Measuring health and health state preferences among critically ill patients

Objective: a) to examine the EuroQol instrument's ability to assess a patient's state of health prior to admission to an ICU; b) to describe a patient's health-related quality of life (HRQoL) before the onset of the condition leading to admission to the ICU, and prior to discharge; c) to compare patients' preferences for a ''common core'' of EuroQol health states with preferences from healthy individuals. Design: Patients in a step-down unit (SDU) retrospectively rated their health states prior to admission to the ICU, their current states of health and the ''common core'' of hypothetical EuroQol states of health. Proxies rated the patients' health states prior to admission to the ICU. Patients' preferences for EuroQol states of health were compared with the preferences obtained from a retrospective cohort of healthy individuals. Setting: An SDU at the University Hospital of Bellvitge, Barcelona, Spain. Patients: 103 critical medical and surgical patients were interviewed. Intervention. The EuroQol questionnaire, a non-disease specific instrument to evaluate HRQoL. Measurements and main results: Agreement between patients and proxies regarding their prior health state was moderate to good in physical and pain areas (kappa: 0.43-0.58), fair for mood (kappa: 0.38) and almost identical for prior overall health (65.9 vs 66.3). Compared with their prior HRQoL, patients had deteriorated in all physical areas and overall health at discharge from the SDU, Preferences for the worst health states varied significantly between patients and healthy individuals. Conclusion: The EuroQol can be reliably used with proxies to determine the state of health of patients prior to admission to the ICU. Preferences between healthy individuals and ICU patients differed.