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August 18, 1989, Vol 262, No. 7 >
ARTICLE | August 18, 1989

Functional Status and Well-being of Patients With Chronic Conditions: Title and subTitle BreakResults From the Medical Outcomes Study FREE

Anita L. Stewart, PhD; Sheldon Greenfield, MD; Ron D. Hays, PhD; Kenneth Wells, MD; William H. Rogers, PhD; Sandra D. Berry, MA; Elizabeth A. McGlynn, PhD; John E. Ware, Jr, PhD
[+] Author Affiliations

The opinions expressed are those of the authors and do not necessarily reflect the opinions of the sponsors or the authors' institutions.

Reprint requests to the Institute for Health & Aging, University of California, San Francisco, 201 Filbert St, Suite 500, San Francisco, CA 94133-3203 (Dr Stewart).


JAMA. 1989;262(7):907-913. doi:10.1001/jama.1989.03430070055030
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References

Enhancing daily functioning and well-being is an increasingly advocated goal in the treatment of patients with chronic conditions. We evaluated the functioning and well-being of 9385 adults at the time of office visits to 362 physicians in three US cities, using brief surveys completed by both patients and physicians. For eight of nine common chronic medical conditions, patients with the condition showed markedly worse physical, role, and social functioning; mental health; health perceptions; and/or bodily pain compared with patients with no chronic conditions. Each condition had a unique profile among the various health components. Hypertension had the least overall impact; heart disease and patient-reported gastrointestinal disorders had the greatest impact. Patients with multiple conditions showed greater decrements in functioning and well-being than those with only one condition. Substantial variations in functioning and well-being within each chronic condition group remain to be explained.

(JAMA. 1989;262:907-913)

