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The significance of quality of life in health care

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Abstract

This paper compares a traditional biomedical model with an outcomes model for evaluating health care. The traditional model emphasizes diagnosis and disease-specific outcomes. In contrast, the outcomes model emphasizes life expectancy and health-related quality of life. Although the models are similar, they lead to different conclusions with regard to some interventions. For some conditions, diagnosis and treatment may reduce the impact of a particular disease without extending life expectancy or improving quality of life. Older individuals with multiple co-morbidities may not benefit from treatments for a particular disease if competing health problems threaten life or reduce quality of life. In preventive medicine, diagnosis of disease is made more difficult because of ambiguity, uncertainty, lead-time bias, and length bias. In some circumstances, successful diagnosis and treatment may actually reduce life expectancy or overall life quality. Example applications of the outcomes model from clinical policy analysis, individual decision making and shared decision-making are offered. The outcomes model has received little attention in dental health care but may have parallels to applications in other areas of medicine.

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References

  1. Kaplan RM. Shared medical decision making: A new paradigm for behavioral medicine. Ann Behav Med 1999; 21(1): 3–11.

    Google Scholar 

  2. Ackoff RL. Systems thinking and thinking systems. Syst Dyn Rev 1994; 10(2-3): 175–188.

    Google Scholar 

  3. Carter RB. Descartes' Medical Philosophy: The Organic Solution to the Mind-Body Problem. Baltimore MD: Johns Hopkins University Press, 1988.

    Google Scholar 

  4. Checkland P. Systems theory and management thinking. Am Behav Sci 1994; 38(1): 75–91.

    Google Scholar 

  5. Ackoff RL, Gharajedaghi J. Reflections on systems and their models. Syst Res 1996; 13: 13–23.

    Google Scholar 

  6. Holman HR, Lorig KR. Patient education: Essential to good health care for patients with chronic arthritis (editorial, comment). Arthritis Rheum 1997; 40(8): 1371–1373.

    Google Scholar 

  7. Ware JE Jr, Bayliss MS, Rogers WH, Kosinski M, Tarlov AR. Differences in 4-year health outcomes for elderly and poor, chronically ill patients treated in HMO and fee-forservice systems. Results from the Medical Outcomes Study. JAMA 1996; 276(13): 1039–1047.

    Google Scholar 

  8. Kaplan RM, The Ziggy theorem: Toward an outcomesfocused health psychology. Health Psychol 1994; 13(6): 451–460.

    Google Scholar 

  9. McGinnis JM, Foege WH. Actual causes of death in the United States. JAMA 1993; 270(18): 2207–2212.

    Google Scholar 

  10. Coronary Primary Prevention Trial Group. The Lipid Research Clinics Coronary Primary Prevention Trial results. I. Reduction in incidence of coronary heart disease. JAMA 1984; 251(3): 351–364.

    Google Scholar 

  11. Golomb BA. Cholesterol and violence: Is there a connection? Ann Intern Med 1998; 128(6): 478–487.

    Google Scholar 

  12. Kaplan RM. Behavior as the central outcome in health care. Am Psychol 1990; 45: 1211–1220.

    Google Scholar 

  13. Fisher ES, Welch HG. Avoiding the unintended consequences of growth in medical care: How might more be worse? JAMA 1999; 281(5): 446–453.

    Google Scholar 

  14. Eddy DM. Clinical decision making: From theory to practice. Principles for making difficult decisions in difficult times. JAMA 1994; 271(22): 1792–1798.

    Google Scholar 

  15. Zir LM, Miller SW, Dinsmore RE, Gilbert JP, Harthorne JW. Interobserver variability in coronary angiography. Circulation 1976; 53(4): 627–632.

    Google Scholar 

  16. Detre KM, Wright E, Murphy ML, Takaro T. Observer agreement in evaluating coronary angiograms. Circulation 1975; 52(6): 979–986.

    Google Scholar 

  17. Schnitt SJ, Connolly JL, Tavassoli FA, et al. Interobserver reproducibility in the diagnosis of ductal proliferative breast lesions using standardized criteria. Am J Surg Pathol 1992; 16(12): 1133–1143.

    Google Scholar 

  18. Rothwell PM, McDowell Z, Wong CK, Dorman PJ. Doctors and patients don't agree: Cross sectional study of patients' and doctors' perceptions and assessments of disability in multiple sclerosis. Br Med J (Clin Res Ed) 1997; 314(7094): 1580–1583.

