Question:

Why is it important to measure HRQOL?

Answer:

There are at least four reasons why measuring HRQOL is relevant in clinical practice:

First, any experienced health care provider knows that traditional biological outcomes do not always correlate with functional status and overall well-being. For example, some diabetics with well-controlled glucose levels may still feel listless or depressed despite the favorable biochemical profile, and others with elevated glucose levels may nonetheless feel upbeat and vigorous. Similarly, an irritable bowel syndrome (IBS) patient with 6 daily bowel movements may have the same decrement in worker productivity as an IBS patients with 3 daily bowel movements. In both cases the traditional "hard" outcome (glucose levels, bowel movement frequency) fails to capture other aspects of health. Measuring HRQOL directly acknowledges this disconnect.

Second, not only do traditional biological outcomes miss key aspects of health, but also patients rarely value these outcomes in the same manner as providers. For example, patients with hypertension often fail to share the same enthusiasm as their providers in achieving specific blood pressure goals, but are quick to comply with therapy when their hypertension leads to headache or lassitude. Measuring HRQOL directly acknowledges that patients often value different outcomes than their providers.

Third, HRQOL is a key component to understanding the true burden of any disease. Traditional measures of disease burden include the population prevalence of a disease, direct and indirect cost of care of a disease, mortality rates of a disease, and the worker productivity decrements related to a disease. However, in order to fully appreciate the true burden of a disease one must also appreciate the HRQOL decrement engendered by the disease. The notion of "weighting" diseases not only by their cost and prevalence but also by their HRQOL decrement has an innate sense of fairness and is a fundamental principle of health economics.

Fourth, diseases marked by morbidity but not mortality are best measured by patient-centered outcomes like HRQOL. For example, HRQOL may have little clinical relevance in the management of patients with acute necrotizing pancreatitis or exsanguinating variceal hemorrhage, but great relevance in patients with chronic migraine headache, fibromyalgia, or depression.

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