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

Hutchinson, Anastasia F., Graco, Marnie, Rasekaba, Tshepo Mokuedi, Parikh, Sumit, Berlowitz, David John and Lim, Wen Kwang 2015, Relationship between health-related quality of life, comorbidities and acute health care utilisation, in adults with chronic conditions, Health and quality of life outcomes, vol. 13, pp. 1-10, doi: 10.1186/s12955-015-0260-2.

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Title Relationship between health-related quality of life, comorbidities and acute health care utilisation, in adults with chronic conditions
Author(s) Hutchinson, Anastasia F.
Graco, Marnie
Rasekaba, Tshepo Mokuedi
Parikh, Sumit
Berlowitz, David John
Lim, Wen Kwang
Journal name Health and quality of life outcomes
Volume number 13
Article ID 69
Start page 1
End page 10
Total pages 10
Publisher BioMed Central
Place of publication London, Eng.
Publication date 2015
ISSN 1477-7525
Keyword(s) health-related quality of life
Acute healthcare utilisation
Chronic disease management
Ambulatory care sensitive conditions
Chronic obstructive pulmonary disease
Chronic heart failure
Diabetes
Aged care
Summary 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 63years (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.
Language eng
DOI 10.1186/s12955-015-0260-2
Field of Research 111099 Nursing not elsewhere classified
1117 Public Health And Health Services
Socio Economic Objective 920210 Nursing
HERDC Research category C1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2015, The Authors
Free to Read? Yes
Use Rights Creative Commons Attribution licence
Persistent URL http://hdl.handle.net/10536/DRO/DU:30074897

Document type: Journal Article
Collections: School of Nursing and Midwifery
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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.