ in all patient groups (r = 0.53 to approximately 0.70). Anxiety and depression on the HADS showed moderate correlations with the SGRQ score in the mild and severe patients (r = 0.51 to approximately 0.57). Multiple regression analysis showed that in patients with mild COPD, the MRC and VO2 max accounted for the total score on the SGRQ. Anxiety on the HADS plus the MRC scale accounted for the total score on the SGRQ in patients with moderate COPD, and anxiety on the HADS, the MRC scale and the FEV1 significantly influenced the SGRQ severe COPD patients. CONCLUSIONS: The disease staging proposed by the BTS guidelines can separate patients with COPD according to impairments in their health status. Furthermore, the factors that influence health status differed in patients at the three disease stages. Our findings support the boundaries used in disease staging and some recommendations from the BTS guidelines.

Aged↗
PubMed1988

Social networks and the functional health status of the poor: a secondary analysis of data from the National Survey of Personal Health Practices and Consequences.

This study uses data from the Wave I of the National Survey of Personal Health Practices and Consequences (N = 3025) to examine the relationship between social networks and the health status of the poor. No single category of networks was found to be consistently predictive of health status among the poor. The number of close friends, satisfaction with number of close ties, frequency of contact with network ties and church attendance were all significantly related to health status, but in no case were sufficient to bring health status levels of the poor up to the level of the nonpoor.

Adult↗
PubMed1999

Rural health status: what do statistics show that we don't already know?

Arguably the policies and programs designed to bring about improvements in the health status of rural and remote residents have been limited by the absence of systematic statistical data about health status and its relationship with place of residence. The Australian Institute of Health and Welfare addresses this problem in the recent report Health in rural and remote Australia. The report compares the health status, health risk factors and preventative measures, and health resources for rural, remote and urban areas. The data highlights that people in rural and remote areas of Australia have poorer health status than their metropolitan counterparts on several counts. While further work is required, the report provides a useful and important basis for identifying and monitoring the pattern of health status and resource availability in rural and remote Australia.

Australia↗
PubMed2001

Health status of Gypsy Travellers.

BACKGROUND: Although previous studies suggest that Gypsy Travellers have poorer health status and excess mortality compared with the general population, there is no epidemiological evidence using validated measures in this nomadic ethnic group. The aim of this study was to compare the health status of traditional Gypsy Travellers with norms from the UK population, and with a concurrent comparison group using the Euroqol health status measure (EQ-5D). METHODS: Eighty-seven adult Gypsy Travellers were matched for age and sex with English or Irish residents, registered with an urban general practice in an area of high social deprivation. Both samples completed the EQ-5D questionnaire by interview. A comparison was also made with normative data from the UK general population. RESULTS: Travellers had poorer health status than their settled counterparts on two of the five dimensions (mobility and activity) but not on the overall summary score. Travellers reported significantly poorer health than the matched comparison group on the EQ-5D visual analogue scale. Both the Travellers and the comparison group had much poorer health status on the EQ-5D index than the UK population norms, even when compared with the lowest socioeconomic group. CONCLUSIONS: Health status of Gypsy Travellers was significantly poorer than in the lowest socio-economic UK population group, but was not so markedly different from a concurrent, matched, socially deprived resident group. Gypsy Travellers did have poorer health status than matched comparators in relation to mobility, activity and perception of overall health. Quantitative assessment of health status in the Traveller community is feasible.

Activities of Daily Living↗
PubMed2006

The impact of four common lumbar spine diagnoses upon overall health status.

