LONGITUDINAL CLINICAL OUTCOME COMPARISONS WITH 5 INDEXES

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The overall objective of Project 2 is to prospectively compare generic versus disease-targeted measures of Health-Related Quality of Life (HRQOL) in three patient populations. We will study six generic instruments: the EuroQol (EQ-5D). Health Utilities Index Mark 2 (HUI2), the Self-Administered Quality of Well-being scale (QWB-SA), the Health and Activities Limitation Index (HALex), the Medical Outcomes Study 36 Item Short Form (SF-36), and the Standard Gample. In addition 3 utility based scores will be imputed from SF-36 data. Each measure we will be administered to 300 patients in each of three categories: Arthritis - hip replacement, vision impairment - cataract extraction with lens replacement and comprehensive management of congestive heart failure. A disease-targeted measure will also be given to each clinical group. Subjects will be recruited from three academic medical centers: the University of California, San Diego, University of California, Los Angeles and the University of Wisconsin. Each subject will be measured at baseline and again at 1, 3, and 6 months. The specific aims of the study are: 1) To evaluate discdminant validity of the nine generic indexes in three patient populations. 2) To evaluate the responsiveness of the measures to clinical change. 3) To evaluate the validity and responsiveness of genedc versus disease-targeted measures. 4) To develop guidelines for the use of HRQOL measures in the three patient populations. 5) To evaluate three methods for imputing utility based scores from SF-36 data. In addition to traditional psychometric analysis, responsiveness and reproducibility will be estimated. Multivariate longitudinal modeling will also be conducted. The results of the study should provide guidance on the selection of measures for outcomes studies and cost/utility analysis.