REFERENCES

1 +
Berk A, Paringer L, Mushkin SJ.  The economic cost of illness: fiscal 1975 . Med Care . 1978;;16:785-790.
2 +
Rice DP. Scope and Impact of Chronic Diseases in the US . Washington, DC: US Dept of Health, Education, and Welfare; 1979;:5-36. Publication NIH 79-1896
3 +
Rice DP, Hodgson TA, Kopstein AN.  The economic costs of illness: a replication and update . Health Care Financing Rev . 1985;;7:61-80.
4 +
Breslow L.  A quantitative approach to the World Health Organization definition of health: physical, mental, and social well-being . Int J Epidemiol . 1972;;1:347-355.
5 +
Brook RH, Davies-Avery A, Greenfield S, et al.  Quality of medical care assessment using outcome measures: an overview of the method . Med Care . 1977;;15( (suppl) ).
6 +
Brook RH, Ware JE, Rogers WH, et al.  Does free care improve adults' health? N Engl J Med . 1983;;309:1426-1434.
7 +
Cluff LE.  Chronic disease, function and the quality of care . J Chronic Dis . 1981;;34:299-304.
8 +
Deyo RA.  Measuring functional outcomes in therapeutic trials for chronic disease . Controlled Clin Trials . 1984;;5:223-240.
9 +
McDermott W.  Absence of indicators of the influence of its physicians on a society's health . Am J Med . 1981;;70:833.
10 +
Schroeder SA.  Outcome assessment 70 years later: are we ready? N Engl J Med . 1987;;316:160-162.
11 +
Tarlov AR.  Shattuck lecture: the increasing supply of physicians, the changing structure of the health-services system, and the future practice of medicine . N Engl J Med . 1983;;308:1235.
12 +
Manning WG, Newhouse JP, Ware JE.  The status of health in demand estimation; or, beyond excellent, good, fair, and poor . In: Fuchs VR, ed. Economic Aspects of Health . Chicago, Ill: University of Chicago Press; 1982;:143-184.
13 +
Ware JE, Manning WG, Duan N, Wells KB, Newhouse JP.  Health status and the use of outpatient mental health services . Am Psychol . 1984;; 39:1090-1100.
14 +
Weissman MM, Myers JK, Thompson WD.  Depression and its treatment in a US urban community: 1975-1976 . Arch Gen Psychiatry . 1981;;38:417-421.
15 +
Bergner L, Hallstrom AP, Bergner M, Eisenberg MS, Cobb LA.  Health status of survivors of cardiac arrest and of myocarcial infarction controls . Am J Public Health . 1985;;75:1321-1323.
16 +
Cassileth BR, Lusk EJ, Strouse TB, et al.  Psychosocial status in chronic illness: a comparative analysis of six diagnostic groups . N Engl J Med . 1984;;311:506-511.
17 +
Croog SH, Levine S. Life After a Heart Attack: Social and Psychological Factors Eight Years Later . New York, NY: Human Sciences Press, Inc; 1982;.
18 +
Croog SH, Levine S, Testa MA, et al.  The effects of antihypertensive therapy on the quality of life . N Engl J Med . 1986;;314:1657-1664.
19 +
Deyo RA, Diehl A.  Measuring physical and psychosocial function in patients with low-back pain . Spine . 1983;;8:635-642.
20 +
Deyo RA, Inui TS, Leininger JD, Overman SS.  Measuring functional outcomes in chronic disease: a comparison of traditional scales and a self-administered health status questionnaire in patients with rheumatoid arthritis . Med Care . 1983;;21:180-192.
21 +
Fletcher A, Bulpitt CJ.  The treatment of hypertension and quality of life . Quality Life Cardiovasc Care . (January) /February 1985;:140-150.
22 +
Furberg CD, Schucker B, Chesney MA, et al.  Report of the working group: mild hypertension . In: NK Wenger, ME Mattson, CD Furberg, J Elinson, eds. Assessment of Quality of Life in Clinical Trials of Cardiovascular Therapies . New York, NY: Le Jacq Publishing Inc; 1984;:285-295.
23 +
Given CW.  Measuring the social psychological health states of ambulatory chronically ill patients: hypertension and diabetes as tracer conditions . J Community Health . 1984;;9:179-195.
24 +
Kaplan RM, Atkins CJ, Timms R.  Validity of a quality of well-being scale as an outcome measure in chronic obstructive pulmonary disease . J Chronic Dis . 1984;;37:85-95.
25 +
Mason JH, Weener JL, Gertman PM, Meenan RF.  Health status in chronic disease: a comparative study of rheumatoid arthritis . J Rheumatol . 1983;; 10:763-768.
26 +
Mayou R, Foster A, Williamson B.  Psychosocial adjustment in patients one year after myocardial infarction . J Psychosom Res . 1978;;22:447-453.
27 +
Paykel ES, Weissman MM.  Social adjustment and depression: a longitudinal study . Arch Gen Psychiatry . 1973;;28:659-663.
28 +
Romm FJ, Hulka BS, Mayo F.  Correlates of outcomes in patients with congestive heart failure . Med Care . 1976;;14:765-776.
29 +
