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    Quality of life

    Published: September 14, 2018

    What Does Quality Mean?

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    Quality of life

    • 1. QUALITY OF LIFE
    • 2. What Does Quality Mean? What Does Quality Mean? •Take a moment and write down your answer to this question.
    • 3. What is Quality of Life? What is Quality of Life? •Take a moment and write down your answer to this question.
    • 4. Quality Quality •A peculiar or essential character •A degree of excellence •A social status •A distinguishing attribute •A vividness of hue
    • 5. Same or Different Quality? Same or Different Quality?
    • 6. Which is a Quality Product? Which is a Quality Product?
    • 7. Which is a Quality Product? Which is a Quality Product?
    • 8. A Corporate Approach to Product Quality A Corporate Approach to Product Quality Philosophical ◦Definition Economical ◦Profit margin ◦Marketing equilibrium Marketing ◦Buying behavior ◦Customer satisfaction Operations Management ◦Engineering practices ◦Manufacturing control Can we apply this approach to health care?
    • 9. Another View to Product Quality Another View to Product Quality Manufacturer ◦Concerned with design, engineering, and manufacturing processes Consumer ◦Satisfaction – preferences and expectations ◦May have nothing to do with the function of the product Product itself ◦As a system and its operation and functionality Can we apply this view to health care?
    • 10. Does Where You Shop Guarantee QUALITY? Does Where You Shop Guarantee QUALITY?
    • 11. Does Where YOU Shop for HEALTH CARE Guarantee QUALITY Services and Subsequently, QOL? Does Where YOU Shop for HEALTH CARE Guarantee QUALITY Services and Subsequently, QOL?
    • 12. What is Life? What is Life? State or mode of living Experience of being alive Quality that distinguishes a vital & functional being from a dead body A principle that underlies the distinctive quality of animate beings Course of existence Biological ◦Motion ◦Reproduction ◦Metabolism ◦Consumption & growth ◦Stimulus response Philosophical/religious ◦Being ◦Purpose and significance ◦“Why are we here?”
    • 13. LIFE - scans the age continuum LIFE - scans the age continuum
    • 14. Life - health to illness trajectory Life - health to illness trajectory
    • 15. LIFE - how it can change in an instant –and it’s quality affected too LIFE - how it can change in an instant –and it’s quality affected too
    • 16. Quality of Life Quality of Life
    • 17. Healthy People 2010 Healthy People 2010 •The first goal of Healthy People 2010 is to help individuals of all ages increase their life expectancy and improve their quality of life. •US DHHS, p. 8
    • 18. QOL – Who’s Perspective QOL – Who’s Perspective YOU – subjective; self-report Others – objective (how you perform on a physical test; the amt. of money in your pocket; your economic classification based on your income, etc.)
    • 19. QOL…Words to Describe QOL…Words to Describe Quality of life Health ◦General ◦Physical ◦Psychological ◦Spiritual ◦Opposite of disease (a continuum) Health related quality of life Well-being ◦Wellness ◦General ◦Body, mind, soul ◦Physical, psychological, spiritual Functional status ◦Activities of daily living (daily life)
    • 20. Definitions Definitions The degree to which a person enjoys the important possibilities of his/her life (Univ. of Toronto) Subjective QOL is about feeling good and being satisfied with things in general. Objective QOL is about fulfilling the societal and cultural demands for material wealth, social status, and physical well-being (Denmark)
    • 21. QOL – Multiple Domains QOL – Multiple Domains The interpersonal domain includes social support, interpersonal dynamics and cultural dynamics. The environmental domain includes socioeconomic status, transportation, assistive devices, safety and aesthetics. The societal domain includes one’s personal social system and the global societal system. (Advances in Nursing Science, 2006)
    • 22. QOL – Multiple Domains QOL – Multiple Domains The metaphysical domain includes self-esteem, self- determination, cognition, purpose, optimism and life satisfaction. The spiritual domain includes prayer, worship, fellowship and meaning. The biological domain involves functional capacity, physical comfort, health promotion and health maintenance.
