In this issue begins a remarkable series of articles reflecting a decade of research by the Center for Health Quality, Outcomes and Economic Research (CHQOER), Bedford Massachusetts Veterans Administration (VA) Medical Center health services research group led by Lewis E. Kazis, ScD, and numerous colleagues. They have assessed the health status of 2425 veterans receiving ambulatory care within the VA system from 1993 to 1996, to measure their health status with special emphasis on diabetes, chronic lung disease, mental health, alcohol abuse, and oral health.
Health care systems of the future will be expected to know the level of health of the people they care for, to what degree they are improving health, at what cost, and how they compare to other similar systems of care. To do this we need efficient ways to measure health status over time using comparable standardized measures. To know that the burden of illness differs among individual patients and groups is important for predicting future health care use, for estimating appropriate costs, and for benchmarking performance comparisons.
These are issues of first-order importance if we are to improve ambulatory care for defined populations whether it be a National Health Service, a Health Maintenance Organization, the Veterans Administration health service, or a neighborhood health center.
What do this group of researchers have to tell us? They have created a new version of the famous SF-36 health status survey using a 5-point scale for answers to questions about perceived health. Their new Veterans SF-36 health survey outperforms the regular SF-36 for the population. They have created and validated questionnaires to measure perceived health status for specific ambulatory chronic health conditions. They have shown how the VA can use ambulatory care severity adjustment to allow comparisons across the many VA care sites. They have shown the link between perceived illness and the future use of health services. They have demonstrated that longitudinal health status monitoring is practical. It is now being used throughout the VA system.
If we are ever going to move from just worrying about cost control to focusing on better health for populations of patients, then work like this will be the essential future of health care information. The initial article in this issue describe the basic approach used by this research group. This will be followed in later issues with their studies of specific chronic conditions.