Katherine R. Jones

Health status improvement after surgical correction of primary hyperparathyroidism in patients with high and low preoperative calcium levels

BACKGROUND We conducted a prospective cohort study to determine whether there are differences in functional health status between patients with low (< 10.9 mg/dL) and high (> or = 10.9 mg/dL) serum calcium levels before surgical correction of primary hyperparathyroidism (HPT) and to compare changes in health status after correction of primary HPT. METHODS The SF-36 Health Survey, which provides demographic and condition-specific information, was used to obtain information on patients with primary HPT seen in a university hospital endocrine surgery clinic over a 4-year period before operation and again 2 months and 6 months after operation. RESULTS A total of 155 patients were studied; 86 had calcium levels < 10.9 mg/dL (normal < 10.5 mg/dL) and 69 had serum calcium levels > or = 10.9 mg/dL (range 10.9 to 13.4 mg/dL). One hundred four patients completed 6-month reports, 55 with low calcium levels and 49 with high calcium levels. Both high and low calcium groups showed marked and virtually identical impairment of functional health status. Both groups showed marked improvement in health status at 2 months and additional improvement at 6 months, returning to normal or near normal in 6 of 8 SF-36 domains. CONCLUSIONS Patients with primary hyperparathyroidism have significant functional health status impairment independent of the level of serum calcium. Dramatic improvement is seen after surgical correction. Referral for surgical treatment of primary HPT should not be delayed until serum calcium is elevated, as recommended in the 1990 National Institutes of Health consensus statement.

Assessment of patient outcomes after operation for primary hyperparathyroidism.

BACKGROUND We have used the SF-36, an accepted health status assessment tool, in conjunction with condition-specific clinical information, to assess patient-reported health status before and after operation for primary hyperparathyroidism (1 degree HPT). METHODS Beginning in March, 1994, a convenience sample of patients has been asked to complete the SF-36 and provide additional demographic and condition-specific information for study. The SF-36, which measures eight components of functional status and well-being, is completed in person before operation and again by mail at 2 and 6 months after operation. Clinical and condition-specific data are gathered at the same times. RESULTS Fifty-nine patients have entered the study; 56 had abnormal parathyroid tissue removed. Patients with 1 degree HPT have lower SF-36 scores in all health domains at baseline than do healthy patients. At 2 months, scale scores for emotional role limitations and bodily pain improved by more than 10 points. At 6 months all eight scale scores showed improvement, seven of eight by 10 points or more. Commensurate improvements in HPT-specific measures were also seen. CONCLUSIONS Patient-reported measurements of health outcomes after parathyroidectomy for 1 degree HPT show improvement in all aspects of health status 6 months after operation. Most dramatic improvements were reported in reduction of bodily pain and in improved vitality and emotional and physical function. Surgical correction of 1 degree HPT improves patient health status and quality of life.

Surgical correction of primary hyperparathyroidism improves quality of life

BACKGROUND The SF-36 health status assessment tool is well suited for measuring the morbidity associated with primary hyperparathyroidism (HPT). The purpose of this study was to test the hypothesis that surgical correction of primary HPT leads to measurable improvement in patient reported functional health status and well-being. METHODS For the past 4 years patients with primary HPT have been asked to complete the SF-36 and to provide additional demographic and condition-specific information for study before operation. They then completed the SF-36 again by mail 2 months and 6 months after operation. RESULTS One hundred forty patients entered the study through March 1998; 110 patients completed follow-up at 2 months and 82 at 6 months. Marked impairment compared to population norms occurred before operation in 7 of 8 domains of health status. Substantial improvement occurred in 5 of 8 domains of health status at 2 months and in 6 of 8 domains at 6 months. Statistically significant improvement was demonstrated in limitations caused by physical and emotional role function, social function, bodily pain, and vitality. CONCLUSIONS Successful operation to correct primary HPT significantly improves patient reported functional health status and quality of life. Most improvement is seen within 2 months, but additional improvement in both physical and mental function is seen at 6 months.

Core Outcomes Measures for Inguinal Hernia Repair

BACKGROUND Demands on the medical profession to develop performance measures and demonstrate cost-effectiveness make it imperative that a uniform approach to the measurement of outcomes for common conditions be adopted. We report here on patient acceptance, response rates, and utility of a new set of core outcomes measures for patients with inguinal hernia (IH), which incorporates patient reporting of outcomes. METHODS Beginning in March 1994, a convenience sample of patients scheduled for IH repair completed a series of questionnaires addressing a range of patient case mix and outcomes dimensions, including demographics, comorbid conditions, SF-36 health status (Medical Outcomes Study 36-item short-form health survey), and condition-specific questions, expectations, and responses to the surgical experience before and after operation. Surgical data were abstracted from the medical records. RESULTS One hundred three patients were entered in the study; 63 completed 2-month reports and 44 completed 6-month reports. Acceptance of the study and response rates were excellent. Differences in health status associated with IH have been identified in two SF-36 domains, and changes in function after repair noted in several others, supporting the applicability of this measure. Outcomes may also differ by type of hernia and type of repair performed. CONCLUSIONS A core outcomes measurement set for IH that encompasses demographics, comorbidities, health status, expectations, utilization, and condition-specific data provides a portrait of patient outcomes that is useful to providers and patients, and combined with cost and satisfaction data, it can be used for benchmarking and improving surgical care.

Using Health Care Outcomes to Improve Patient Care in the NICU

The authors describe their use of outcomes research in improving the care of infants in a ten-hospital network of neonatal intensive care units. Improvements in the processes of care for infants born with very low birth weights, and those suffering from chronic lung disease and nosocomial infections, are among the issues discussed.

Variations in the Hemodialysis Treatment Process

The Medicare end-stage renal disease (ESRD) program costs more than

Return to work after inguinal hernia repair

2 billion a year. Costs per treatment vary significantly across hemodialysis facilities, yet the relationship of these cost differentials to case mix and outcomes is uncertain. This study analyzed treatment variations in 527 chronic hemodialysis patients dialyzing in four freestanding and three hospital-based facilities. Results indicated that patients receiving care in the hospital-based units received a more costly routine dialysis treatment as well as more intensive nursing care during the treatment process than did patients in freestanding units. Policy and clinical implications of the findings are discussed.