Rosen RC, Kostis JB.  Behavioral sequellae associated with adrenergic-inhibiting antihypertensive agents: a critical review . Health Psychol . 1985;;4:579-604.
30 +
Bergner L, Hallstrom AP, Bergner M, Eisenberg MS, Cobb LA.  Health status of survivors of cardiac arrest and of myocardial infarction controls . Am J Public Health . 1985;;75:1321-1323.
31 +
Tarlov A, Ware JE Jr, Greenfield S, Nelson EC, Perrin E, Zubkoff M.  The Medical Outcomes Study: an application of methods for monitoring the results of medical care . JAMA . 1989;;262:925-930.
32 +
Rogers WH, McGlynn B, Berry SH, et al. The Medical Outcomes Study Implementation: Sampling Methods, Data Collection, and Respondent Characteristics . Santa Monica, Calif: The RAND Corp. In press.
33 +
Stewart AL, Hays RD, Ware JE.  The MOS short-form general health survey: reliability and validity in a patient population . Med Care . 1988;;26:724-735.
34 +
Ware JE, Sherbourne CD, Davies AR, Stewart AL. The MOS Short-Form General Health Survey: Development and Test in a General Population . Santa Monica, Calif: The RAND Corp; 1988;. Publication P-7444.
35 +
Montgomery EA, Paranjpe AV. A Report Card on HMO's 1980-1984 . Menlo Park, Calif: The Henry J. Kaiser Family Foundation; 1985;.
36 +
Ware JE.  Standards for validating health measures: definition and content . J Chronic Dis . 1987;; 40:473-480.
37 +
Nelson E, Conger B, Douglass R, et al.  Functional health status levels of primary care patients . JAMA . 1983;;249:3331-3338.
38 +
Davies AR, Ware JE. Measuring Health Perceptions in the Health Insurance Experiment . Santa Monica, Calif: The RAND Corp; 1981;. Publication R-2711-HHS.
39 +
Lurie N, Ward NB, Shapiro MF, Brook RH.  Termination from Medi-Cal: does it affect health? N Engl J Med . 1984;;311:480-484.
40 +
Stewart AL, Ware JE, Brook RH, Davies-Avery A. Conceptualization and Measurement of Health for Adults in the Health Insurance Study: Vol II, Physical Health in Terms of Functioning . Santa Monica, Calif: The RAND Corp; 1978;. Publication R-1987/2-HEW.
41 +
Read LJ, Quinn RJ, Hoefer MA.  Measuring overall health: an evaluation of three important approaches . J Chronic Dis . 1987;:40( (suppl) ):7S-22S.
42 +
Colton T. Statistics in Medicine . Boston, Mass: Little Brown & Co Inc; 1974;.
43 +
Larzelere RE, Mulaik SA.  Single-sample tests for many correlations . Psychol Bull . 1977;;84:557-569.
44 +
Pocock SJ, Hughes MD, Lee RJ.  Statistical problems in the reporting of clinical trials: a survey of three medical journals . N Engl J Med . 1987;; 317:426-432.
45 +
Lohr KN, Kamberg CJ, Keeler EB, Goldberg GA, Calabro TA, Brook RH.  Chronic disease in a general adult population: findings from the Rand Health Insurance Experiment . West J Med . 1986;;145:537-545.
46 +
Limitation of Activity due to Chronic Conditions: United States, 1974 . Rockville, Md: National Center for Health Statistics; 1977;. US Dept of Health, Education, and Welfare publication (HRA) 77-1537. Vital and Health Statistics Series 10, No. (111) .
47 +
Bloom JR, Monterossa S.  Hypertension labeling and sense of well-being . Am J Public Health . 1981;;71:1228-1232.
48 +
Brook RH, Kamberg CJ.  General health status measures and outcome measurement: a commentary on measuring functional status . J Chronic Dis . 1987;;40( (suppl 1) ):131S-136S.
49 +
Chobanian AV.  Antihypertensive therapy in evolution . N Engl J Med . 1987;;314:1701-1702.
50 +
Levine S.  The changing terrains in medical sociology: emergent concern with quality of life . J Health Soc Behav . 1987;;28:1-6.
51 +
Rubenstein LV, Calkins DR, Fink A, et al.  How to help your patients function better . West J Med . 1985;;143:114-117.
52 +
Nelson E, Wasson J, Kirk J, et al.  Assessment of function in routine clinical practice: description of the COOP chart method and preliminary findings . J Chronic Dis . 1987;;40( (suppl) ):55S-64S.
53 +
Jette AM, Davies AR, Cleary PD, et al.  The functional status questionnaire: reliability and validity when used in primary care . J Gen Intern Med . 1986;;1:143-149.
54 +
Greenfield S, Kaplan S, Ware JE.  Expanding patient involvement in care: effects on patient out-comes . Ann Intern Med . 1985;;102:520-528.
55 +
Kaplan MH, Feinstein AR.  The importance of classifying initial co-morbidity in evaluating the outcome of diabetes mellitus . J Chronic Dis . 1974;; 27:387-404.
56 +
Greenfield S, Aronow H, Elashoff R, Watanabe D.  Flaws in mortality data: the hazards of ignoring comorbid disease . JAMA . 1988;;260:2253-2255.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Berk A, Paringer L, Mushkin SJ.  The economic cost of illness: fiscal 1975 . Med Care . 1978;;16:785-790.