    Google Scholar 

  19. Shiels C, Hutchinson A, Eccles M, Smoljanovic L. Accuracy and reliability of assessment of severity of illness before and after an educational intervention. J Eval Clin Pract 1996; 2(4): 265–271.

    Google Scholar 

  20. Unsworth CA, Thomas SA, Greenwood KM. Rehabilitation teams decisions on discharge housing for stroke patients. Arch Phys Med Rehabil 1995; 76(4): 331–340.

    Google Scholar 

  21. Kendall BS, Ronnett BM, Isacson C, et al. Reproducibility of the diagnosis of endometrial hyperplasia, atypical hyperplasia, and well-differentiated carcinoma. Am J Surg Path 1998; 22(8): 1012–1019.

    Google Scholar 

  22. Sylvester PA, Wong NA, Warren BF, Ranson DL. Unacceptably high site variability in postmortem blood alcohol analysis. J Clin Path 1998; 51(3): 250–252.

    Google Scholar 

  23. Frierson HF Jr, Wolber RA, Berean KW, Franquemont DW, Gaffey MJ, Boyd JC. Interobserver reproducibility of the Nottingham modification of the Bloom and Richardson histologic grading scheme for infiltrating ductal carcinoma. Am J Clin Pathol 1995; 103(2): 195–198.

    Google Scholar 

  24. Drapá JL, Pessis E, Auleley GR, Chevrot A, Dougados M, Ayral X. Quantitative MR imaging evaluation of chondropathy in osteoarthritic knees. Radiology 1998; 208(1): 49–55

    Google Scholar 

  25. Naitoh M, Yuasa H, Toyama M, Shiojima M, Ushida M, Iida H. Observer agreement in the detection of proximal caries with direct digital intraoral radiography. Oral Surg Oral Med Oral Path Oral Radiol Endod 1998; 85(1): 107–112

    Google Scholar 

  26. Bright AS, Torpey B, Magid D, Codd T, McFarland EG. Reliability of radiographic evaluation for acromial morphology. Skeletal Radiol 1997; 26(12): 718–721.

    Google Scholar 

  27. Mussurakis S, Buckley DL, Coady AM, Turnbull LW, Horsman A. Observer variability in the interpretation of contrast enhanced MRI of the breast. Br J Radiol 1996; 69(827): 1009–1016.

    Google Scholar 

  28. Dahlström L, Lindvall AM. Assessment of temporomandibular joint disease by panoramic radiography: Reliability and validity in relation to tomography. Dentomaxillofaci Radiol 1996; 25(4): 197–201.

    Google Scholar 

  29. Jarvik JG, Haynor DR, Koepsell TD, Bronstein A, Ashley D, Deyo RA. Interreader reliability for a new classification of lumbar disk disease. Acad Radiol 1996; 3(7): 537–544.

    Google Scholar 

  30. Wennberg JE. The Dartmouth Atlas of Health Care in the United States. Hanover, NH: Trustees of Dartmouth College, 1998.

    Google Scholar 

  31. Fisher ES, Wennberg JE, Stukel TA, Sharp SM. Hospital Readmission Rates for Cohorts of Medicare Beneficiaries in Boston and New Haven. New England J Med 1994; 331(15); 989–995.

    Google Scholar 

  32. Gold MR, Siegel JE, Russell LB, Weinstein MC. Cost-Effectiveness in Health and Medicine. New York: Oxford University Press, 1996.

    Google Scholar 

  33. Kaplan RM, Anderson JP. The general health policy model: An integrated approach. In: Spilker B (ed), Quality of Life and Pharmacoeconomics in Clinical Trials. New York: Raven, 1996; 309–322.

    Google Scholar 

  34. Kaplan RM, Ganiats TG, Sieber WJ, Anderson JP. The Quality of Well-Being Scale: Critical similarities and differences with SF-36. Int J Qual Health Care 1998; 10(6): 509–520.

    Google Scholar 

  35. Field MJ, Gold MR. Summarizing Population Health, Washington DC, Institute of Medicine, 1998.

    Google Scholar 

  36. Lopez AD, Murray CC. The global burden of disease, 1990-2020 (news). Nat Med 1998; 4(11): 1241–1243.

    Google Scholar 

  37. Black WC, Welch HG. Advances in diagnostic imaging and overestimations of disease prevalence and the bene-fits of therapy. New Engl J Med 1993; 328(17): 1237–1243.

