An assessment of the effects of the use of measures of health-related quality of life in routine clinical care: An application to lung transplantation

Introduction. The use of HRQL in routine clinical practice has the potential to play many important roles in patient management and the provision of patient services. We hypothesized that the inclusion of HRQL in routine clinical care will: (a) Improve patient-clinician communication; (b) Affect the clinical management of patients; (c) Improve patients' health status and health-related quality of life.;Results. There were no differences between intervention and control groups at baseline. At the end of the 6 months, in the intervention group, the mean (standard deviation) number of issues discussed per encounter was 1.75 (1.15); in the control group 1.36 (1.00) (p = 0.003; Cohen's d = 0.38). In the intervention group, the mean (standard deviation) management composite was 3.27 (3.35); in the control group 2.19 (2.84) ( p = 0.001; Cohen's d = 0.35). EQ5D index was not statistically significant different between the groups (p = 0.48).;Conclusions. This study revealed that the use of HRQL in routine clinical care of patients is feasible; patients and clinicians evaluated the intervention as positive. We were able to detect effects on patient-clinician communication and patient management, but did not detect an improvement in patient outcomes.;Methods. A randomized controlled clinical trial was conducted at the out-patient clinic, University of Alberta Hospital, Edmonton. Patients were randomly assigned to intervention group (completion of Health Utilities Index (HUI2 and HUI3) on touch-screen with feedback to clinicians) and control (completion of HUI2 and HUI3 on touch-screen without feedback). Feedback involved a graphical representation, the "HUI score card". The HUI score card includes a display of single-attribute and overall HUI2 and HUI3 scores. Training in the interpretation of the HUI results was provided on regular basis to clinicians. All clinical encounters were audio-taped and were subsequently examined by three blinded raters. At every visit, changes in clinical management (medication changes, number of referrals and test ordered) were recorded in a chart review form and summed to produce the management composite. At the end of every visit, patients completed the EQ-5D. Primary statistical analysis includes repeated measures ANOVA.