Patricia Katz, Jonathan Showstack, Ed Yelin, James Smith, and colleagues in the PRL-IHPS and the Arthritis Research Group

1. New Ways to Look at Health and
Healthcare Outcomes: Focusing on
Patients’ Perspectives and Values
Patricia Katz, Jonathan Showstack, Ed Yelin, James Smith, and
colleagues in the PRL-IHPS and the Arthritis Research Group
Issue: Traditionally, patient health status and
effects of healthcare were based on PRL-IHPS Faculty
outputs of the medical system
have led efforts to
Newer trends focus on patients’ perspectives: incorporate patient-
• Satisfaction with medical care centered measures in a
• Self-reports of symptoms and functioning variety of arenas
• Personal values and experiences
Example 1: Fertility Experiences Project
• Quantified time expenditures and out-of-pocket costs of
infertility treatment, as well as total medical costs
• Identified risk of depression following treatment failure and
social impact of infertility
• Found disparities in access to infertility treatment
Implications:
• Current policies surrounding infertility treatment produce
huge disparities in access to care and provide incentives for
treatment options that produce greater costs after conception
(i.e., costs of multiple births)
Example 2: Measurement of Disability and
Functioning
• Standard measures of disability focus on low levels of
functioning, such as ability to eat or rise from toilet
• Patients experience disruptions in activity long before these
basic activities are affected
• New measure of disability asks about effects of health on a
range of activities, from very basic activities to household
tasks to social and recreational activities and work, and
allows people to express the value of the activity
Implications:
• Measures impact of health that are important to patients
• Focused on patients’ functional goals
• Can be used to target interventions before more serious
disability occurs