Knowledge Item: CA-Medical Outcomes-12
 Length of Time a Participant is Maintained at the Same or an Improved Quality of Life as a Function of the Type of Medical Project Providing Treatment

This Knowledge Item is a follow-up to Knowledge Item: CA-Quality of Life-50 and Knowledge Item: CA-Quality of Life-51 which also present data on the days that quality of life is maintained for  a third group of projects, Community Based Organizations, that provide psychosocial services with linkages to medical care. This Knowledge Item follows up on the earlier work by explicitly controlling for the clients stage of HIV disease, as measured by a control factor of the earliest known CD4 count, and the classification of factor as to whether the client had an AIDS-defining condition during the course of the treatment episode. Since the CBO projects did not collect data on medical test results or opportunistic infections, their data is not used here. The data from one project (with 38 patients) were not included in these analyses because that project explicitly targeted AIDS patients at the end of their lives by providing home healthcare under a managed care model, and it was believed that the data from that project would skew the results for the Managed Care projects.

The probability of maintaining an individual at or above the baseline Total Quality of Life Score was estimated from a Cox (proportional hazards) regression or survival analysis. Initial levels of quality of life and initial levels of physical functioning (as measured by CD4 count) were controlled.

More than half of the individuals, in this progressive disease, may be maintained at the same or higher quality of life for a period of time approaching the maximum in our evaluation study, of about three years. Different rates of maintaining patients at full, 90%, and 80% quality of life are found for Managed Care projects not utilizing wrap-around psychosocial services and University-based Comprehensive Healthcare programs that do utilize wrap-around psychosocial services.

Further analyses given in Knowledge Items: CA-Quality of Life and Health-37, -42, -43, -50, -51, and -39, as well as Knowledge Items: CA-Medical Outcomes-11 and -13 show additional analyses that confirm that the projects with wrap-around comprehensive psychosocial services, supplementing basic medical services, tend to maintain the patient at the same or an increased quality of life for a longer time, and with a greater ratio of improvement, than just medical services. The additional Knowledge Items use alternate statistical designs and models with different factors "controlled," but the different methods of assessing the relative effectiveness of these different types of service models in achieving improved quality of life for the patients all point out the importance of integrated psychosocial or "wrap-around" services. 

Click graphic to expand. (IE 6 users may also have to click the graphic expansion button in the new window.)

Click graphic to expand. (IE 6 users may also have to click the graphic expansion button in the new window.)

More Information:     CHAID and CHAID Diagram