Outcomes Measures

Assessing endpoints or outcomes is the next step in developing outcomes management systems. Although traditional endpoints such as complications and mortality rates are important, they are imprecise for nonmorbid disease processes such as sinusitis. Therefore, these measures must be supplemented by more precise and useful measurements. Unlike hearing or vision loss, patients with sinusitis suffer in ways that are less easily measured but that certainly affect their functioning and well-being. Therefore, it is clear that patient-based quality-of-life measures should be a vital element of any studies in patients with sinusitis. The recommended elements of a quality-of-life outcomes monitor for sinusitis include a general health assessment, which is a global view of the patient's well-being as well as a disease-specific assessment that focuses more narrowly on the disease entity and that is usually more sensitive to clinical change with treatment.6,9,10

Probably the most widely tested instrument used for general health assessment today is the SF-36 Health Survey, or some form of it.11 This 36-item survey measures 8 domains of general health grouped into physical and mental health areas. In a study of 165 patients presenting to otolaryngologists with chronic sinusitis, patients with chronic sinusitis demonstrated significant decrements from expected normative levels of functioning when tested with this survey in such areas as physical role functioning, bodily pain, general health, vitality, and social functioning.10 Whenever a quality-of-life measurement is reported, it is important to put it into perspective. For example, the vitality score reported in chronic sinusitis refractory to medical therapy can be thought of as indicating that one-fourth of these patients would be expected to report that they are tired most or all of the time. As a generic measure, the SF-36 also permits comparisons between diseases, to understand the relative health impact of chronic sinusitis as com-

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