    Google Scholar 

  38. American Cancer Society. Cancer Facts and Figures-1999, Atlanta: American Cancer Society, 1999.

    Google Scholar 

  39. Eddy DM. Screening for breast cancer. Ann Int Med 1989; 111(5): 389–399.

    Google Scholar 

  40. Fletcher SW.Whither scientific deliberation in health policy recommendations? Alice in the Wonderland of breast-cancer screening. New Engl J Med 1997; 336(16): 1180–1183.

    Google Scholar 

  41. Black WC, Welch HG. Screening for disease. Am J Roentgenol 1997; 168(1): 3–11.

    Google Scholar 

  42. Welch HG, Black WC. Using autopsy series to estimate the disease 'reservoir' for ductal carcinoma in situ of the breast: How much more breast cancer can we find? Ann Intern Med 1997; 127(11): 1023–1028.

    Google Scholar 

  43. Landis SH, Murray T, Bolden S, Wingo PA. Cancer statistics, 1999. CA Cancer J Clin 1999; 49(1): 8–31.

    Google Scholar 

  44. Benson MC, Whang IS, Pantuck A, Ring K, Kaplan SA, Olsson CA. Prostate specific antigen density: A means of distinguishing benign prostatic hypertrophy and prostate cancer. J Urol 1992; 147(3 Pt 2): 815–816.

    Google Scholar 

  45. Smith DS, Catalona WJ. The nature of prostate cancer detected through prostate specific antigen based screening. J Urol 1994; 152(5 Pt 2): 1732–1736.

    Google Scholar 

  46. Kaplan RM. Breast cancer screening: When to begin? In: Blechman AE, Brownell KD (eds), Behavioral Medicine and Women: A Comprehensive Handbook, New York: Guilford Publications, 1998; 213–220.

    Google Scholar 

  47. Wingo PA, Ries LA, Rosenberg HM, Miller DS, Edwards BK. Cancer incidence and mortality, 1973-1995: A report card for the U.S. Cancer 1998; 82(6): 1197–1207.

    Google Scholar 

  48. Middleton RG. Prostate cancer: Are we screening and treating too much? (Editorial, comment). Ann Intern Med 1997; 126(6): 465–467.

    Google Scholar 

  49. (a) Coley CM, Barry MJ, Fleming C, Fahs MC, Mulley AG. Early detection of prostate cancer. Part II: Estimating the risks, benefits, and costs. American College of Physicians. Ann Intern Med 1997; 126(6): 468–479;

    Google Scholar 

  50. (b) Coley CM, Barry MJ, Fleming C, Mulley AG. Early detection of prostate cancer. Part I: Prior probability and effectiveness of tests. The American College of Physicians. Ann Intern Med 1997; 126(5): 394-406.

    Google Scholar 

  51. Optenberg SA, Thompson IM. Economics of screening for carcinoma of the prostate. Urol Clin North Am 1997; 17(4): 719–737.

    Google Scholar 

  52. Fowler FJ Jr, Barry MJ, Lu-Yao G, Wasson JH, Bin L. Outcomes of external-beam radiation therapy for prostate cancer: A study of Medicare beneficiaries in three surveillance, epidemiology, and end results areas. J Clin Oncol 1996; 14(8): 2258–2265.

    Google Scholar 

  53. Fleming C, Wasson JH, Albertsen PC, Barry MJ, Wennberg JE. A decision analysis of alternative treatment strategies for clinically localized prostate cancer. Prostate Patient Outcomes Research Team. JAMA 1993; 269(20): 2650–2658.

    Google Scholar 

  54. Krahn MD, Mahoney JE, Eckman MH, Trachtenberg J, Pauker SG, Detsky AS. Screening for prostate cancer. A decision analytic view. JAMA 1994; 272(10): 773–780.

    Google Scholar 

  55. Fisher B. Cancer surgery: A commentary. Cancer Treat Rep 1984; 68(1): 31–41.

    Google Scholar 

  56. Frosch D, Kaplan RM. Shared medical decision making. Am J Prev Med 1999; 17(4): 285–294.

    Google Scholar 

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Kaplan, R.M. The significance of quality of life in health care. Qual Life Res 12 (Suppl 1), 3–16 (2003). https://doi.org/10.1023/A:1023547632545

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