 
Grant for $2.8 Million Awarded to School of Public Health Researcher |
Dr. Fredric Wolinsky, professor of health services research, has received a four-year, $2,884,660 grant for a study titled, "Identification of Clinically Relevant Changes in Health-Related Quality of Life." Dr. Kathleen Wyrwich, assistant professor of health services research, is co-principal investigator.
The grant was awarded by the Agency for Healthcare Research and Quality (AHRQ), formerly the Agency for Health Care Policy and Research. It is the major federal agency supporting research designed to improve the quality of health care, reduce its cost and broaden access to essential services.
"An increased burden of illness from chronic diseases presents new challenges to physicians trying to determine whether treatment is likely to help or harm," said Carolyn Clancy, director of the Center for Outcomes and Effectiveness Research of the AHRQ. "This study will help physicians and patients understand the impact of health care on the 'end results' that matter to patients."
In today's health care system, one of the greatest problems is knowing how to evaluate what procedures, treatments or providers do better than others. To accomplish this, health-related quality of life measures have been developed. These measures reflect the patient's perspective on how they feel they are doing.
Some health-related quality of life measures are designed to be used with patients having a particular disease (disease-specific) and others are designed to be used by all kinds of patients (generic). Although some reliable and valid disease-specific and generic health-related quality of life measures have been developed, guidelines are not well established for knowing how much change in a patient's health-related quality of life score between two points in time represents a clinically important difference.
"If a patient starts taking a new medication and is on that medication for a month, does the patient then feel better? If so, how much better? Is it enough to be deemed clinically important? Developing and verifying minimal clinically important differences is the first purpose of this project," Wolinsky said.
Secondly, the study aims to determine whether a particular value of a statistical test, called the standard error of measurement, routinely corresponds to these minimally clinically important differences. This study will look at three disease-specific and one generic health-related quality of life measures. The diseases being looked at are coronary artery disease and/or congestive heart failure, chronic obstructive pulmonary disease and asthma.
To accomplish the aims of this study, three sets of data will be collected. First there will be three national panels of nine expert physicians each, who treat middle-aged or older adults that have coronary artery disease and/or congestive heart failure, chronic obstructive pulmonary disease or asthma. Each panel will focus on one of the three diseases and come to some consensus on the minimum amount of change in the health-related quality of life measure necessary to be clinically important. Next, 1,800 patients (600 in each disease category) will be enrolled in a study that includes a series of interviews designed to monitor their health-related quality of life over 12 months. Half of these will involve outpatients from the primary care clinics at the St. Louis Veterans Administration Medical Center, and half will involve outpatients at the general medicine clinics of Indiana University Medical Center in Indianapolis. Finally, primary care physicians of these 1,800 patients will be asked to answer a brief set of questions about a patient's current health status at the first interview and after follow-up visits, and the treatment actions that the changes in the patient's conditions prompted.
"Our research focuses on the development of reliable and valid measures of health-related quality of life for which minimally clinically important differences can be identified and used for evaluating what procedures, treatments or providers do better than others," Wolinsky said. "These minimally clinically important differences will be critical pieces of information in the development, monitoring, evaluation and survival of managed care plans."
These findings have not only wide potential ramifications for the managed care industry, but for the manner in which physicians practice every day.
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