Definition: "Outcome" Verses "Change Status" Measures

"Outcome" Verses "Change Status" Measures

As a comprehensive strategy to measure patient improvement or decline on various medical and psychosocial outcomes, two different measures ("Outcome" and "Change Status") were used to evaluate degree of success in selected Knowledge Items.

The "Outcome" variable measures success by comparing the patient's "best" possible score (least number of barriers recorded, lowest distress level, lowest score on symptom severity index, highest quality of life score, highest CD4 count, or lowest viral load) from any time during the treatment episode to the baseline score. A successful outcome using this measure is one in which the "best" score throughout the treatment episode shows improvement from, or equivalence to, the score at first assessment.

The "Change Status" variable measures success by comparing the patient's last assessment score (number of barriers experienced, distress level, symptom severity index score, quality of life score, CD4 count, or viral load) to the baseline score. A successful outcome is one in which the last assessment score shows improvement from, or equivalence to, the score at first assessment.

The chart below shows possible scenarios for overall improvement or decline according to the alternate outcome measures. As can be seen from the three scenarios below, it is possible for a client to show a positive outcome (improvement) on the "Outcome" measure while showing a negative outcome (decline) on the "Change Status" measure. However, if a client improves on the "Change Status" measure, they must also improve on the "Outcomes" measure. For this reason, a higher overall success rate is likely when using only the "Outcome" measure.

Scenario	Status on "Outcome" Measure	Status on "Change Status" Measure
1	Client *improves* on this measure because every post-baseline assessment shows functioning above baseline level. Technically, the client only needs to show improvement on one post-baseline assessment to be "successful" according to this measure.	Client improves on this measure because the last post-baseline assessment shows functioning above baseline level.
2	Client declines according to this measure because every post-baseline assessment shows the client functioning below baseline level. To show improvement via the "Outcome" measure, the client must show improved functioning on at least one post-baseline assessment.	Client declines according to this measure because the last assessment shows a level of functioning below baseline level.
3	Client improves according to this measure because the third and forth assessments show the client functioning at baseline or above baseline level	Client declines according to this measure, (regardless of the fact that s/he surpassed baseline level functioning on two assessment occasions throughout the treatment episode) because the last assessment shows functioning below baseline level.
4	Client improves on this measure because on at least one assessment (the last one in this case), the client shows functioning at baseline level.	Client improves on this measure because the last post-baseline assessment shows functioning above baseline level.

*Note that it is impossible for a client to show improvement on the "Change Status" Measure (see Scenario 4) and decline on the "Outcome" Measure. For this reason, a higher overall success rate is likely when using only the "Outcome" measure.

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