    • 23. QOL – Multiple Domains QOL – Multiple Domains Being ◦Who you are ◦Physical-health, personal hygiene, nutrition, etc. ◦Psychological-adjustments, cognitions, feelings, self- control, etc. ◦Spiritual-values, standards of conduct, spiritual beliefs, etc. Belonging ◦Your fit in your environment ◦Physical, Social, Community Becoming ◦Your purposeful activities to achieve goals, hopes, & wishes ◦Practical (day-to-day), Leisure, Growth (improve self) (U of Toronto)
    • 24. QOL and MG QOL and MG Busch et al. (1996) ◦86 subjects ◦After thymectomy ◦For those with moderate to severe disease, QOL same as others but some emotional deficits Padua et al. (2001) ◦46 subjects ◦Clinical assessment related to patients’ QOL ◦As muscle deficit progresses not necessarily a decreased in mental status ◦But even with mild disease, some decline in mental status Paul et al. (2002) ◦27 subjects ◦A negative functional status impacts physical functioning, emotions, and social health ◦Persons with MG accommodate their physical activities and have the same general QOL as general population
    • 25. QOL and MG QOL and MG Kittiwatanapaisan et al. (2003) ◦67 subjects ◦Fatigue correlates with depression ◦When control fatigue, fatigue correlated with activity restriction & years of dx Leonardi et al. (2010) ◦102 subjects ◦Disability correlates with health-related QOL ◦Disability impacts physical QOL more than mental health ◦Disease severity impacts QOL
    • 26. Centers for Disease Control (CDC) Centers for Disease Control (CDC) Healthy Days (4 questions); Activity Limitations (5); Healthy Days Symptoms (5) Healthy Days ◦Would you say that in general your health is Excellent Very good Good Fair Poor
    • 27. Centers for Disease Control (CDC) Centers for Disease Control (CDC) Now thinking about your physical health, which includes physical illness and injury, for how many days during the past 30 days was your physical health not good? Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good? During the past 30 days, for about how many days did poor physical or mental health keep you from doing your usual activities, such as self- care, work, or recreation?
    • 28. World Health Organization Well-Being Index World Health Organization Well-Being Index •All of the time; Most of the time; More than half of the time; Less than half of the time; Some of the time; At no time •I have felt cheerful and in good spirits •I have felt calm and relaxed •I have felt active and vigorous •I woke up feeling fresh and rested •My daily life has been filled with things that interest me
    • 29. Health Self-Rating Scale Health Self-Rating Scale •Subscale of the Multilevel Assessment Instrument (Lawton et al., 1982) •Overall health •poor, fair, good, excellent •Health compared to 3 years ago •Not as good, same, better •Health problems stand in your way •A great deal, a little, not at all •Health compared to people your age •Not as good, same, better
    • 30. SF-12 SF-12 Self-report, general survey for monitoring outcomes in patients with chronic conditions In general, would you say your health is: ◦Excellent, Very Good, Good, Fair, Poor During the past 4 weeks, have you had any of the following problems with your work or other regular activities as a result of your physical health? ◦Accomplished less than you would like Yes or No These questions are about how you feel and how things have been with you during the past 4 weeks. How much of the time during the past 4 weeks… ◦Did you have a lot of energy? All the time, Most of the time, A good bit of the time, Some of the time, A little of the time, None of the time
    • 31. MGQOL 15 MGQOL 15 Burns et al., (2008) 15 items from a 60 item instrument Mobility (9), Symptoms (3), General Contentment (1), Emotional Well-being (2) Please indicate how true each statement has been (over the past four weeks): ◦I have trouble using my eyes Not at all; A little bit; Somewhat; Quite a bit; Very much ◦I have trouble driving Not at all; A little bit; Somewhat; Quite a bit; Very much ◦I feel overwhelmed by my condition Not at all; A little bit; Somewhat; Quite a bit; Very much
    • 32. Final Thoughts Final Thoughts •Quality is defined differently depending on your frame of reference •Quality of life is multidimensional •QOL can vary depending on the timeframe and situation
    • 33. What Do YOU Think? What Do YOU Think?