Quality of Life and Health Knowledge Item 39: Results from HRSA/HAB's SPNS Innovative Models of Care

Knowledge Item: CA-Quality of Life and Health-39
Trends in Quality of Life Over the Course of the Treatment Episode Part V–Hierarchical Linear Models Showing Change

Hierarchical linear modeling (or HLM) methods are used to study change in quality of life 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 increasing quality of life over the course of their involvement with the programs represented here.

Furthermore, patients receiving services in projects with "wrap-around" psychosocial services (as represented by University-based Comprehensive Healthcare Programs and Psychosocial Community Based Organizations with linked medical services) improve more over time than patients in Managed Care Medical Programs which do not have strongly integrated psychosocial service components.

Patients from Comprehensive Care and CBO projects had higher quality of life scores than Managed Care patients when services started.
There were no Gender by Project Type interactions on initial level of quality of life.
Overall, patients had an increasing level of quality of life.
Males showed more change in quality of life than females.
Patients from Psychosocial CBO projects showed more positive change than patients from Managed Care Projects.
Patients from University-based Comprehensive Healthcare Projects showed more positive change than patients from Managed Care Projects.
The difference between change at the Psychosocial CBO and Managed Care projects is qualified by an interaction with gender.

Further analyses given in Knowledge Items: CA-Quality of Life and Health-37, -38, -42, -43, -50, -51, and as well as Knowledge Items: CA-Medical Outcomes-11, -12, and -13 show additional analyses that confirm with alternate methods 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.

In interpreting this Knowledge Item, and all others in this section on Quality of Life and Health, remember that the ratings of quality of life, symptom impact, and healthcare utilization are based on patient self reports.

Knowledge Item Citation: Huba, G. J., Panter, A. T., Melchior, L. A., and the HRSA/HAB SPNS Cooperative Agreement Steering Committee (1998-2001). Knowledge Item: CA-Quality of Life and Health-39 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 - June 2000.

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.