Children's Health and the Assessment of Health-Related Quality of Life
Edward L. Schor State of Iowa Department of Public Health
Recent changes in health care have heightened a need to define health more specifically and, some fear, more narrowly. For those who would advocate for children and for the inclusion of their quality of life (QOL) as a legitimate goal of health care, it may be helpful to understand the origins and implications of past and present efforts to measure health and the outcomes of health care. This chapter presents such a description.
During the past decade there has been great interest in evaluating the effectiveness of health care by measuring the outcomes achieved ( Patrick & Erickson, 1993). Donabedian ( 1966) suggested that quality has three components: structure (i.e., the settings in which care is provided including the characteristics of the providers of care); process (i.e., the data collected, assessments made and treatment provided); and outcome (i.e., the results achieved in terms of recovery, restoration of function, and survival). Some have simplistically reformulated this triad to suggest that structure plus process equals outcome. However, when desired outcomes are not achieved, it may not be clear whether the health care was ineffective, the outcomes selected were the wrong ones, or some other factor intervened to affect outcome. This dilemma is especially pronounced when the desired outcome is an improvement in children's QOL.