Knowledge Item:
CA-Quality of Life and Health-50
Trends in Quality of Life Over the Course of the Treatment
Episode Part XIII–Length of Time a Participant is Maintained at the
Same or an Improved Quality of Life as a Function of Treatment in
Different Types of Programs
This Knowledge Item is a direct
follow-up to Knowledge Item:
CA-Quality of Life and Health-43.
The probability of maintaining an
individual at or above the baseline Total Quality of Life Score was
estimated from a Cox (proportional
hazards) regression or survival analysis. This Knowledge Item
contrasts the relative ability of three kinds of services–managed
medical care; comprehensive medical care including
"wrap-around" social services; community-based psychosocial
service providers–to maintain patients at 100%, 90%, and 80% of
their baseline total quality of life. The Comprehensive Medical Care
and Psychosocial Service providers had indistinguishable curves that
maintained patient-rated quality of life for the longest periods of
time. The Managed Medical Care programs were not as successful at
maintaining quality of life. These results statistically control for the
initial baseline level of quality of life, differences due to
psychosocial and behavioral comorbidities, and other patient
characteristics.
More than half of the
individuals, in this progressive disease, may be maintained at the same
or higher quality of life for a period of time approaching the maximum
in our evaluation study, of about three years. Patients in the
Comprehensive Medical Care and Psychosocial Service (with linked
medical) Programs are the most likely to be maintained.
Further analyses given in
Knowledge Items: CA-Quality
of Life and Health-37, -42,
-43, -51, and -39,
as well as Knowledge
Items: CA-Medical Outcomes-11, -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.
Days Quality of
Life is Maintained at Three
Types of Projects
More Information:
Survival
Function or Survival Curve
Mean Days Quality
of Life is Maintained at or Above Baseline Level
More Information:
CHAID and CHAID Diagram
Mean Ratio of
Highest Quality of Life Score to Baseline Over the Course of Treatment
(Ratio > 100 is Improvement) Over the Course of Treatment
More Information:
CHAID and CHAID Diagram
Note: The sample
size for this Knowledge Item is 38 patients smaller than that of Knowledge
Item
CA-Quality of Life and Health-43 to which this is a follow-up. We
did not use the data from one Managed Care medical site in this analysis specifically
because the goal of the project was to treat people at the end of
their lives when quality of life is low. All other projects, including
those whose data are used here, are primarily providers of outpatient medical care,
rather than home health care.
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., Melchior, L. A., Panter, A. T., and the HRSA/HAB SPNS Cooperative Agreement Steering Committee (1998-2001). Knowledge Item:
CA-Quality of Life and Health-50 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 February - June 2000.
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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.
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