BACKGROUND CONTEXT: The Short Form 36 (SF-36) health survey has been shown to be a valid instrument when used to measure the self-reported physical and mental health of patients. The impact of lumbar spinal disorders can be assessed as the difference between the SF-36 scale scores and age- and gender-specific population norms. PURPOSE: To establish the impact upon the self-reported health status of patients with one of four common lumbar spinal diagnoses. STUDY DESIGN: A cross-sectional, observational assessment of the health status of spine patients. METHODS: Data from patients presenting to the participating centers of the National Spine Network with low back pain or leg pain were collected prospectively using the Health Status Questionnaire 2.0. A database search identified patients with either herniated nucleus pulposus with radicular pain (HNP), lumbar spinal stenosis without deformity (SPS), degenerative spondylolisthesis (DS), and painful disc degeneration/spondylosis (DDD). The mean SF-36 scale scores were generated for each of the diagnostic groups. The impact of these diagnoses on health status was determined as the calculated difference from the age- and gender-specific population norms for each of the eight health scale scores. These scores, usually negative in this population, represent how far below normal these patients are. The analysis was stratified according to the age of the patients (<40 years, 40-60 years, >60 years). Analysis of variance and pair-wise comparison with Bonferroni correction were used to assess the significance of differences across diagnosis and age groups. RESULTS: Data from a total of 4,442 patients were available for this study. All four diagnostic groups had large, negative impact scores for the eight general health scales with the greatest impact upon the three scales that best measure physical health. The greatest impact on these physical health scales (physical functioning, role-physical, and bodily pain) was seen in the HNP diagnostic group. The younger age groups (<40 years and 40-60 years) had the greatest physical impairment when compared with the age- and gender-specific population norms. Analysis of variance showed a significant relationship between diagnosis and SF-36 scores, and between age groups and SF-36 scores. CONCLUSIONS: All four lumbar spine disorders have a significant negative impact on all eight of the SF-36 scales. The greatest negative impact was seen in those scales that measure physical health (role limitations due to physical symptoms [RP], physical functioning [PF], and bodily pain [BP]). The HNP diagnostic group experienced a significantly greater impact upon these three scales. This diagnostic group had the youngest patients, whose baseline physical functional status would be expected to be the most optimal. When we stratified by age in all the diagnostic groups, the greatest negative impact scores for physical health were seen in the <40 years and 40-60 years age groups. These patients were also more likely to perceive their health as poor, experience decreased energy, and have more social impairment when compared with their age/gender norms.

Adult↗
PubMed2002

The reliability of self-assessed health status.

The use of self-assessed health status (SAHS) as a measure of health is common in empirical research. We analyse a unique Australian survey in which a random sub-sample of respondents answer a standard self-assessed health question twice-before and after an additional set of health related questions. A total of 28% of respondents change their reported health status. Response reliability is related to age, income and occupation. We also compare the responses of these individuals to other respondents who are queried only once, to isolate effects of question order and mode of administration.

Adolescent↗
PubMed2005

Do dialysis- and transplantation-related medical factors affect perceived health status?

BACKGROUND: Quality of life and perceived health status (PHS) are important indicators of patient care together with morbidity, mortality and health-care resource utilization. The aim of this study is to explore how various medical conditions might influence perceived health status. METHODS: The study sample consisted of 128 kidney transplant recipients. PHS was measured using the self-administered SF-36 questionnaire. Stepwise linear regression analysis of 17 demographic, dialysis-, transplantation- and co-morbidity-related factors was performed in order to explore predictors of worse PHS. RESULTS: Older age, female gender, lower education, increased number of hospitalizations during the dialysis period and diabetes mellitus were identified as significant predictors of worse PHS. Age was the most important predictor of PHS, explaining 23.3% of variance in the SF-36 physical component and 4.4% in the SF-36 mental component. Between age groups, major differences were found in predictors of perceived health status-serum creatinine was the most important for patients younger than 45 years and the number of hospitalizations for patients of 45 years and over. CONCLUSIONS: Biological and medical factors are significant predictors of the physical component of PHS, although they can explain only up to one-third of its variance. Other dimensions of PHS are weakly influenced by these medical parameters. It seems important to evaluate perceived health status separately among the age groups because they differ in their predictors.

Adolescent↗
PubMed1993

Asthma health status. Ongoing measurement in the context of continuous quality improvement.

There are no widely accepted measures of health status for asthmatic patients, and these must be developed. Criteria for good health status measures are described. Their intended use determines their form. The concepts of continuous quality improvement (CQI) are used here to define a new perspective about asthma health status measures. In the context of CQI, a patient-centered continuous measurement can be used to understand and reduce variance in health status. Ongoing health status measures can be applied to groups of patients or individuals. Medical students collected data about the health status of their asthmatic patients as part of a project to introduce them to CQI. These results are presented as an example of this new direction.

Asthma↗
PubMed1983

Dental health status of recipients of community dental health services.

