During the past decade, patient-based health outcomes research has become a growth industry. Its data are being merged with clinical and economic databases to inform health care decision-making. Supported by a variety of health care organizations, accrediting bodies, employers, health policy strategists, and an expanding coterie of investigators, outcomes research seeks to assess the health of populations and the value of health care interventions as reflected in measurable changes in outcomes. With increasing emphasis on the patient as the focal point of health care, preservation of functioning and well-being is viewed as the principal goal of medical care and, of course, is best evaluated by the patient. As a consequence, measurement of patient-based assessment of health-related quality of life (HRQOL) is now an important focus of outcomes research.
However, the term and concept of ''quality of life'' has been problematic. 1 Quality of life is generally defined as an individual' s overall satisfaction with life and general sense of well-being and includes elements regarding health, personal accomplishments and resources, life situation, spirituality, level of activity, and social support. 2 HRQOL may be more narrowly and specifically defined. It focuses on self-perceived health and well-being domains. These include assessments of physical function, somatic sensation, psychological status, social interactions, functional capacity, and sense of wellbeing as influenced by health status. Each of these is subjective, based entirely on the perception of the individual, and usually self-reported. No objective functional testing or assessment is included. HRQOL in patients may also be defined by the nature and intensity of symptoms of the responsible disease and those attributable to its treatment. From a patient' s perspective, important outcomes of health interventions include the elimination or reduction of symptoms, if present, improved health-related quality of life, and restoration of normal life expectancy. Although its proponents would suggest that HRQOL is the outcome patients care most about, one wonders-perhaps as one ageswhether restoration of life expectancy might be an even higher priority, at least for some.
Abbreviations: HRQOL, health-related quality of life; SF-36, short form-36.