Health-related Quality of Life: A Strategy for Improving Physician-Patient Communication and Patient Outcomes
Thomas E. Burroughs, Ph.D.
Radhika Desikan, Ph.D.
What is the impact of real-time patient specific feedback at doctor visits on enhancing diabetic care and quality of life?
- To improve the quality of information the physician has when seeing a patient with diabetes
- To test a strategy for using HRQOL feedback to improve patient-physician communication
- To improve health outcomes and quality of life among people with diabetes
Type I and Type II Diabetic patients will be recruited from the Diabetes Registry at Washington University. This is a two-stage demonstration project. Stage 1 includes the design and testing of a Health Related Quality of Life (HRQOL) instrument and computerized reporting system. Stage 2 involves testing the impact of the real-time HRQOL feedback system on satisfaction with patient/physician communication, patient knowledge, and adherence.
Diabetes is a chronic disease with considerable morbidity, mortality, and has a significant impact on health-related quality of life. Current strategies to improve communication focus on broad behavioral strategies rather than individually tailored approaches to address patient needs. Besides, there has been no research yet that has attempted to use HRQOL feedback to facilitate better physician-patient communication.
The purpose of this study is to establish and test a mechanism for using health-related quality of life (HRQOL) information to improve satisfaction with patient-physician communication in routine clinical diabetes practice, leading to improved patient knowledge, adherence, and metabolic control.
Type 1 and Type 2 diabetic patients from the Diabetes Registry at Washington University will be identified for the study. Washington University endocrinologists and residents who are involved with caring for the Registry patients will be recruited for the study. Those physicians interested in participating in the study will be randomly divided into a) feedback group and b) no feedback group. Patients visiting both groups of doctors will complete sets of questionnaires. These comprise the shortened DQOL (shortened diabetes quality of life), the short form-8 (SF-8), and patient satisfaction with communication. Both groups of physicians will complete the physician satisfaction with communication survey. Feedback group physicians will receive feedback on their patients HRQOL using the DQOL and the SF-8, whereas this information although collected, will be withheld from the non-feedback group. At the end of the study, comparisons will be made between the two groups with respect to patient satisfaction with communication.
6 Month Report:
1) The project has been completed and analysis is currently underway to address the key research questions.
2) A manuscript titled "Diabetes Quality of Life - short Form: A mechanism for assessing patient health status issues in physician office settings" is currently under review at Diabetes Care. The abstract follows.
Objective: To design and test the reliability and validity of a shortened version of the Diabetes Quality of life questionnaire.
Research Design and Methods: 498 participants with Types I or II diabetes completed the DQOL, a measure of current diabetes self-care behaviors and a measure of demographic and health characteristics. A 3-stage statistical process identified the underlying structure of the DQOL and the items from within each DQOL component that were most predictive of self-care behaviors and satisfaction with diabetes control.
Results: Principal components analysis identified 5 key underlying factors in the DQOL. Best subset regression analysis identified a set of 12 questions that best explained self-care behaviors and satisfaction with diabetes control. Subsequent regression analyses found that the 12-item scale was as effective at predicting self-care behaviors (Shortened Scale R2=.225, Full Scale R2=.207) and satisfaction with diabetes control (Shortened Scale R2=.533, Full Scale R2=.527) as was the full DQOL.
Conclusions: The 12-item DQOL Short Form provides a vehicle for assessing health-related quality of life in a physician office setting in order to identify quality of life issues that might not arise during the typical patient-physician encounter. The shortened instrument was able to predict self-reported diabetes care behaviors and satisfaction with diabetes control as effectively as the full version of the instrument.
To design and test the reliability and validity of a shortened version of the Diabetes Quality of life questionnaire. Read the full Final Report.