Health-related quality of life issues for dialysis patients.

摘要

Up to now, evaluations of care for dialysis patients have focused primarily on biomedical quality, utilization, and cost indicators. The patient's self-assessed, health-related quality of life (HRQOL) has received much less attention, despite the fact that it is particularly relevant for those suffering from a severe chronic disease such as end stage renal disease (ESRD). This study evaluated factors which affect HRQOL and may be used to improve HRQOL for dialysis patients. It also evaluated the impact of HRQOL on several other types of patient outcomes, including employment, exercise frequency, and hospital admissions.; An ecological model was used as the theoretical approach. In this model, health status is viewed as affected by factors from five different environmental levels. These include: (1) intrapersonal factors; (2) primary groups; (3) the health care system; (4) community contextual factors; and (5) macrosystem factors.; Three types of statistical methods were applied. First, multiple regression was used to analyze factors explaining variation in baseline HRQOL scale scores and in HRQOL change scores. Second, logistic regression was used to evaluate the impact of HRQOL scales on other patient outcomes. Third, multiple equation LISREL models were used as a second, comparative approach for analyzing factors explaining variation in HRQOL change scores.; The results of the statistical analysis supported six of ten hypotheses regarding ecological factors affecting HRQOL. The statistical analysis also supported all three hypotheses regarding the impact of HRQOL on other patient outcomes.; This study has a number of policy implications. The statistical results show that a wide range of psychosocial factors affect HRQOL. This implies that Medicare should modify its reimbursement policy for dialysis centers to promote expanded use of allied health staff and home health care services, increased involvement of patients in decisions affecting their care, enhanced family and social support networks, and improved rehabilitation through increased staff encouragement for patients' efforts to maintain independence.; The wide range of factors found to affect HRQOL also provides an additional argument for Medicare to move more actively to expand capitation reimbursement for ESRD. That reimbursement method allows more flexibility in using available funding to meet patients' needs.