Severity of a case for outcome assessment in health care--definitions and classification of instruments

Health outcomes in economic evaluation: who should value health?

The valuation of health states is an integral part of economic evaluation studies. The source of these valuations (general public vs. patients) is surrounded by controversy. Health state values generated by the general public are often different compared with those of patients. General public values may not account for adaptation of the patients; patients' values potentially incorporate self-interest. Decisions on the appropriate source of health values ultimately depend on the specific decision-making context and objectives of the evaluation. Differences in valuations and implications for decision-making should be explicitly addressed. Further research should systematically identify circumstances in which public and patients' valuations diverge. There appears ground for development of methods that allow the simultaneous incorporation of patients and public preferences. Existing literature which discusses the issues around the health state valuation is summarized.

Common mental disorders and use of general health services: a review of the literature on population-based studies

OBJECTIVE

To review population-based studies on the association between common mental disorders and the use of general (non-mental) health care services.

METHOD

Literature search in Medline and PsychLit databases. Only studies with a prospective design and correction for somatic morbidity were included for review.

RESULTS

On the most general level of outcomes considered and in the majority of studies, mental disorders were associated with higher service use. This general tendency is not consistently reflected in the use of specific health care services, but is materialized in different patterns of out-patient and in-patient service utilization, which vary from study to study. Findings for the elderly were less clear-cut than for other age groups.

CONCLUSION

Mental disorders are related to higher general health care service use on a global, aggregated level. These associations are not specific for certain types of services.

Length of hospital stay and health services use of medical inpatients with comorbid noncognitive mental disorders: a review of the literature

We reviewed 23 studies on the association between noncognitive mental disorders and the use of general health care services by medical patients admitted to a general hospital. Only studies with a prospective design and with a correction for possible confounding factors were included. In most studies, only service use during index admission was observed, but eight studies included a longer observation period during follow-up after hospital discharge. The 15 studies that were restricted to service use during index admission showed mixed results: length of hospital stay was related to common mental disorders in some studies, but other studies did not find such an association. The eight studies that used a longer observation period showed findings that are more consistent. They demonstrated mainly that symptoms or complaints of depression are related to a higher resource use within general medical services.

Technology assessment using the association between outcome measures and patterns of illness severity

The inclusion of a patient's illness experience as outcome in the assessment of health care technology has revealed methodological limitations such as the interpretation of multi-attribute scores and lack of knowledge about the association between illness and disease information. In an attempt to overcome these limitations, a cross-sectional study is performed to search for patterns of illness severity and investigate the association between illness measures and between illness patterns and disease factors. A sample of 211 patients with ulcerative colitis is studied using the sickness impact profile (SIP) and the rating form for inflammatory bowel disease patient concerns (RFIPC) as illness measures. SIP and RFIPC scores show low association, suggesting that they provide complementary information about the patient's illness status. Cluster analysis is performed using the two measures of illness separately to identify groups of patients with different degrees of severity of illness (clusters). The cluster description covers illness, disease and social and demographic variables. The RFIPC clusters show a general pattern of ascendant rank scores for the RFIPC items. SIP clusters differ, not only in the level of severity, but also in specific types of disability. The patients in the clusters with the highest degree of disability (reflected by SIP) show a non-linear relationship with patients' concerns (reflected by RFIPC) and disease factors.