Sunday, May 13, 2012

Quality ...

My first job after I finished grad school was with a small healthcare research start-up where I had the opportunity to work on some pretty interesting and novel projects. Unfortunately "interesting and novel" doesn't always equate to "revenue generation", and the company was eventually swallowed up by a multi-service HRO before ultimately being shut down. I had moved on to another position at a big corporation by then, but I'll always look at that first job as a fantastic learning opportunity and one of best work environments I'll probably ever encounter.

One of the many research projects I worked on involved quality of life in patients with ARDS (Acute Respiratory Distress Syndrome.) The specifics of that study centered around the economics of resource utilization on patients with low probability of returning to "high function". This was a very "hot topic" in healthcare research at the time, and there were (and still are) several metrics employed to measure "quality of life". What we did was take the prevailing policy metric of the time and use it to create a very straightforward geometric score for measuring the quality of life in patients post-illness. Depending on factors like age and co-morbidities (additional illnesses), we were able to create "percentage of expected well-being" scores for these patients. We eventually were able to publish a paper on our findings.

Basically, the chart above (created by a team led by Dr. R.M. Kaplan of UCLA for the revision of the Quality of Well-Being Scales for the AHCPR) was the basis for our work. We simply utilized existing expected QWBs and measured the QWBs of patients at multiple time points post-illness. The score for the sick patients were taken as a percentage of the expected score for their age to determine the effect of the illness on perceived quality of life. One could think of it like this: for a 40 year old male, the average quality of well-being is about 80% of what it is for very young children (this kind of makes sense when you think about it -- when you're a baby, you can basically poop yourself and it's someone else's problem and if you start to cry, there's a pretty good chance a breast will be stuck in your mouth. Kind of easy to see where it's all downhill from there by some accounts.) But if you get sick and never achieve full functionality after the illness, it's not hard to see that your own perception of well-being will be compromised even further, perhaps dropping our 40 year old healthy male's 80% to 60% if he can't do all the things he previously could after his illness. But this work all stemmed from Kaplan's QWB vs. age trends.

Kaplan's work showed that  expected quality of life is essentially a decreasing function of age that accelerates after middle age. Kind of depressing, if you think about it, huh? Basically, the older you get, the lower your quality of well-being and if you happen to get specific serious illness too, well ... much lower still. It's still kind of a controversial score and there are many different ways to measure quality of life. The well-being score is very narrow in scope, but it served our purposes simply by providing a health-centric baseline against which to measure the effect of illness.

So anyway what does this have to do with cycling?

This weekend, I had an opportunity to race one of my favorite venues in the MASS series, French Creek. But I didn't go. I had a tough week leading up to it between my allergies flaring up worse than they have all year so far and work being relentless. In truth, I just didn't have a race in me this week. My allergies had kind of calmed down by Saturday morning, but mentally I was just a bit too tired to face the idea of an endurance race, especially on a course that requires as much focus and energy as French Creek. I probably could have finished - maybe even had a decent ride - but it wouldn't have been fun.

So instead of racing, I grabbed the Misfit and headed out to Middle Run just to ride my bike in the woods. And I think that's where all of this fits together.

A few shots from a day on the trails
Personally, I've always interpreted Kaplan's result as kind of incomplete. On one level, I get it -- we're going to have more health issues as we get older.  And then on top of that job stress, family concerns, financial issues - these things can pile on top of us, and the older we get, the heavier they can feel because, well, after childhood the real world's problems are no longer someone else's to deal with. But I think it would be a mistake to read too much into the QWB scale. It doesn't address a centrally important detail that allows us to re-gain some of that quality that erodes from the typical stresses of age.  I think that, as we get older, we're better able to adapt ourselves to those stresses and, perhaps with the exception of debilitating physical issues, we can find a balancing release (or releases) that replenishes some of those quality points we may lose otherwise. And we all know the importance of finding the right stress relievers. It doesn't matter what they may be - hobbies, vocations, even regular activities like a good night's sleep or spending time with a pet.

But whatever they may be, it's left to us to maintain them as something to improve our quality of life. Because sometimes, even the things we love to do can add stress instead of relieving it. As cyclists, it's very easy to get caught up in this thing we love to do to the point where it starts to turn against us and becomes a source of stress instead of a positive release. And for those of us who race, the risk can increase, especially if we get caught up feeling like we have to race even when we don't want to (or perhaps shouldn't.)  And I think we all reach that point now and then. There's a certain amount of fear involved with being to laissez-faire about racing. It's easy to see where the slippery slope that sitting out a race or taking a DNF may lead - we take it easy, don't ride as much, get out of shape, etc. But that risk only exists if we turn riding into an obligation instead of a fun activity. Racing is fun, except when it isn't. And if it stops being fun, then we shouldn't do it, because that makes riding not fun. And if riding isn't fun, then it doesn't improve our quality of life. I mean, sure, it may keep us physically fit in the short run, but if we really don't want to be out there, we're really just working against our mental fitness by doing it.  And then wouldn't we do better to find a more enjoyable activity to accomplish that fitness?

This weekend, I didn't race but I did ride because I wanted to ride. I would have liked to race, but I knew that with everything else that went on last week, it would have been a frustrating experience because I do like to feel I did my best whenever I race. And that wasn't going to be possible this weekend. So I did the smarter thing, and re-balanced myself for the week by off-setting the earlier stresses with my favorite stress-release, a nice long ride on my bike in the woods. And then I followed that up with a short road ride with Joanna this morning - a nice easy pace for just an hour before heading to NJ for Mother's Day.

And hopefully, by using the weekend to refresh my outlook and spending some time just playing on my bike in the woods, I pulled my own QWB score back up just a bit.

QWB refill?


  1. Good weekend, nice long metaphor comparing cycling in general and your weekend to your journey in the healthcare field, better then my recent post for sure.

  2. Thanks for such a thoughtful post. You've inspired me to try a SS out!