A new information system was used routinely to monitor clinical dental services. Data on 20,729 courses of treatment support the validity and usefulness of continuously collected information about dental health status. Patients who had not attended a community clinic within the year before examination did not need courses of treatment that differed appreciably from those for patients who had attended within the previous year. Patients who attended without scheduled appointments had a lower prevalence of caries free primary dentitions than those with such appointments. Dentists with patients having more caries free permanent dentitions provided a higher number of courses of treatment a year.

Adolescent↗
PubMed2004

Health status of clients receiving methadone maintenance treatment using the SF-36 health survey questionnaire.

This study investigated the health status of a representative sample of clients (35 Maori, 72 non-Maori) receiving methadone maintenance treatment in New Zealand, using the SF-36 health survey. The publication of New Zealand norms in 1999 enabled comparisons of the health of the Methadone Treatment Programme study participants with that of the New Zealand population. Although over 50% of participants rated their health as good, very good or excellent, 44% rated their health as fair or poor and compared with population norms, the health of the study participants was significantly poorer on all eight SF-36 scales. Male and female participants rated their health similarly to male and female clients attending another New Zealand Methadone Treatment Programme. Results highlighted the impact of a chronic disorder and co-existing health-related problems on the health and well-being and day-to-day functioning of this client group. Higher frequency of benzodiazepine use was associated with poorer social functioning, mental health and role functioning and higher frequency of cannabis use was associated with poorer role functioning due to emotional problems. Findings support routine monitoring of health status with clients receiving methadone maintenance treatment as a guide to preventative and treatment interventions and health maintenance strategies.

Adult↗
PubMed1988

Poverty, health services, and health status in rural America.

Access to health services for everyone has been a major policy goal in the United States: inequitable access is assumed to lead to inequitable health status, particularly for low-income groups. A sophisticated model of the relation between poverty, health care needs, service use, and health outcomes is used to analyze cross-sectional data on 7,823 adults from 36 rural communities. Improved access and use are helpful, but evidence clearly indicates that combined health and social initiatives will be necessary to reduce inequalities in health status.

Cross-Sectional Studies↗
PubMed1999

Health status and satisfaction with pharmacy services.

OBJECTIVE: To evaluate the relationship between self-reported health status and satisfaction with pharmacy services. STUDY DESIGN: Secondary analysis of data previously collected via a computer-assisted telephone interview system. PATIENTS AND METHODS: Survey respondents were enrollees in a large managed care organization who were recent patrons of either traditional or mail pharmacy services. Satisfaction data were gathered using an existing satisfaction with pharmacy services survey. Health status was measured using the Medical Outcome Study's Short-Form 12-Item Health Survey. The relationships between satisfaction with pharmacy services and health status were analyzed using structural equation modeling. RESULTS: A significant positive relationship between mental health status and satisfaction with pharmacy services was hypothesized and confirmed. The correlations between mental health status and satisfaction, however, were not strong (r = .10 to .18). No relationship between physical health status and satisfaction with pharmacy services was observed. Similar results were observed in patrons of both traditional and mail pharmacy services. CONCLUSION: This investigation offers evidence that satisfaction with healthcare services is more closely related to mental health status than to physical health status. This has important implications for case-mix adjustments in the measurement of satisfaction with care.

Computer Communication Networks↗
PubMed1997

Association between time homeless and perceived health status among the homeless in San Francisco.

The purpose of this study was to describe the perceived health of the homeless, and to measure the effect of time homeless on perceived health status, after controlling for sociodemographic characteristics and health conditions. The design was cross-sectional; the population was a representative sample of homeless in San Francisco, interviewed on health issues. Analysis of predictors of poor or fair health status was by logistic regression. In this sample of 2780 persons, 37.4% reported that their health status was poor or fair as compared to good or excellent. Reporting poor or fair health status was significantly associated with time homeless, after controlling for sociodemographic variables and health problems including results from screening for HIV and TB (OR = 1.49, 95% CI 1.24-1.79). Comparisons with data from the National Health Interview Survey (NHIS) showed poorer health status among the homeless persons in this study. Standardized morbidity ratios were highest for asthma; there was twice the number of homeless persons reporting asthma, in younger as well as older adults, as would be expected using NHIS rates. There was also an excess of arthritis, high blood pressure and diabetes in those age 18-44 as compared to adults in the Health Interview Survey. The time spent homeless remains associated with self-reported health status, after known contributors to poor health are controlled. Persons who have been homeless for longer periods of time may be the persons to whom health care interventions should be aimed.

Adult↗