What are the benefits and risks of using functional status and health-related quality of life as health outcomes for quality indicators for the elderly and patients with multiple comorbid conditions? Potential benefits could include evidence for improved outcomes and quality of care with use of these quality indicators; potential harms include patient burden, incomplete reporting and data, and adverse patient selection by physicians due to the difficulty of impacting these outcomes.

Adapted from the JAGS article attached:

Although functional status and health-related quality of life (HRQOL) are important outcomes for people with multiple chronic conditions (MCCs) and are currently being developed by several key stakeholders, including the Centers for Medicare & Medicaid Services. However, evidence is unclear on the use of quality indicators for functional status and HRQOL that would be relevant for populations with MCCs. The indicators that exist are used for specific populations or settings and have problems with feasibility and usability. Although a recent systematic review addressed evidence to support interventions for improving QOL and functional status, this review could not be applied to the issue of quality measurement. It is unclear

whether measuring HRQOL and functional status, or implementing quality indicators using these tools, affects patient status or quality of care. Measurement tools for functional status may not capture the effect of interventions aimed at preventing or ameliorating functional decline. Furthermore, the evidence base may not be sufficiently robust for endorsement of indicators that hold providers accountable for preventing or reversing functional decline in populations of older adults with MCCs in the ambulatory setting. Dedicated research is needed to systematically evaluate usability and feasibility of implementing quality indicators.

This will help organizations and national quality groups better understand what evidence supports improvement in quality for patients with multiple chronic conditions.

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