**5. Conclusions**

For many experts, the best indicators of the effectiveness of health services are *indicators of Health-Related Quality of Life (HRQoL), wellbeing and citizen satisfaction*. These indicators all measure global outcomes in patients and in the population, since *quality of life and well-being* have multidimensional values and account for the perspective of the patient undergoing the clinical and/or surgical interventions, procedures and services which are recommended and prescribed by practitioners, with informed consent, such as treatment and/or functional recovery and rehabilitation.

The **generic surveys** recommended for the assessment of HRQoL as an indicator are those which grant a comprehensive perspective on patients based on the Biopsychosocial Model of Health, placing patients in the main role of the outcome.

Of these surveys, the most widely used at the international level is SF-36 due to quality criteria and because, **it is used as a reference instrument and because** and it allows more comparisons, giving greater consistency to outcomes obtained at different healthcare and social/health centres and across different countries. Alternative questionnaires exist which may be used based on patients and their health and social circumstances.

Alternative questionnaires are available such as the Nottingham Health Profile (NHP) that is better when measuring health impact in populations, or the SIP when one wants to know the perception of illness that patients refer, the main drawback being it has 136 items, thus not recommended in elderly patients. Specific questionnaires can be used based on patient characteristics. If these are chronic, the Quality of Life Profile for Chronically Ill patients (PLC) is a good option. Based on the objectives, if functional capacity is to be assessed, The *Duke* Activity Status *Index (DASI)* is valid, reliable, and sensitive. It is also predictive in patients with cardiovascular alterations, which was its first use. If you want to estimate psychological or mental well-being, the Psychological General Well-Being Index (PGWBI) is appropriate.

On the other hand, all of these questionnaires can be self-administered. Still, patient's cognitive characteristics must be taken into account, basically that they can read and understand the questions correctly so that answers are reliable.

The **goal** of using these questionnaires when assessing HRQoL is the conversion of evidence into effective results which increase patient quality of life and wellbeing, as health is a fundamental resource for life, and this requires applied or clinical research and a public health system for the improvement of quality of care, HRQoL, and wellbeing.

*Modifiers of Health-Related Quality of Life by Biological, Psychological and Social… DOI: http://dx.doi.org/10.5772/intechopen.97451*
