3 Measures that Assess Patient Quality of Life

February 18, 2020 - In healthcare, the concept of patient quality of life is essential. After all, neither provider nor patient wants to begin a new treatment path if it’s going to seriously reduce quality of life.

The trouble is, quality of life is really hard to understand, and to that end, measure. Because it can mean something different to various patients, industry leaders and individual providers may struggle to prioritize patient quality of life.

According to the World Health Organization, health-related quality of life goes beyond just being free of disease.

“The Constitution of the World Health Organization (WHO) defines health as ‘A state of complete physical, mental, and social well-being not merely the absence of disease…’” the organization writes on its website.

“WHO defines Quality of Life as an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns,” WHO continues. “It is a broad ranging concept affected in a complex way by the person's physical health, psychological state, personal beliefs, social relationships and their relationship to salient features of their environment.”

Other US-based public health leaders corroborate that definition, acknowledging that quality of life depends on patient health in the context of a patient’s lifestyle and social needs.

“The construct of HRQOL enables health agencies to legitimately address broader areas of healthy public policy around a common theme in collaboration with a wider circle of health partners, including social service agencies, community planners, and business groups,” according to the Centers for Disease Control and Prevention (CDC).

And because quality of life is so personal, it can be exceptionally difficult to assess. Health status, plus the social determinants of health and other lifestyle needs, sway providers’ abilities to fully understand how a patient feels about her health.

Nonetheless, healthcare has taken a step toward measuring quality of life. Using various different measures, medical professionals and researchers have established methods for understanding how a patient feels about her own health and have worked to make use of that information.

Although these measures may use different vocabularies or have different applications, they are all rooted in a single theme: hearing from the patient about her own quality of life is essential to measuring it.

The “Healthy Days Measure”

Developed by the CDC, the “Healthy Days Measure” looks at how patients perceive their own health. Specifically, the measure covers the following:

• Would you say that in general your health is excellent, very good, good, fair or poor?
• Now thinking about your physical health, which includes physical illness and injury, how many days during the past 30 days was your physical health not good?
• Now thinking about your mental health, which includes stress, depression, and problems with emotions, how many days during the past 30 days was your mental health not good?
• During the past 30 days, approximately how many days did poor physical or mental health keep you from doing your usual activities, such as self-care, work, or recreation?

Part of the Healthy Days Measure looks at the counter, the “Unhealthy Days Measure,” which combines the number of physically unhealthy days and mentally unhealthy days.

If an individual experiences three days of just being physically unhealthy and two days of being just mentally unhealthy, she has experienced five unhealthy days that month. These are determined by questions two and three listed above.

Patient-reported outcomes measures (PROMs)

Patient-reported outcomes measures, known in short as PROMs, are essential measures of healthcare quality that specifically look at the way in which a certain procedure or treatment impacted patient’s daily life.

PROMs are “any report of the status of a patient’s health condition that comes directly from the patient, without interpretation of the patient’s response by a clinician or anyone else,” according to the National Quality Forum (NQF). “In other words, PRO tools measure what patients are able to do and how they feel by asking questions.”

These metrics are often integrated into other clinical quality measures in an effort to better understand the way a certain procedure met industry benchmarks as well as improved patient physical and cognitive functioning. PROMs measure the outcome of a treatment, not the process, shining an important light on the outcomes of certain procedures.

PROMs examine physical health, including pain levels and sleep quality, as well as mental health concerns such as anxiety, depression, fatigue, and social function.

Some common PROM questions include:

• In general, please rate how well you carry out your usual social activities and roles. (This includes activities at home, at work and in your community, and responsibilities as a parent, child, spouse, employee, friend, etc.)
• To what extent are you able to carry out your everyday physical activities such as walking, climbing stairs, carrying groceries, or moving a chair?
• How often have you been bothered by emotional problems such as feeling anxious, depressed or irritable?
• In general, how would you rate your physical health?

Other PROMs include more specific prompts catered to an individual procedure or specialist encounter.

There are also PROMs designed for older adult patients, pediatric patients, and family caregivers.

Quality Adjusted Life Years (QALYs)

The Quality Adjusted Life Year (QALY) differs from the other quality of life measures mentioned because it manages to quantify quality of life. Healthcare leaders and researchers around the globe use the QALY to put a dollar amount to a certain healthcare intervention, working to assess return on investment (ROI) and other factors that drive decisions to implement a strategy.

“The QALY is primarily used in cost-effectiveness analyses to guide decisions regarding the distribution of limited health care resources among competing health programs or interventions for a population of interest, but has also been used to aid decisions regarding clinical management and individual patient care,” wrote M. Bryant Howren, from the University of Iowa, in a glossary entry on Springer.

Researchers use the measure to better understand the cost of using a certain intervention to improve quality of life for an individual patient or population.

“Quality adjusted life years (QALYs) are an outcome measure used to asses both the quantity and quality of life lived with a specific disease or after a given treatment,” according to researchers from the Kaiser Family Foundation’s Health System Tracker.

For example, public health leaders are currently using the QALY to assess the cost of some social determinants of health programming. A food security program used the QALY to understand how much it would cost to improve quality of life and survivorship for an individual patient for one year.

Patient-centered care is only slated to become a bigger priority in healthcare, and with it, the idea of improving the quality of life for patients. As more healthcare professionals work toward this goal, understanding the key ways to measure quality of life will be essential.