2 +
Rice DP. Scope and Impact of Chronic Diseases in the US . Washington, DC: US Dept of Health, Education, and Welfare; 1979;:5-36. Publication NIH 79-1896
3 +
Rice DP, Hodgson TA, Kopstein AN.  The economic costs of illness: a replication and update . Health Care Financing Rev . 1985;;7:61-80.
4 +
Breslow L.  A quantitative approach to the World Health Organization definition of health: physical, mental, and social well-being . Int J Epidemiol . 1972;;1:347-355.
5 +
Brook RH, Davies-Avery A, Greenfield S, et al.  Quality of medical care assessment using outcome measures: an overview of the method . Med Care . 1977;;15( (suppl) ).
6 +
Brook RH, Ware JE, Rogers WH, et al.  Does free care improve adults' health? N Engl J Med . 1983;;309:1426-1434.
7 +
Cluff LE.  Chronic disease, function and the quality of care . J Chronic Dis . 1981;;34:299-304.
8 +
Deyo RA.  Measuring functional outcomes in therapeutic trials for chronic disease . Controlled Clin Trials . 1984;;5:223-240.
9 +
McDermott W.  Absence of indicators of the influence of its physicians on a society's health . Am J Med . 1981;;70:833.
10 +
Schroeder SA.  Outcome assessment 70 years later: are we ready? N Engl J Med . 1987;;316:160-162.
11 +
Tarlov AR.  Shattuck lecture: the increasing supply of physicians, the changing structure of the health-services system, and the future practice of medicine . N Engl J Med . 1983;;308:1235.
12 +
Manning WG, Newhouse JP, Ware JE.  The status of health in demand estimation; or, beyond excellent, good, fair, and poor . In: Fuchs VR, ed. Economic Aspects of Health . Chicago, Ill: University of Chicago Press; 1982;:143-184.
13 +
Ware JE, Manning WG, Duan N, Wells KB, Newhouse JP.  Health status and the use of outpatient mental health services . Am Psychol . 1984;; 39:1090-1100.
14 +
Weissman MM, Myers JK, Thompson WD.  Depression and its treatment in a US urban community: 1975-1976 . Arch Gen Psychiatry . 1981;;38:417-421.
15 +
Bergner L, Hallstrom AP, Bergner M, Eisenberg MS, Cobb LA.  Health status of survivors of cardiac arrest and of myocarcial infarction controls . Am J Public Health . 1985;;75:1321-1323.
16 +
Cassileth BR, Lusk EJ, Strouse TB, et al.  Psychosocial status in chronic illness: a comparative analysis of six diagnostic groups . N Engl J Med . 1984;;311:506-511.
17 +
Croog SH, Levine S. Life After a Heart Attack: Social and Psychological Factors Eight Years Later . New York, NY: Human Sciences Press, Inc; 1982;.
18 +
Croog SH, Levine S, Testa MA, et al.  The effects of antihypertensive therapy on the quality of life . N Engl J Med . 1986;;314:1657-1664.
19 +
Deyo RA, Diehl A.  Measuring physical and psychosocial function in patients with low-back pain . Spine . 1983;;8:635-642.
20 +
Deyo RA, Inui TS, Leininger JD, Overman SS.  Measuring functional outcomes in chronic disease: a comparison of traditional scales and a self-administered health status questionnaire in patients with rheumatoid arthritis . Med Care . 1983;;21:180-192.
21 +
Fletcher A, Bulpitt CJ.  The treatment of hypertension and quality of life . Quality Life Cardiovasc Care . (January) /February 1985;:140-150.
22 +
Furberg CD, Schucker B, Chesney MA, et al.  Report of the working group: mild hypertension . In: NK Wenger, ME Mattson, CD Furberg, J Elinson, eds. Assessment of Quality of Life in Clinical Trials of Cardiovascular Therapies . New York, NY: Le Jacq Publishing Inc; 1984;:285-295.
23 +
Given CW.  Measuring the social psychological health states of ambulatory chronically ill patients: hypertension and diabetes as tracer conditions . J Community Health . 1984;;9:179-195.
24 +
Kaplan RM, Atkins CJ, Timms R.  Validity of a quality of well-being scale as an outcome measure in chronic obstructive pulmonary disease . J Chronic Dis . 1984;;37:85-95.
25 +
Mason JH, Weener JL, Gertman PM, Meenan RF.  Health status in chronic disease: a comparative study of rheumatoid arthritis . J Rheumatol . 1983;; 10:763-768.
26 +
Mayou R, Foster A, Williamson B.  Psychosocial adjustment in patients one year after myocardial infarction . J Psychosom Res . 1978;;22:447-453.
27 +
Paykel ES, Weissman MM.  Social adjustment and depression: a longitudinal study . Arch Gen Psychiatry . 1973;;28:659-663.
28 +
Romm FJ, Hulka BS, Mayo F.  Correlates of outcomes in patients with congestive heart failure . Med Care . 1976;;14:765-776.
29 +
