The Relationship of 60 Disease Diagnoses and 15 Conditions to Preference-Based Health-Related Quality of Life in Ontario Hospital-Based Long-Term Care Residents

Background: Population-based diagnosis-and condition-specific health-related quality of life (HRQoL) scores are required for decision-making and research purposes. These HRQoL scores do not exist for hospital-based long-term care (LTC) residents. Objective: To estimate the impact of 60 diseases and 15 conditions on caregiver-assessed preference-based HRQoL. Methods: Residents in hospital-based LTC facilities in Ontario, Canada were identified from administrative databases containing resident minimum data set (MDS) assessments completed between August 1st, 2003 and March 31st, 2008. A preference-based HRQoL measure, the MDS Health-Status Index (MDS-HSI) score, was calculated for 66,193 residents. Average MDS-HSI scores and multivariate linear regression models were used to estimate the impact of the diagnoses and conditions, respectively. Results: After adjusting for age, sex, and other diagnoses, aphasia exhibited the largest negative relationship to the MDS-HSI (-0.085), followed by cancer (-0.072) and Alzheimer disease (-0.062). Cancer was also the second most prevalent diagnosis (27.6%). Lack of balance was a common condition (87.3%) and it had the greatest negative relationship to MDS-HSI scores among the 15 conditions (-0.099). The diagnoses and conditions regression models had R-2 values of 0.12 and 0.34, respectively, suggesting that clinical conditions provided better explanatory variables for the MDS-HSI than diagnoses. Conclusions: The findings suggest that diseases affect preference-based HRQoL differently in a hospital-based LTC population compared with previous studies in the general population. The population-based MDS-HSI scores from this study can be used as reference values in cost-effectiveness analyses for hospital-based LTC populations.