Measurement of health status in the 1990s.

The use of health-related quality of life measures, especially those based on function, are likely to increase during the next decade. This increase, however, is most likely to occur in clinical research and clinical practice. Unless the necessary political will, resources, data, and policy researchers coexist, there will be relatively little advance in the use of health status measures for decision-making and policy. This prediction is based on the observation that policy research tends to rely on available national data, that currently these data provide limited information about health status, and that there appears to be insufficient interest and resources to broaden data collection or to develop methods that incorporate a broad spectrum of health outcomes (e.g. death, impairment, functional status, and perceptions) into a single instrument or measure of health on large populations and communities. This state of affairs is particularly unfortunate as we face a decade in which available health and medical care may become more limited and social inequity in access and health status may become more marked. The effect of social inequities and restrictions to health care on the health of the nation cannot continue to be determined with reference only to the structure and process of the health care system. Health and quality of life outcomes are what count. And, these outcomes cannot be determined without appropriate and inclusive measures of health-related quality of life. Of course, we hope our prediction is wrong and that the motivation and resources will be found to help resolve methodologic issues in the measurement of population health status and quality of life and to provide the necessary data. We hope that government agencies, employers, and private providers will begin to collect health-related quality of life data on the constituents and populations they serve. Even if these data are imperfect or primitive, the effects of improving accessibility and quality of health care can only be assessed adequately in terms of the health-related quality of life of the nation.

[1]  R A Deyo,et al.  Comparative Validity of the Sickness Impact Profile and Shorter Scales for Functional Assessment in Low-Back Pain , 1986, Spine.

[2]  W. Frankenburg,et al.  Pediatric screening tests , 1975 .

[3]  D. Makuc,et al.  Use of Ambulatory Medical Care by the Poor: Another Look at Equity , 1981, Medical care.

[4]  R L Kane,et al.  Methodology for measuring health-state preferences--IV: Progress and a research agenda. , 1989, Journal of clinical epidemiology.

[5]  E. Nelson,et al.  The Measurement of Health Status in Clinical Practice , 1989, Medical care.

[6]  D. Patrick.  Commentary: Patient reports of health status as predictors of physiologic health in chronic disease , 1987 .

[7]  W. Frankenburg,et al.  The Denver developmental screening test. , 1967, The Journal of pediatrics.

[8]  I. J. Good,et al.  The estimation of the implicit utilities of medical consultants , 1970 .

[9]  D. Balaban,et al.  Patterns of Change in Disability and Well-Being , 1989, Medical care.

[10]  M H Branson,et al.  Active life expectancy. , 1983, The New England journal of medicine.

[11]  Nicky Hart.  Inequalities in Health: The Individual Versus the Environment , 1986 .

[12]  D J Balaban,et al.  Weights for Scoring the Quality of Well-being Instrument Among Rheumatoid Arthritics: A Comparison to General Population Weights , 1986, Medical care.

[13]  A. Stewart,et al.  The MOS short-form general health survey. Reliability and validity in a patient population. , 1988, Medical care.

[14]  S. Magura.  16. Wald MS: Family Preservation: Are We Moving Too Fast. We Need More Data on the Impact of Interventions with Children. Public Welfare, 1988. 17. Achenbach TM, Edelbrock C: Manual for the Child Behavior Checklist. Burlington, VT: , 1990 .

[15]  D L Patrick,et al.  Methods for measuring levels of well-being for a health status index. , 1973, Health services research.

[16]  M. Bergner.  Quality of Life, Health Status, and Clinical Research , 1989, Medical care.

[17]  M. Weinstein,et al.  Cost-effectiveness of interventions to prevent or treat coronary heart disease. , 1985, Annual review of public health.

[18]  J. Goldman,et al.  Psychological Methods of Child Assessment , 1984 .

[19]  R. Deyo,et al.  Generic and Disease-Specific Measures in Assessing Health Status and Quality of Life , 1989, Medical care.

[20]  Alan Williams,et al.  Economics and the Rational Use of Medical Technology , 1988 .

[21]  G. Loomes,et al.  The use of QALYs in health care decision making. , 1989, Social science & medicine.

[22]  D. Sullivan,et al.  A single index of mortality and morbidity. , 1971, HSMHA health reports.

[23]  J. Ware,et al.  Choosing measures of health status for individuals in general populations. , 1981, American journal of public health.

[24]  H. Dunn.  Points of attack for raising the levels of wellness. , 1957, Journal of the National Medical Association.

[25]  T. Parsons.  The Social System , 1953 .

[26]  D. Patrick.  Constructing Social Metrics for Health Status Indexes , 1976, International journal of health services : planning, administration, evaluation.

[27]  M. Weinstein,et al.  A cost-effectiveness analysis of exercise as a health promotion activity. , 1988, American journal of public health.

[28]  D. Patrick,et al.  Disablement in the Community , 1989 .

[29]  E. Diener,et al.  Subjective well-being. , 1984, Psychological bulletin.

[30]  M. Bergner.  Measurement of health status. , 1985, Medical care.

[31]  E B Perrin,et al.  Measuring the quality of medical care. A clinical method. , 1976, The New England journal of medicine.