Rosen RC, Kostis JB.  Behavioral sequellae associated with adrenergic-inhibiting antihypertensive agents: a critical review . Health Psychol . 1985;;4:579-604.
30 +
Bergner L, Hallstrom AP, Bergner M, Eisenberg MS, Cobb LA.  Health status of survivors of cardiac arrest and of myocardial infarction controls . Am J Public Health . 1985;;75:1321-1323.
31 +
Tarlov A, Ware JE Jr, Greenfield S, Nelson EC, Perrin E, Zubkoff M.  The Medical Outcomes Study: an application of methods for monitoring the results of medical care . JAMA . 1989;;262:925-930.
32 +
Rogers WH, McGlynn B, Berry SH, et al. The Medical Outcomes Study Implementation: Sampling Methods, Data Collection, and Respondent Characteristics . Santa Monica, Calif: The RAND Corp. In press.
33 +
Stewart AL, Hays RD, Ware JE.  The MOS short-form general health survey: reliability and validity in a patient population . Med Care . 1988;;26:724-735.
34 +
Ware JE, Sherbourne CD, Davies AR, Stewart AL. The MOS Short-Form General Health Survey: Development and Test in a General Population . Santa Monica, Calif: The RAND Corp; 1988;. Publication P-7444.
35 +
Montgomery EA, Paranjpe AV. A Report Card on HMO's 1980-1984 . Menlo Park, Calif: The Henry J. Kaiser Family Foundation; 1985;.
36 +
Ware JE.  Standards for validating health measures: definition and content . J Chronic Dis . 1987;; 40:473-480.
37 +
Nelson E, Conger B, Douglass R, et al.  Functional health status levels of primary care patients . JAMA . 1983;;249:3331-3338.
38 +
Davies AR, Ware JE. Measuring Health Perceptions in the Health Insurance Experiment . Santa Monica, Calif: The RAND Corp; 1981;. Publication R-2711-HHS.
39 +
Lurie N, Ward NB, Shapiro MF, Brook RH.  Termination from Medi-Cal: does it affect health? N Engl J Med . 1984;;311:480-484.
40 +
Stewart AL, Ware JE, Brook RH, Davies-Avery A. Conceptualization and Measurement of Health for Adults in the Health Insurance Study: Vol II, Physical Health in Terms of Functioning . Santa Monica, Calif: The RAND Corp; 1978;. Publication R-1987/2-HEW.
41 +
Read LJ, Quinn RJ, Hoefer MA.  Measuring overall health: an evaluation of three important approaches . J Chronic Dis . 1987;:40( (suppl) ):7S-22S.
42 +
Colton T. Statistics in Medicine . Boston, Mass: Little Brown & Co Inc; 1974;.
43 +
Larzelere RE, Mulaik SA.  Single-sample tests for many correlations . Psychol Bull . 1977;;84:557-569.
44 +
Pocock SJ, Hughes MD, Lee RJ.  Statistical problems in the reporting of clinical trials: a survey of three medical journals . N Engl J Med . 1987;; 317:426-432.
45 +
Lohr KN, Kamberg CJ, Keeler EB, Goldberg GA, Calabro TA, Brook RH.  Chronic disease in a general adult population: findings from the Rand Health Insurance Experiment . West J Med . 1986;;145:537-545.
46 +
Limitation of Activity due to Chronic Conditions: United States, 1974 . Rockville, Md: National Center for Health Statistics; 1977;. US Dept of Health, Education, and Welfare publication (HRA) 77-1537. Vital and Health Statistics Series 10, No. (111) .
47 +
Bloom JR, Monterossa S.  Hypertension labeling and sense of well-being . Am J Public Health . 1981;;71:1228-1232.
48 +
Brook RH, Kamberg CJ.  General health status measures and outcome measurement: a commentary on measuring functional status . J Chronic Dis . 1987;;40( (suppl 1) ):131S-136S.
49 +
Chobanian AV.  Antihypertensive therapy in evolution . N Engl J Med . 1987;;314:1701-1702.
50 +
Levine S.  The changing terrains in medical sociology: emergent concern with quality of life . J Health Soc Behav . 1987;;28:1-6.
51 +
Rubenstein LV, Calkins DR, Fink A, et al.  How to help your patients function better . West J Med . 1985;;143:114-117.
52 +
Nelson E, Wasson J, Kirk J, et al.  Assessment of function in routine clinical practice: description of the COOP chart method and preliminary findings . J Chronic Dis . 1987;;40( (suppl) ):55S-64S.
53 +
Jette AM, Davies AR, Cleary PD, et al.  The functional status questionnaire: reliability and validity when used in primary care . J Gen Intern Med . 1986;;1:143-149.
54 +
Greenfield S, Kaplan S, Ware JE.  Expanding patient involvement in care: effects on patient out-comes . Ann Intern Med . 1985;;102:520-528.
55 +
Kaplan MH, Feinstein AR.  The importance of classifying initial co-morbidity in evaluating the outcome of diabetes mellitus . J Chronic Dis . 1974;; 27:387-404.
56 +
Greenfield S, Aronow H, Elashoff R, Watanabe D.  Flaws in mortality data: the hazards of ignoring comorbid disease . JAMA . 1988;;260:2253-2255.

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