Articles: outcome-assessment-health-care.
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Clinics in chest medicine · Sep 1993
ReviewOutcome assessment in elderly patients with critical illness and respiratory failure.
Although elderly patients tend to have diminished physiologic reserve, the independent impact of age on outcome from critical illness is controversial. Physiologic status is perhaps a more important measure of a patient's underlying health and anticipated response to critical illness. Age, therefore, should not be used as a sole determinant for intensive care department admission.
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In this paper we consider whether methods currently used to measure utility of health outcomes are consistent with the equity criteria adopted by researchers. We show that unless the chosen equity criterion is incorporated in the design of the measurement instrument, the derived health state utilities are inconsistent with the equity criterion (except under special circumstances). Adjustment algorithms are derived, based on the axioms of von Neumann-Morgenstern utility theory, which take account of difference equity criteria currently adopted in the literature. The proposed approach is based on simple lottery questions of the type already used widely in empirical studies.