Assessment of Health Status. M9205 September19, 2000

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1 Assessment of Health Status M9205 September19, 2000

2 Health Status The degree to which an individual or population has achieved a state of complete physical, mental and social well-being, beyond the absence of disease or infirmity.

3 Questions: how healthy (ill) is this individual how healthy (ill) is this group of individuals how healthy (ill) is this community

4 Usually expressed as life expectancy infant mortality disease-specific death rate age-specific death rate

5 Can be asked at a single point in time at sequential points retrospectively

6 Can be compared Across geographic boundaries Across age groups Across social or cultural groups Across health services systems

7 Going beyond absence of disease ADL IADL SF-36 YPLL QALY DALY

8 ADL Activities of daily living Example: Medical Outcomes Study scale Self care (eating, bathing, toileting, dressing Mobility Communication Psychosocial adjustment Cognitive function Movement today is toward quality of life measures

9 IADL Instrumental Activities of Daily Living Intended to be more sensitive to areas of lesser disability Include such things as financial management shopping cooking travel

10 SF-36 Developed and used to compare self-reported health status across groups Includes mental as well as physical health Includes physical and social function role limits due to physical function or mental health pain and vitality health perception and general mental health

11 YPLL (Years of potential life lost) Comparisons of populations with different age distributions and causes of death All years as equivalent 65 used for international comparison Number of deaths in a group multiplied by the difference between the midpoint age at death and 65.

12 YPLL, example In a population, 5 individuals die at average age 44 of HIV-related causes; 10 die at age 61 of heart disease; 3 die at 12 of traffic injuries =21 x 5=105 YPLL to HIV 65-61=4 x 10=40 YPLL to heart disease 65-12=53 x 3=159 YPLL to injury

13 QALY (Quality Adjusted Life Years) Used for comparisons of populations with different disease distributions Defining quality is the problematic issue Range of value from 0 (death) to 1 (optimal health) assigned to year, and then summed

14 QALY, example Adult with poor health habits; MI at 48; kidney failure at 55; lives to =.9; 22-48=.7; 48-55=.6; 56-66=.4; 67-8= = 47.6 QALY s

15 Child born with cardiac irregularity; repaired by age 4; return of heart problems at 50; lives to =.4; 4-50=.9; 51-65= = 55 QALY s

16 DALY Similar to QALY, but with focus on disability. Uses similar scaling to identify degree of disability

17 Application to a population need to identify the midpoint of the population on any scale used or construct more complex measures around differing subgroups in the population

18 Why would you want to know any of these? to decide on needed program inputs to decide on relative impact of programs to establish program priorities

19 Basic issues: dimensions of health to be measured physical health Vs. mental health self-report Vs. external evaluator based on use of services or other observation

20 Limits of understanding of health status birth and death records? hospital admission/discharge records? insurance billing records? household survey?

21 Discussion of Bohpal Wilensky MMWR

22 References for next week Briggs LW, Rohrer JE, Ludke L, Hilsenrath PE, Phillips KT Geographic variation in primary care visits in Iowa HSR 30:5 (567-71) Liu LL, Clemens CJ, Shay DK et al 1997 The Safety of Newborn Early Discharge JAMA 278:4 (293-8). Phillips KA, Mayer ML, Aday LA Barriers to care among racial/ethnic groups under managed care. Health Affairs 19:4 (65-75).

23 References, cont. Singer M, Stopka T, Siano C, Springer K, Barton G, Khoshnood K, Heimer R, Gorry de Puga A, 2000 The social geography of AIDS and Hepatitis Risk: Qualitative Approaches for Assessing local differences in steril-syringe access among injection drug users. AJPH 90:7 ( ). Weinberger M, Oddone EZ, Henderson WG Does increased access to primary care reduce hospital readmissions? NEJM 334:22 ( )

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