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January 4, 1995

Linking Clinical Variables With Health-Related Quality of Life: A Conceptual Model of Patient Outcomes

Author Affiliations

From the Primary Care Outcomes Research Institute, New England Medical Center, and the Department of Medicine, Tufts University (Dr Wilson), and the Department of Health Care Policy, Harvard Medical School (Dr Cleary), Boston, Mass.

JAMA. 1995;273(1):59-65. doi:10.1001/jama.1995.03520250075037

HEALTH-related quality of life (HRQL) is increasingly used as an outcome in clinical trials, effectiveness research, and research on quality of care. Factors that have facilitated this increased usage include the accumulating evidence that measures of HRQL are valid and "reliable,"1 the publication of several large clinical trials showing that these outcome measures are responsive to important clinical changes,2-5 and the successful development and testing of shorter instruments that are easier to understand and administer.6-13 Because these measures describe or characterize what the patient has experienced as the result of medical care, they are useful and important supplements to traditional physiological or biological measures of health status.

Given this improved ability to assess patients' health status, how can physicians and health care systems intervene to improve HRQL? Implicit in the use of measures of HRQL in clinical trials and in effectiveness research is the concept that clinical