Measuring Quality of Life in a Reformed Health System

Prologue: One of the most troubling aspects of managed care, be it for mental or physical ailments, is the degree to which the outcomes of care can be assessed. Many hours of research and many millions of dollars have been devoted to the development of outcomes measures. For chronic mental illness, one of the most promising avenues in this regard is a measurement of quality of life that constitutes what Anthony Lehman refers to as “quality-of-life outcome assessment frameworks.” The main components of such a framework are a person s ability to function, access to resources and opportunities in the community, and sense of well-being. Three types of frameworks exist: general quality of life, health-related quality of life, and disease-specific quality of life. Lehman notes a recent upsurge in interest in quality-of-life concerns; underlying this interest, he states, “is the fundamental question about what difference medical treatments really make in people s lives, reflected by the well-known medical aphorism, 'The surgery was a success, but the patient died!.” Looking at quality of life as it relates to mental health care serves as an example “within the broader context of any chronic and debilitating illness that persists over many years and that detracts from a person's productivity and economic status.” Lehman is professor of psychiatry and director of the Center for Mental Health Services Research at the University of Maryland School of Medicine in Baltimore. He received his medical degree in psychiatry from the University of Rochester and also holds a public health degree from the University of California, Los Angeles. Lehman is principal investigator for the Schizophrenia Patient Outcomes Research Team (PORT), a five-year federal study to develop treatment recommendations for schizophrenia. Abstract: “Quality of life” encompasses functional status, access to resources and opportunities, and sense of well-being. It offers a useful perspective on the value of health care, especially for chronically disabling conditions, including chronic mental illness. At least three major quality-of-life outcome assessment frameworks are available: general quality of life, health-related quality of life, and disease-specific quality of life. Choice of a framework must be driven by the intent of the services. For persons with chronic, disabling conditions, a general quality-of-life perspective is most appropriate, one that accounts not only for direct health outcomes but also for the potential social and economic effects of medical disability.