Authors
- Neuhauser, Duncan PhD
Article Content
FOR any healthcare delivery system, including ambulatory care within the Veterans Administration, we should ask 3 basic questions.
First, who do we serve? We need to know the status of patients' physical and mental health to help them. Payne et al. (2005) address this question, analyzing care for 1900 veterans receiving ambulatory care and showing how health status is related to the use of services inside and outside the Veterans Administration's healthcare system.
Second, how do we know we are helping the people we serve? Clark et al. (in press) construct illness severity indices for 6 common health conditions, that can be used to measure individual and population health. To answer this question we need to be able to measure population health over time. Ren et al. (2005) analyze over time the performance of general and disease-specific health indices for back pain and chronic lung disease and shows their different properties.
An even more basic question is whether our health status measures are accurate. Skinner et al. (2005) compare patient self-reports with medical records and Miller et al. (2005) show that where you ask patients about their health makes a difference.
Diabetes provides a particularly good model for ambulatory care of chronic conditions. Diabetes is more than just a blood glucose level. It can influence many aspects of well-being. Thus, these consequences and comobidities should be measured in a holistic way. Linzer et al. (2005) and Fincke et al. (in press) both address this issue of instrument validity. Patient behavior is critical to the cause of diabetic problems and to their successful management. Borzecki et al. (2005) shows the relationship between health-related behaviors (smoking and alcohol use), health status, and care use for more than 1200 diabetic patients.
Third, how can we reorganize care to better meet the needs of the people we serve? The body of research by Kazis et al. (2004) and colleagues being presented in several issues of this journal lay the essential groundwork for giving us the tools to define who we care for and what their needs are, both of which are the essential foundations for improvement.
REFERENCES
Borzecki, A. M., Lee, A., Kalman, D., & Kazis, L. E. (2005). Do poor health habits affect health related quality of life and health care utilization in veterans? The Veterans Health Study. Journal of Ambulatory Care Management, 28(2), 141-156. [Context Link]
Clark, J. A., Spiro, A., III, Miller, D. R., Fincke, B. G., Skinner, K. M., & Kazis, L. E. (in press). Patient-based measures of illness severity in the Veterans Health Study. Journal of Ambulatory Care Management. [Context Link]
Fincke, B. G., Clark, J. A., Linzer, M., Spiro, A., III, Miller, D. R., Lee, A., & Kazis, L. E. (in press). Assessment of long-term complications due to type 2 diabetes using patient self-report: The Diabetes Complications Index. Journal of Ambulatory Care Management. [Context Link]
Kazis, L. E., Miller, D. R., Skinner, K. M., Lee, A., Ren, X. S., Clark, J. A., et al. (2004). Patient reported measures of health: The Veterans Health Study. Journal of Ambulatory Care Management, 27(1), 70-83. [Context Link]
Linzer, M., Pierce, C., Lincoln, E., Miller, D. R., Payne, S. M., Clark, J. A., et al. (2005). Preliminary validation of a patient based self-assessment measure of severity of illness in type 2 diabetes: Results from the pilot phase of the Veterans Health Study. Journal of Ambulatory Care Management, 28(2), 167-176. [Context Link]
Miller, D. R., Clark, J. A., Rogers, W. H., Skinner, K. M., Spiro, A., III, Lee, A., et al. (2005). The influence of place of administration on health related quality of life assessments: Findings from the Veterans Health Study. Journal of Ambulatory Care Management, 28(2), 111-124. [Context Link]
Payne, S. M. C., Lee, A., Clark, J. A., Rogers, W. H., Miller, D. R., Skinner, K. M., et al. (2005). Utilization of medical services by Veterans Health Study (VHS) respondents. Journal of Ambulatory Care Management, 28(2), 125-140. [Context Link]
Ren, X. S., Kazis, L. E., Lee, A., & Rogers, W. H. (2005). The role of generic and disease-specific measures of physical and role functioning in assessing patient outcomes: A longitudinal study. Journal of Ambulatory Care Management, 28(2), 157-166. [Context Link]
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