Quality of life: an outcomes perspective

This article compares a traditional biomedical model with an outcomes model for evaluating medical and rehabilitation care. The traditional model emphasizes diagnosis and disease-specific outcomes. In contrast, the outcomes model emphasizes life expectancy and health-related quality of life (QOL). Although the models are similar, they lead to different conclusions with regard to some interventions. For some conditions, diagnosis and treatment may reduce the impact of a particular disease without extending life expectancy or improving QOL. Older individuals with multiple comorbidities may not benefit from treatments for a particular disease if competing health problems threaten life or reduce QOL. Overall outcomes and benefits of treatment can be summarized by using measures of life expectancy that adjust for QOL. The quality-adjusted life year (QALY) has been proposed as a comprehensive summary index. QALYs have gained widespread usage in many areas of medicine. The outcomes model has been applied widely in rehabilitation research, but few studies estimate the benefits of treatments using QALYs. These methodologies can also serve as a basis for approaches to sharing medical decisions between patients and providers. Opportunities to apply these new methods are discussed.