Knowledge Item:
CA-Medical Outcomes-29
Relationship of Change in Quality of Life, CD4 Counts, Karnofsky
Ratings, and Viral Loads
This Knowledge Item examines the
level of change shown for patients in terms of four major indicators
of self-rated quality of life, medical-provider-rated disease severity
(Karnofsky Severity
Ratings), CD4 count, and viral load. That is, the
Knowledge Item looks at the correspondence of estimated change in two
medical test results, clinician ratings of illness severity, and
patient ratings of quality of life. This
Knowledge Item uses as its way of operationalizing the degree of
change, the slope parameters from the hierarchical linear modeling
analyses, or the degree to which there is sustained and consistent
change throughout the treatment episode.
The numerous statistical analyses of this Knowledge Item show three
major principles of change in these patients.
Principle I: Patients initially low in CD4 Counts and high in viral
loads will have the greatest change toward health (that is, increasing
levels of CD4 cells and decreasing viral loads). Less ill patients will
not change as much.
Principle II: Patients initially functioning poorly psychomedically as
measured by low levels of self-rated quality of life and poor
functioning on the Karnofsky Severity index will tend to improve the
most.
Principle III: Changes toward greater medical health (higher CD4 counts,
lower viral loads) are largely uncorrelated with the degree of change
rated by the medical practitioner (via the Karnofsky Severity Rating)
or
the patient (through the health related quality of life scale).
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-29 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 - May 2000.
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