Barriers to the use of health status measures in clinical investigation, patient care, and policy research.

Despite growing interest and sophistication in health status assessment, these measures are not widely used in settings where they would be appropriate. The reasons include conceptual, methodologic, practical, and attitudinal barriers, some of which are common to a variety of applications (e.g., clinical research, patient care, or policy research). These barriers include skepticism about the validity and importance of self-rated health; preferences for physiologic outcomes or death rates; unfamiliarity with questionnaire scores; a paucity of direct instrument comparisons to aid in selection; and the costs of pilot testing, data collection, and data manipulation. In clinical trials, the uncertain responsiveness of questionnaire instruments to small but clinically important changes may be of particular concern. For patient care, additional barriers are posed by the need for rapidly processing data, the need for providing highly understandable results to clinicians, and clinicians' uncertainty about how to use the information. In policy research, there is often insufficient time for responding (with health status measurement) to decision makers' needs, and many have reservations about concepts such as quality-adjusted life years that arise from health status measurement. To facilitate a better intuitive grasp of health status scores, more comparisons with traditional clinical scales and physiologic measures are needed. More effort should be given to demonstrating (and improving) the responsiveness of scales to clinically important changes and to developing very brief questionnaires. Better education of health professionals about these measurement techniques is needed, as well as better methods of presenting results. Finally, a "laboratory" to provide measurement services to investigators and clinicians may make use of these scales more attractive.