For patients with chronic illnesses such as AIDS and rheumatoid arthritis, health-related quality of life (HRQOL) has emerged as an important outcome of health care. Debate continues, however, about the dimensions of and contributors to HRQOL in relation to their relevance and relative importance, the strengths of their influence, and their dynamic nature. While there continues to be debate, there are three general areas of agreement: (1) HRQOL is a multi-dimensional concept; (2) the assessment of HRQOL is subjective; and (3) research on HRQOL should be based on strong conceptual models. This amended application proposes a secondary data analysis to test the Wilson and Cleary (1995) HRQOL model that identifies six dimensions of HRQOL and then to evaluate, longitudinally, how the relationships change. The six dimensions include biological and physiological variables, symptoms status, functional status, general health perception, characteristics of the individual, and characteristics of the environment. Using structural equation modeling, data from The American Rheumatism Association Medical Information System (ARAMIS) and The AIDS Time-Oriented Health Outcome Study (ATHOS), two established databases, will be used. Both of these databases have one or more measured variables that can be used as indicators for each of the dimensions in the model. Understanding the relationships and linkages among the dimensions of HRQOL and how these relationships change over time will facilitate the design and targeting of appropriate interventions for quality patient care, provide rich information to reveal trends, suggest relationships between provider variations and patient outcomes, and identify potentially problematic patterns of care. Traditional HRQOL measures have not provided sufficient information for understanding the outcomes of patient care. With nurses' focus on prevention, health promotion, symptom management, and the alleviation of acute and chronic illness effects, a valid HRQOL model may be the appropriate strategy for capturing their impact on patient care. A valid conceptual model that captures HRQOL throughout the health-illness continuum would be valuable not only to nursing, but to consumers, providers, administrators, and policy makers.
