Complete summary of the course 'BMS 56: Health outcome measurement' of the master's program Biomedical Sciences of the Radboud university Nijmegen. Includes all information of the lectures, self study assignments and work groups.
Week 1
Measurements are central to clinical practice, being the basis of diagnosis, prognosis and
evaluation of results.
Measurement of health can be done in different ways, resulting in different outcomes:
- Tests and measures → clinical outcomes (blood pressure, glucose levels, etc.)
- Patient reporting → patient reported outcomes PROs (pain, depression, etc.)
PROs are assessed with patients reported outcome measures (PROMs), which can be
questionnaires or single item scales. They show the aspect of the patient’s health status that is
coming directly from the patient. They are used for several measurements:
- To evaluate the effectiveness of clinical interventions
- To guide individual patient care during patient-clinician interaction by involving the
patient in goal setting and improving self-efficacy
- To improve quality by combining individual data from audits or feedback
- To report on patient choice and value-based payments
PROMs measurement is expected to contribute to high value healthcare
, Conceptual models
To categorize different domains in health, models exist. One of these models is the Wilson &
Cleary ‘health related quality of life’ (HRQL) model, in which biological/physiological variables,
symptoms, functional status, health perceptions and quality of life are distinguished. In diabetes
mellitus 2, for example, this model will show the physiological disturbances but also the altered
functional status of the patient:
- Biological and physiological variables: disturbed insulin production and high glucose
levels in the blood
- Characteristics of the individual: their personal motivation and coping behaviour
- Environmental characteristics: their work environment, stress levels, support systems
- Non-medical factors: financial situation and place of residence
The Wilson & Cleary model is also used to hypothesize causal pathways through which different
factors influence HRQL. The arrows indicate the most important flows of influence.
Left side of the model:
- Diagnosis of the patient
- Treatment outcome when dependent on clinical outcome measurements
- Performances done by clinicians (except PROs)
- Objective measures
Functional status is either an outcome of disease or a diagnosis
Right side of the model:
- Outcome measures (perceived health and HRQL)
- Outcomes measured by PROs only
- Subjective measures
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