Knowledge Item: CA-Medical Outcomes-19
More Complex Hierarchical Linear Models Showing Differential Change in Karnofsky Severity Ratings for Groups Formed by Needs and Vulnerabilities

Hierarchical Linear Modeling (or HLM) methods are used to study change in Karnofsky Severity Ratings over time. For each person, an individual trend is line fit to that patient's quality of life scores over time. The method uses all observations for individual patients and takes into account the fact that patients received the assessments at different times in their treatment histories. After fitting "individual" curves for each patient, overall trends in the "average curves" or "trajectories" are studied and related to other factors. HLM modeling can be considered the "definitive" method for studying change in the kinds of naturally-occurring treatment assessment data from these projects.

The hierarchical models show that on the average patients experience decreasing Karnofsky Severity Ratings over the course of their involvement with the programs represented here. This Knowledge Item studies the rate of change as a function of different service needs and vulnerabilities of the patient. A number of service needs-vulnerabilities are related to both the initial Karnofsky Severity Rating of the patient at the time of enrollment into the program and to the rate of change throughout the program but these relationships are fairly small.

On Average,

• There is a statistically significant decrease in Karnofsky Ratings over time, but it is relatively tiny in magnitude over a year. Clients are seen by their clinicians as slightly more ill.

• There is no statistically significant differential change in Karnofsky Severity Ratings over time by Gender. 

• There is no statistically significant differential change in Karnofsky Severity Ratings over time by Project Type.

• There is no statistically significant differential change by  the Gender by Project Type interaction.

• Degree of change in Karnofsky Ratings over time is largely unrelated to patient need and vulnerability factors.

This test of the difference in rate of estimated change is not statistically significant.

This test of the difference in rate of estimated change is not statistically significant.

This test of the difference in rate of estimated change is not statistically significant.

This test of the difference in rate of estimated change is statistically significant.

Click graphic to expand. (IE 6 users may also have to click the graphic expansion button in the new window.)

This test of the difference in rate of estimated change is not statistically significant.

Click graphic to expand. (IE 6 users may also have to click the graphic expansion button in the new window.)

This test of the difference in rate of estimated change is statistically significant.

This test of the difference in rate of estimated change is not statistically significant.

This test of the difference in rate of estimated change is not statistically significant.

This test of the difference in rate of estimated change is not statistically significant.

This test of the difference in rate of estimated change is not statistically significant.

This test of the difference in rate of estimated change is not statistically significant.

This test of the difference in rate of estimated change is not statistically significant.

This test of the difference in rate of estimated change is not statistically significant.

This test of the difference in rate of estimated change is not statistically significant.

This test of the difference in rate of estimated change is not statistically significant.

This test of the difference in rate of estimated change is statistically significant.

This test of the difference in rate of estimated change is not statistically significant.

This test of the difference in rate of estimated change is statistically significant.

This test of the difference in rate of estimated change is not statistically significant.

This test of the difference in rate of estimated change is not statistically significant.

This test of the difference in rate of estimated change is not statistically significant.

This test of the difference in rate of estimated change is not statistically significant.

This test of the difference in rate of estimated change is not statistically significant.

This test of the difference in rate of estimated change is not statistically significant.

This test of the difference in rate of estimated change is not statistically significant.

This test of the difference in rate of estimated change is not statistically significant.

This test of the difference in rate of estimated change is not statistically significant.

This test of the difference in rate of estimated change is statistically significant.

This test of the difference in rate of estimated change is not statistically significant.

This test of the difference in rate of estimated change is not statistically significant.

This test of the difference in rate of estimated change is not statistically significant.

This test of the difference in rate of estimated change is not statistically significant.

This test of the difference in rate of estimated change is not statistically significant.

This test of the difference in rate of estimated change is not statistically significant.

This test of the difference in rate of estimated change is not statistically significant.

This test of the difference in rate of estimated change is statistically significant.

This test of the difference in rate of estimated change is not statistically significant.

This test of the difference in rate of estimated change is not statistically significant.

This test of the difference in rate of estimated change is not statistically significant.

This test of the difference in rate of estimated change is statistically significant.

Knowledge Base Citation: The Knowledge Base and this Knowledge Item were designed and authored by G. J. Huba, Ph.D.; in collaboration with Lisa A. Melchior, Ph.D.; A. T. Panter, Ph.D.; and the staff of The Measurement Group. Cite this work as "Huba, G. J., Melchior, L. A., and Panter, A. T. (1998 - 2001). The Measurement Group Knowledge Base on HIV/AIDS Care. On the World Wide Web: http://www.TheMeasurementGroup.com."

Questions or Comments: Contact The Measurement Group.

Use of Knowledge Base Information: Acceptable Uses and Limitations.

Collaborators from Participating Projects: Cooperative Agreement Steering Committee 1999. 

Participating Projects: This Knowledge Base is based on the service delivery experiences of 27 Cooperative Agreement Projects on Innovative Models of HIV/AIDS Care. These projects and the Evaluation and Dissemination Center which produced this Knowledge Base were funded by the Health Resources and Services Administration (HRSA), HIV/AIDS Bureau (HAB) as Special Projects of National Significance (SPNS) between 1994 and 1999. Click the Model Programs button above for descriptions of the projects that contributed to this specific Knowledge Item, a list of key staff, and project grant numbers.

Why This Evaluation was Conducted: Editorial.

More Information: Design of this Knowledge Base.

Recommended Citation Format for Web Materials: American Psychological Association Publication Manual Section, Revised 2001.

Work on the Knowledge Base and the cross-cutting evaluation was supported in part by Grant Number 5 U90 HA 00030-05 from the Health Resources and Services Administration (HRSA), HIV/AIDS Bureau's (HAB) Special Projects of National Significance (SPNS). The contents of this Knowledge Base are solely the responsibility of The Measurement Group and do not necessarily represent the official views of HRSA or HRSA/HAB's Special Projects of National Significance nor may they represent the positions of the individual grantees whose projects are included in the cross-cutting evaluation.

© Copyright 2005 by The Measurement Group LLC. All rights reserved.