Leveraging Health-Related Quality of Life in Population Health Management: The Case for Healthy Days

Abstract

Measuring population health with morbidity and mortality data, often collected at the site of care, fails to capture the individual's perspective on health and well-being. Because health happens outside the walls of medical facilities, a holistic and singular measure of health that can easily be captured for an entire population could aid in understanding the well-being of communities. This paper postulates that Healthy Days, a health-related quality of life measure developed and validated by the Centers for Disease Control and Prevention, is an ideal survey instrument to advance population health. A systematic literature review was conducted and revealed a strong evidence base using Healthy Days with significant correlations to chronic disease conditions. Building on the literature base and experience, methods for analyzing Healthy Days data are discussed, including stratified sampling techniques, statistical measures to account for variance, and modeling techniques for skewed distributions. Using such analytic techniques, Healthy Days has been used extensively in national health surveillance. As the health care system faces increasing costs and constrained resources, the Healthy Days survey instrument can be used to inform public policies and allocate health service resources. Because Healthy Days captures broad dimensions of health from the individual's perspective, it is a simple way to holistically measure the health and well-being of a population and its trend over time. Expanded use of Healthy Days can aid population health managers and contribute to the understanding of the broader determinants of the nation's and individual community's health and aid in evaluating progress toward health goals.

Perceived discrimination and health-related quality-of-life: gender differences among older African Americans

“…These questions have been validated and recommended for assessing HRQOL in diverse populations [3]. In two separate questions, interviewers asked participants to report on the number of days during the past 30 days that their physical health and mental health was not good [1].…”

“…Because of the skewed distribution of all three HRQOL variables, dichotomous variables were calculated for poor overall, physical, and mental HRQOL defined as 14 or more unhealthy days during the past 30 days [10]. We chose a threshold of 14 or more days based on the threshold’s widespread use clinically and in previous HRQOL research [34, 35] and the recommendation for using binary variables to ease statistical assumptions [3]. …”

“…Health-related quality-of-life (HRQOL) is an important population health measure of physical and mental functioning that correlates with morbidity and mortality [1–3]. Women generally report worse quality-of-life and self-reported health than men [2, 4, 5] and possible reasons include differences in social circumstances (e.g., caregiver roles for adults and children, less social support), socioeconomic factors (e.g., differences in occupation, income, and educational attainment) and physiologic factors (e.g., reproductive changes throughout the life course, heavier burden of chronic health complications) [5].…”

Hope and health‐related quality of life among chronically ill uninsured/underinsured adults

“…Despite the well‐recognized link between unidimensional physical and mental health indicators and mortality and morbidity, organizations such as the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health have drawn attention to the importance of multidimensional health indicators (Forrest, Blackwell, & Camargo, ; Slabaugh et al, ). Multidimensional measures of health correspond well with the World Health Organization's (WHO) conceptualization of health as “a complete state of physical, mental, and social well‐being” (World Health Organization, ).…”

Support Buffers Financial Strain's Effect on Health-related Quality of Life

“…Additionally, the currently employed HRQoL measure captures very specific, and albeit somewhat limited, dimensions of HRQoL. Despite the numerous advantages of the presently employed measure, 51 alternative measures of HRQoL, such as the Short Form Survey Instrument 52 or the WHO Quality of Life Assessment, 53 may offer more comprehensive evaluations of this construct and should be explored in future studies. Along similar lines, future research would benefit from examining the proposed relations using objective measures of social support, as the current study included only measures of perceived social support.…”