Knowledge Item:
CA-Medical Outcomes-11
Maximum Degree of Improved Quality of Life as a Function of
the Type of Medical Project Providing Treatment
This Knowledge Item is a
follow-up to Knowledge
Item: CA-Quality of Life-50 and Knowledge
Item: CA-Quality of Life-51 which also present data on the days
that quality of life is maintained for a third group of projects,
Community Based Organizations, that provide psychosocial services with
linkages to medical care. This Knowledge Item follows up on the earlier
work by explicitly controlling for the clients stage of HIV disease, as
measured by a control factor of the earliest known CD4 count, and the
classification of factor as to whether the client had an AIDS-defining
condition during the course of the treatment episode. Since the CBO
projects did not collect data on medical test results or opportunistic
infections, their data is not used here. The data from one project
(with 38 patients) were not included in these analyses because that
project explicitly targeted AIDS patients at the
end of their lives by providing home healthcare under a managed care
model, and it was believed that the data from that project would skew the
results for the Managed Care projects.
The maximum change in quality of
life over the course of the treatment episode was estimated and is
related to a number of factors, including most importantly the relative ability of
two kinds of services–managed
medical care as opposed to comprehensive medical care including
"wrap-around" social services–to improve the overall quality of life of their
patients. The Comprehensive Medical Care providers had patients who obtained the
greatest increase in quality of life over the treatment episode. These results statistically control for the
initial baseline level of quality of life, differences due to
psychosocial and behavioral comorbidities, differences due to medical
condition near intake, and other patient
characteristics.
On average, the
patients in the University-based
Comprehensive Healthcare projects had an average increase of 19%, and
the patients in the Managed Care projects had an increase of 6%. Minor
variations in these estimates are shown in the Additional Statistics
section of this Knowledge Item; the different estimates are based on
controlling different factors including patient demographics, time in
program, time between assessments, initial quality of life level, and
other behaviors and vulnerabilities. These
results specifically correct for the medical health of the patients
(as assessed by CD4 classifications) near the time of enrollment
at the different projects.
Further analyses given in
Knowledge Items: CA-Quality
of Life and Health-37, -42,
-43, -50,
-51, and -39,
as well as Knowledge
Items: CA-Medical Outcomes-12 and
-13 show additional analyses that confirm that the projects with
wrap-around comprehensive psychosocial services, supplementing basic
medical services, tend to maintain the patient at the same or an
increased quality of life for a longer time, and with a greater ratio
of improvement, than just medical services. The additional Knowledge
Items use alternate statistical designs and models with different
factors "controlled," but the different methods of assessing
the relative effectiveness of these different types of service models
in achieving improved quality of life for the patients all point out
the importance of integrated psychosocial or "wrap-around"
services.
Note: The Maximum QOL
Improvement Ratio is the highest quality of life score recorded during
the patient's treatment episode divided by the baseline quality of life
score multiplied by 100. A ratio above 100 indicates improvement at
least one time after the baseline measurement while a ratio below 100
indicates that the patient declined after the baseline measurement.
Means presented above are adjusted for when, during the treatment
episode, the first and last assessments occurred.
More Information:
CHAID and CHAID Diagram
In interpreting this
Knowledge Item, and all others in this section on Medical Outcomes, remember that the ratings of quality of life, symptom
impact, and healthcare utilization are based on patient self reports
unless noted otherwise.
Knowledge Item Citation: Huba, G. J., Melchior, L. A., Panter, A. T., and the HRSA/HAB SPNS Cooperative Agreement Steering Committee (1998-2001). Knowledge Item:
CA-Medical Outcomes-11 from
HRSA/HAB's SPNS Cooperative Agreements on Innovative Models of Care, The Measurement Group Knowledge Base on HIV/AIDS Care, Online at
www.TheMeasurementGroup.com.
Last Updated:
March 25, 2005; data through June 15,
1999; analyses conducted March - November 2000.
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