Concepts And Measurement Of Quality Of Life In Health Care

This volume brings together a number of scholarly studies on the definition, assessment and measurement of human quality of life. The book contains fundamental analyses of basic concepts such as welfare, wellbeing, happiness and quality of life itself, but contains also discussions on the application of such concepts for measuring purposes mainly in a health care context. Although the approach to these problems in the book is predominantly philosophical, there are also some studies which take a different, mainly sociological and medical, point of view. Most of the authors have a Scandinavian origin and their essays mirror the current debate on quality of life in northern Europe. The book however also contains contributions by distinguished scholars from the U.K., France, Italy and the Netherlands.

Questions concerning the notion of quality of life, its definition, and its ap plications for purposes of assessment and measurement in social and medical contexts, have been widely discussed in Scandinavia during the last ten years. To a great extent this discussion mirrors the international develop ment in the area. Several methods for the assessment and measurement of quality of life have been borrowed from the UK and the US and then further developed in northern Europe. But there has also been an internal develop ment. This holds in particular for the social arena, where Scandinavia has had a special tradition both in theory and practice. In this volume an attempt is made to illustrate some aspects of the philo sophical, and in general theoretical, discussion concerning quality of life in Scandinavia. In addition, some prominent scholars from other parts of Europe, i. e. , France, the Netherlands, the UK and Italy, have been invited to contribute. The volume is divided into three sections. The first contains philosophical analyses of the general notion of quality of life and proposes a number of different explications. The second section considers various ap plications of the notion of quality of life in health care. The papers serve to disentangle some intellectual and ethical problems that stem from these ap plications. The third section is more practical and focuses on methods of measuring quality of life in medicine and health care.

The National Roundtable on Health Care Quality was established in 1995 by the Institute of Medicine. The Roundtable consists of experts formally appointed through procedures of the National Research Council (NRC) who represent both public and private-sector perspectives and appropriate areas of substantive expertise (not organizations). From the public sector, heads of appropriate Federal agencies serve. It offers a unique, nonadversarial environment to explore ongoing rapid changes in the medical marketplace and the implications of these changes for the quality of health and health care in this nation. The Roundtable has a liaison panel focused on quality of care in managed care organizations. The Roundtable convenes nationally prominent representatives of the private and public sector (regional, state and federal), academia, patients, and the health media to analyze unfolding issues concerning quality, to hold workshops and commission papers on significant topics, and when appropriate, to produce periodic statements for the nation on quality of care matters. By providing a structured opportunity for regular communication and interaction, the Roundtable fosters candid discussion among individuals who represent various sides of a given issue.

This volume, developed by the Observatory together with OECD, provides an overall conceptual framework for understanding and applying strategies aimed at improving quality of care. Crucially, it summarizes available evidence on different quality strategies and provides recommendations for their implementation. This book is intended to help policy-makers to understand concepts of quality and to support them to evaluate single strategies and combinations of strategies.

Quality, as exemplified by Quality-of-life (QoL) assessment, is frequently discussed among health care professionals and often invoked as a goal for improvement, but somehow rarely defined, even as it is regularly assessed. It is understood that some medical patients have a better QoL than others, but should the QoL achieved be compared to an ideal state, or is it too personal and subjective to gauge? Can a better understanding of the concept help health care systems deliver services more effectively? Is QoL worth measuring at all? Integrating concepts from psychology, philosophy, neurocognition, and linguistics, this book attempts to answer these complex questions. It also breaks down the cognitive-linguistic components that comprise the judgment of quality, including description, evaluation, and valuations, and applies them to issues specific to individuals with chronic medical illness. In this context, quality/QoL assessment becomes an essential contributor to ethical practice, a critical step towards improving the nature of social interactions. The author considers linear, non-linear, and complexity-based models in analyzing key methodology and content issues in health-related QoL assessment. This book is certain to stimulate debate in the research and scientific communities. Its forward-looking perspective takes great strides toward promoting a common cognitive-linguistic model of how the judgment of quality occurs, thereby contributing important conceptual and empirical tools to its varied applications, including QoL assessment.

Patient-reported outcomes (PROs) are measures of how patients feel or what they are able to do in the context of their health status; PROs are reports, usually on questionnaires, about a patient's health conditions, health behaviors, or experiences with health care that individuals report directly, without modification of responses by clinicians or others; thus, they directly reflect the voice of the patient. PROs cover domains such as physical health, mental and emotional health, functioning, symptoms and symptom burden, and health behaviors. They are relevant for many activities: helping patients and their clinicians make informed decisions about health care, monitoring the progress of care, setting policies for coverage and reimbursement of health services, improving the quality of health care services, and tracking or reporting on the performance of health care delivery organizations. We address the major methodological issues related to choosing, administering, and using PROs for these purposes, particularly in clinical practice settings. We include a framework for best practices in selecting PROs, focusing on choosing appropriate methods and modes for administering PRO measures to accommodate patients with diverse linguistic, cultural, educational, and functional skills, understanding measures developed through both classic and modern test theory, and addressing complex issues relating to scoring and analyzing PRO data.

The rubric "Quality of Life" first came to the explicit attention of the medical profession a little over thirty years ago. Despite the undoubted fact that each one of us has his or her own Quality of Life, be it good or bad, there is still no general agreement about its definition, or the manner in which it should be evaluated. Although much has been written about quality of life, this work has been largely concerned with population-based studies, especially in health policy & health economics. The importance of individual quality of life has been neglected, in part because of a failure to define quality of life itself with sufficient care, in part perhaps because of a belief that it is impossible to develop a meaningful method of measuring individual variables. It is a fundamental belief of the editors of this book that the primary focus of quality of life is & must continue to be the individual, who alone can define it & assess its changing personal significances. The individual perspective is of vital importance not only to patients but to their doctors too, & is more & more frequently proposed as the most meaningful measure of outcome in clinical research, especially in non-remitting or chronic conditions. Workers who wish to consider wider aspects of influences on the illnesses suffered by individuals & the health care that they receive will find much to stimulate them in the methods of documentation proposed in this book. Those mainly concerned with population samples rather than individuals may also find the sensitive methods of investigation proposed here not only to be applicable to their own areas of interest, but also rewarding in perhaps unexpected ways.

This work presents the first serious attempt to impose rigor on the definition and measurement of quality of life among the elderly. The book uses a conference to develop background but goes well beyond the meeting in terms of depth of reviews of the literature and of integration among the chapters.This book is intended for use by researchers in the many disciplines which focus on the mental and physical well-being of the elderly, including those in medicine, nursing, psychiatry, psychology, rehabilitation, sociology and social work, among others. In addition, this book provides important background information for professionals and policy makers interested in ensuring quality of life in the later years.