Abstract
BackgroundPatient recall or the application of population norms are commonly used methods to estimate (unobservable) health status prior to acute-onset illness or injury; however, both measures are potentially subject to bias. This article reports tests of the validity of both approaches, and discusses the implications for reporting changes in health-related quality of life following acute-onset illness or injury.MethodsRecalled pre-injury health status and health status at 5- and 12-months post-injury were collected from participants in a prospective cohort study of people injured in New Zealand. Reported post-injury health status was compared with recalled pre-injury status and New Zealand norms for two groups: those who reported having fully recovered, and those who had not.ResultsThere was a small but statistically significant difference between pre- and post-injury health state valuations for people who had fully recovered, with recalled pre-injury health status being higher than reported post-injury health. Perceived health status for those who had fully recovered was significantly higher than the population norm.ConclusionsRetrospective evaluation of health status is more appropriate than the application of population norms to estimate health status prior to acute-onset injury or illness, although there may be a small upward bias in such measurements.
Highlights
Patient recall or the application of population norms are commonly used methods to estimate health status prior to acute-onset illness or injury; both measures are potentially subject to bias
Generic measures of health status are designed to gauge changes in people’s health status over time such as their recovery from illness or injury. Instruments such as the Health Utilities Index, Short Form 6-dimension health status instrument (SF-6D) and EuroQol 5-dimension health status instrument (EQ-5D) are used for deriving health state preference values for calculating Quality-Adjusted Life Years (QALYs) for use in economic cost-effectiveness analyses [1]
The EQ-5D has been included in national population health surveys in the United Kingdom, Canada, China, Finland, Spain, Denmark, the United States and New Zealand [3,4]
Summary
Patient recall or the application of population norms are commonly used methods to estimate (unobservable) health status prior to acute-onset illness or injury; both measures are potentially subject to bias. This article reports tests of the validity of both approaches, and discusses the implications for reporting changes in health-related quality of life following acute-onset illness or injury. Generic measures of health status are designed to gauge changes in people’s health status over time such as their recovery from illness or injury. Instruments such as the Health Utilities Index, SF-6D and EQ-5D are used for deriving health state preference values for calculating Quality-Adjusted Life Years (QALYs) for use in economic cost-effectiveness analyses [1]. Since 2009, NHS secondary health providers in England have been asked to collect EQ-5D data for four surgical patient groups, pre- and postoperatively, as part of the Patient Reported Outcome Measures (PROMS) initiative [6]. Data have been collected from hundreds of thousands of patients so far [7]
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