Relationship between health-related quality of life, comorbidities and acute health care utilisation, in adults with chronic conditions

Health and Quality of Life Outcomes

Wen Kwang Lim³  David John Berlowitz⁴  Sumit Parikh¹  Tshepo Mokuedi Rasekaba⁵  Marnie Graco⁴  Anastasia F. Hutchinson² 

[1] Northern Clinical Research Centre, Northern Health, 185 Cooper Street, Epping, 3076, Victoria, Australia;Centre for Quality Patient Safety Research, School of Nursing & Midwifery, Deakin University, Victoria, Australia;Department of Medicine and Aged Care, Northern Health & Department of Medicine, The University of Melbourne, Melbourne, Australia;Institute for Breathing and Sleep, Austin Health, Melbourne, Australia;Primary Care Research Unit, General Practice and Primary Health Care Academic Unit, The University of Melbourne, Melbourne, Australia

关键词: Aged care;    Diabetes;    Chronic heart failure;    Chronic obstructive pulmonary disease;    Ambulatory care sensitive conditions;    Chronic disease management;    Acute healthcare utilisation;    Health-related quality of life;   

Others  :  1209230
DOI  :  10.1186/s12955-015-0260-2

 received in 2015-02-23, accepted in 2015-05-08,  发布年份 2015

【 摘 要 】

Background

There is increased interest in developing multidisciplinary ambulatory care models of service delivery to manage patients with complex chronic diseases. These programs are expensive and given limited resources it is important that care is targeted effectively. One potential screening strategy is to identify individuals who report the greatest decrement in health related quality of life (HRQoL) and thus greater need. The aim of this study was to explore the relationship between HRQoL, comorbid conditions and acute health care utilisation.

Methods

A prospective, longitudinal cohort design was used to evaluate the impact of HRQoL on acute care utilisation rates over three-years of follow-up. Participants were enrolled in chronic disease management programs run by a metropolitan health service in Australia. Baseline data was collected from 2007–2009 and follow-up data until 2012. Administrative data was used to classify patients’ primary reasons for enrolment, number of comorbidities (Charlson Score) and presentations to acute care. At enrolment, HRQoL was measured using the Assessment of Quality of Life (AQoL) instrument, for analysis AQoL scores were dichotomised at two standard deviations below the population norm.

Results

There were 1999 participants (54 % male) with a mean age of 63 years (range 18–101), enrolled in the study. Participants’ primary health conditions at enrolment were: diabetes 915 (46 %), chronic respiratory disease 463 (23 %), cardiac disease 260 (13 %), peripheral vascular disease, and 181 (9 %) and aged care 180 (9 %). At 1-year multivariate logistic regression models demonstrated that AQOL utility score was not predictive of acute care presentations after adjusting for comorbidities. Over 3-years an AQoL utility score in the lowest quartile was predictive of both ED presentation (OR 1.58, 95 % CI, 1.16–2.13, p = 0.003) and admissions (OR 1.67, 95 % CI.1.21 to 2.30, p = 0.002) after adjusting for differences in age and comorbidities.

Conclusion

This study found that both HRQoL and comorbidities were predictive of subsequent acute care attendance over 3-years of follow-up. At 1-year, comorbidities was a better predictor of acute care representation than HRQoL. To maximise benefits, programs should initially focus on medical disease management, but subsequently switch to strategies that enhance health independence and raise HRQoL.

【 授权许可】

   
2015 Hutchinson et al.; licensee BioMed Central.

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