Health-Related Quality of Life Issues for Dialysis Patients. Abstract, ExecutiveSummary of Dissertation

摘要

Up to now, evaluations of care for dialysis patients have focused on biomedicalquality, utilization, and cost indicators. The patient's self-assessed, health-related quality of life (HRQOL) has received much less attention. This study evaluated factors affecting HRQOL and the impact of patient outcomes. An ecological model was used as the theoretical approach. In this model, health status is viewed on five levels: (1) intrapersonal; (2) primary groups; (3) the health care system; (4) community; and (5) macro system. Multiple regression was used to analyze factors explaining variation in baseline HRQOL scale scores and in change scores. Logistic regression was used to evaluate the impact of HRQOL on other patient outcomes. Multiple equation, LISREL models were used as second, comparative approach for analyzing factors explaining change scores. The results showed that a wide range of psycho social factors affect HRQOL. This implies that Medicare should consider modifying the reimbursement policy for dialysis centers to promote expanded use of allied health and home health services, enhanced family and social support networks, and improved rehabilitation through increased staff encouragement.