Evaluation of change in health status of chronic headache patients: Influence of patients' reference points and dispositional optimism.

摘要

In the current health care environment of cost containment, quality assurance and provider accountability, the measurement of outcomes has become both important and imperative in judging the effectiveness of any program or therapy. Health-Related Quality-of-Life is one such outcome measure used to evaluate the change in health and related physical, mental social and role functioning following any treatment.; Change in health status as it is currently measured (a difference between baseline and follow-up scores) does not account for individual differences in baselines or "reference points" nor the meaning of change to patients. This study proposed the presence of three categories of reference points: individualized, social and informational; which were hypothesized to be influenced by the individual's overall optimism. An overall, implicit generalized reference health state proposed as a combination of these reference points, was hypothesized to be a standard of comparison in evaluating change in health status. This study also proposed a distinction between the magnitude of change between baseline and follow-up scores and the evaluation of change as perceived by the patient. A conceptual model was developed based on the ideas presented above.; A pre-post study design was used to assess the reference points and change in health status. A sample of 100 newly diagnosed chronic headache patients were surveyed at two neurology clinics. Patients completed the baseline survey at the clinic following the physician interaction; follow-up surveys were completed at home after a month of treatment.; Results confirmed the presence of the informational and individualized reference points, the latter of which was influenced by optimism. The evidence for the generalized reference health state was inconclusive. The hypothesized difference between magnitude and evaluation of change was supported as was a direct relationship between the two. The model was disconfirmed as indicated by a poor fit to the data. However, a respecification of the model indicated that the reference points added value to the currently accepted model of measuring change in health status.; The primary contribution of this study was the presence of reference points and the concept of meaningfulness of a change in health status to patients.