Trying to Balance Quality: Can We Assume that Improving the Quality of Care Delivery also Improves Quality of Life?

REVIEW ARTICLE


Sheena Mc Hugh^1, Margaret Collins² and Ivan Perry¹

Affiliations: ¹Department of Epidemiology and Public Health, University College Cork, Cork, Ireland and ²University of California Cooperative Extension, Tuolumne County, Sonora, California, USA

ABSTRACT

OBJECTIVE
To examine the measurement of quality of life (QoL) in the evaluation of interventions that aim to improve the quality of care for patients with diabetes.

METHOD
A literature review was conducted using three electronic databases (MEDLINE of the National Library of Medicine, PubMed of the National Centre for Biotechnology Information, and the Cochrane Library) to obtain articles published between 1998 and June 2009. Systematic reviews pertaining to chronic disease management and quality improvement at the professional and organizational level of diabetes care delivery were selected.

RESULTS
Twelve systematic reviews satisfied the inclusion criteria. Although a number of the reviews included studies that reported to measure QoL, on further investigation few of the studies involved accurate measurement of the outcome. The majority of studies purporting to assess the outcome actually measured concepts such as psychological well-being and health status, most often using the SF-36. While most review authors acknowledged the lack of data on patient-reported outcomes, a number of the reviews were ambiguous as to what measures were included and what outcomes were being evaluated.

CONCLUSION
The results of this review suggest that there is still ‘‘infrequent and inappropriate’’ measurement of outcomes such as QoL. Quality improvement interventions and chronic disease management programs often lack a theoretical framework to guide the selection of relevant and useful indicators. Without consistent and accurate measurement, we cannot assess the potential trade-off between quality of care and
QoL.

Keywords: diabetes, chronic disease management, quality in healthcare, quality improvement, quality of life, quality indicators
 
Correspondence: Sheena Mc Hugh, Department of Epidemiology & Public Health, University College Cork, Brookfield Health Sciences Complex, College Road, Cork, Ireland. Tel: +353-21-420-5253; Fax: +353-21-420-1923; e-mail: s.mchugh@ucc.ie