Health profiles and quality of life

Abstract

Recent trends in health research are notable for a shift in both the type of outcome measured and the metric of measurement. In the past, patient outcomes were defined by physicians, but recent trends favor patient-determined indexes. Quantity of life has always been an important indicator; now quality of life is gaining added relevance. Finally, a proliferation of quality-of-life indexes beyond a manageable number has led to a recent trend toward consolidation and simplification of various health outcome measures. In the face of these changes, radiologists unfortunately remain somewhat removed from patient outcomes. Most are involved at the level of diagnosis, but remain relatively removed from therapy. This separation between the radiologist and the clinical outcome has two effects on our attempts to perform relevant outcomes research. First, efficacy of therapy can cloud the effect of a proper diagnosis, since even a perfect diagnosis may not improve patient outcome if the therapy is imperfect. Second, and perhaps more important, radiologists have limited access to patients, being dependent on referrals from clinical colleagues, and thus have less control in designing and implementing outcomes research projects. Within these inherent limitations of the practice of radiology, radiologists and radiology do have two important strengths. First, because radiologists are frequently involved in test design and implementation, many have a fundamental understanding of Bayesian analysis, which is at the core of most decision analyses. The radiologist can thus become a central figure in constructing and implementing decision analytic projects. The second strength of radiology is the rapid evolution of minimally invasive therapies. Interventional radiologists are gaining increased access to patients and are becoming the primary therapists in many situations. This increased access to patients and direct implementation of therapy overcome the two primary drawbacks noted above for radiologists performing outcomes research. In outcomes research, radiologists should focus on areas in which they have direct control. Since radiologists are frequently called on to make an initial diagnosis, the value of a negative diagnosis is an area of vast potential, which is rarely discussed. It could fundamentally change outcomes research at the diagnostic level. The benefit of a negative diagnosis arises not only from improved quality of life (due to diminished anxiety) but also from the avoidance of more invasive diagnostic procedures and the potentially negative health outcomes associated with them. Furthermore, increased reliance on the radiologist as primary therapist facilitates the practice of outcomes research for the interventional radiologist, where the efficacy of therapy does not cloud the benefit added by the radiologist.