Health Status and Clinical Practice

Abstract

In Crossing the Quality Chasm: A New Health System for the 21st Century, the Institute of Medicine proposes 6 specific aims to improve the quality of care in the United States.1 These specific aims are to provide care that is safe, effective, timely, efficient, equitable, and patient centered. Of these goals, patient-centered care has received the least attention from both the scientific community and practicing clinicians. Patient-centered care gives patients opportunities to be “involved in medical decision making,” and guides care providers “in attending to their patients’ physical and emotional needs, and maintaining or improving their quality of life.”1 See p 43 To promote patient-centered care, clinicians should measure the health status of their patients with the use of standardized surveys, and then use this information to assist in clinical decision-making. There have been significant advances in health status surveys, and these measures are increasingly being used as primary outcomes in clinical trials. Yet formal health status measures are rarely, if ever, used in clinical practice. The reasons for this apparent gap between research and clinical practice are complex but likely include a lack of understanding of the definition of health status, a lack of familiarity with health status surveys, a perception that these measures are “soft,” and most importantly, a lack of acceptance that health status measures may be useful in clinical practice.Health status is the impact of disease on patient function as reported by the patient. More specifically, health status can be defined as the range of manifestation of disease in a given patient including symptoms, functional limitation, and quality of life, in which quality of life is the discrepancy between actual and desired function (Figure 1). An important point here is that clinicians are traditionally focused on the diagnosis of disease and evaluation …