The relative impact of chronic conditions and multimorbidity on health-related quality of life in Ontario long-stay home care clients

Luke Mondor^{1

2}, Colleen J Maxwell^{1

2

3}, Susan E Bronskill^{1

2

4}, Andrea Gruneir^{1

2

4

5}, Walter P Wodchis^{6

7

8

9}

Affiliations

¹ Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada.
² Health System Performance Research Network (HSPRN), Toronto, ON, Canada.
³ Schools of Pharmacy and Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.
⁴ Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, ON, M5T 3MS, Canada.
⁵ Department of Family Medicine, University of Alberta, Edmonton, AB, Canada.
⁶ Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada. walter.wodchis@utoronto.ca.
⁷ Health System Performance Research Network (HSPRN), Toronto, ON, Canada. walter.wodchis@utoronto.ca.
⁸ Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, ON, M5T 3MS, Canada. walter.wodchis@utoronto.ca.
⁹ Toronto Rehabilitation Institute, Toronto, ON, Canada. walter.wodchis@utoronto.ca.

PMID: 27052421
DOI: 10.1007/s11136-016-1281-y

The relative impact of chronic conditions and multimorbidity on health-related quality of life in Ontario long-stay home care clients

Luke Mondor et al. Qual Life Res. 2016 Oct.

. 2016 Oct;25(10):2619-2632.

doi: 10.1007/s11136-016-1281-y. Epub 2016 Apr 6.

Authors

Luke Mondor^{1

2}, Colleen J Maxwell^{1

2

3}, Susan E Bronskill^{1

2

4}, Andrea Gruneir^{1

2

4

5}, Walter P Wodchis^{6

7

8

9}

Affiliations

¹ Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada.
² Health System Performance Research Network (HSPRN), Toronto, ON, Canada.
³ Schools of Pharmacy and Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.
⁴ Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, ON, M5T 3MS, Canada.
⁵ Department of Family Medicine, University of Alberta, Edmonton, AB, Canada.
⁶ Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada. walter.wodchis@utoronto.ca.
⁷ Health System Performance Research Network (HSPRN), Toronto, ON, Canada. walter.wodchis@utoronto.ca.
⁸ Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, ON, M5T 3MS, Canada. walter.wodchis@utoronto.ca.
⁹ Toronto Rehabilitation Institute, Toronto, ON, Canada. walter.wodchis@utoronto.ca.

PMID: 27052421
DOI: 10.1007/s11136-016-1281-y

Abstract

Purpose: To examine the relative impact of 16 common chronic conditions and increasing morbidity on health-related quality of life (HRQL) in a population-based sample of home care clients in Ontario, Canada.

Methods: Participants were adult clients assessed with the Resident Assessment Instrument for Home Care (RAI-HC) between January and June 2009 and diagnosed with one (or more) of 16 common chronic conditions. HRQL was evaluated using the Minimum Data Set-Health Status Index (MDS-HSI), a preference-based measure derived from items captured in the RAI-HC. Multivariable linear regression models assessed the relative impact of each condition, and increasing number of diagnoses, on MDS-HSI scores.

Results: Mean (SD) MDS-HSI score in the study population (n = 106,159) was 0.524 (0.213). Multivariable analysis revealed a statistically significant (p < 0.05) and clinically important (difference ≥ 0.03) decrease in MDS-HSI scores associated with stroke (-0.056), osteoarthritis (-0.036), rheumatoid arthritis (-0.033) and congestive heart failure (CHF, -0.030). Differences by age and sex were observed; most notably, the negative impact associated with dementia was greater among men (-0.043) than among women (-0.019). Further, HRQL decreased incrementally with additional diagnoses. In all models, chronic conditions and number of diagnoses accounted for a relatively small proportion of the variance observed in MDS-HSI.

Conclusion: Clinically important negative effects on HRQL were observed for clients with a previous diagnosis of stroke, osteo- and rheumatoid arthritis, or CHF, as well as with increasing levels of multimorbidity. Findings provide baseline preference-based HRQL scores for home care clients with different diagnoses and may be useful for identifying, targeting and evaluating care strategies toward populations with significant HRQL impairments.

Keywords: Chronic disease; Health status; Home care services; Ontario/epidemiology; Quality of life.

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The relative impact of chronic conditions and multimorbidity on health-related quality of life in Ontario long-stay home care clients

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The relative impact of chronic conditions and multimorbidity on health-related quality of life in Ontario long-stay home care clients

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