Extensible bandages.

hypertension, arthritis, gastrointestinal disorders, and myocardial infarction-the study devised a generic health status questionnaire providing a yardstick for comparing different conditions. Its short general survey comprised six health concepts: three (physical, social, and role functioning) collected information on dysfunction caused by ill health, and three (mental health, perceptions of overall health, and intensity of pain) measured more subjective components of health and general wellbeing. All measures were rated on scales of 0-100, with higher scores indicating better health. Regression coefficients estimated the effect of single and combined chronic conditions on function and wellbeing, controlling for factors such as sex, age, income, education, and other coexisting illness. The impact of each chronic condition on each health status measure was estimated as the mean deviation from a standard score for patients without chronic conditions. Results were presented graphically for average patients with each condition across each health measure. Does this help our understanding? Reassuringly, the profiles so derived showed a startling ability to discriminate between chronically ill patients and patients with no chronic disease as well as a general population. Given the measures, the findings contribute to an understanding of the importance of chronic disease from the patient's perspective. For example, a nine point difference in physical functioning is equivalent to the effect ofhaving arthritis or back problems. A 13 point difference in perception of health is equivalent to the effect of diabetes or congestive heart failure. Perceptions of health were poorest for patients with congestive heart failure and gastrointestinal disorders and best for patients with hypertension or back problems. Physical function was best for hypertensive patients and poorest for those with myocardial infarction or congestive heart failure. The worst role function was found in patients with myocardial infarction or congestive heart failure and the best in patients with hypertension. Pain also varied among patients, with those with arthritis scoring most pain and those with hypertension least pain. Distinct patterns emerged from the consistency of differences in health status shown by each condition. Such information increases our understanding of the needs of chronically ill patients and what should be done to meet them. This work is a beginning. The new centres for information on outcomes and clinical effectiveness funded by the Department of Health will help to disseminate the results of these and similar efforts, and stimulate further developments and refinements. Additionally, however, two important tasks need tackling by doctors and managers within the NHS before the use of outcome measures can become widespread. The first is a programme of research and development to guide the introduction of outcome measurement in the NHS, beginning perhaps by applying American results to the British experience. The second is to foster an environment in which the interests of the public are paramount. This means finding ways of improving the provision of information to patients to enable their involvement in decisions concerning their own care. The collection and use of information on health outcomes will challenge the potentially destructive competitive instincts of some health managers and the overweening preoccupation of some doctors to restrict the flow ofinformation under the guise of protecting their clinical freedom. To realise these objectives fully, however, requires the establishment of effective working relationships between general practitioners and hospital consultants, doctors and provider managers, and purchasers and providers. The NHS and its patients would be the winners if outcomes become central to health service management. ALISON FRATER Public Health Specialist, North West Thames Regional Health Authority, London W2 3QR DAVID COSTAIN King's Fund Centre, London NW I 7NF