The effect of a comprehensive care intervention on patient reported Health-related Quality of Life in elderly with complex sub-acute care needs.   

An inverse propensity score weighted, controlled prospective study.  

Authors:   

Luis Marco-Ruiz ¹, Espen Nordheim ^1,, Monika Dalbakk ², Lisbet Spansvoll ³, Reza Baharmand ¹, Maryam Taryefi ¹, Phuong Ngo ¹, Markus Rumpsfeld ², Gro Rosvold Berntsen* ^1,4  

1. Norwegian center for e-healthresearch, University Hospital North Norway 

2. Centre for E-health, innovation and co-creation - Tromsø, University Hospital North Norway 

3. Centre for E-health, innovation and co-creation - Harstad, University Hospital North Norway 

4. Institute of Community medicine, UiT – The Arctic University of Norway 

 

Background:

• Rising numbers of frail, multi-morbid elderly with complex, long-term needs (CLNs)
• At risk for sub-optimal care outcomes and escalating costs.
• The Patient-Centered Care Team (PACT) is an intervention for CLNs patients in the context of emergency hospital admissions
• Previous publication on PACT showed: ↓ emergency care use, ↑ planned care, and ↓ mortality by 40%. (1) 

Research question:

Does the PACT intervention also improve patient reported Health related Quality of Life ?

 

Material and Methods: 

• Patients: age over 60 with multimorbidity and CLNs referred to PACT (intervention)
• Controls: Matched to a PACT patient (control), during an emergency hospitalization.

HR-QoL measures:

• Medical outcomes survey, short form 12, v1 physical (SF-12-PSC) and mental score (SF-12-MSC) ,
• Euro-QoL (EQ-5D),
• Patient Generated Index (PGI).

Analyses:

Doubly robust adjustment for design imbalances according to DAG – see Fig 1.

• Inverse propensity score (PS) weighting.
• Multi-variate linear regression outcomes analysis.  

Results:  

• Intervention group improved more than Controls – both in crude and adjusted analyses. See table 1 for details.
• The SF-12 PSC change in the intervention group was 3 times the minimally clinically important difference (MCID) (2).  

Conclusion:  

A comprehensive care program, with a strong focus on person-centred care for multimorbid frail elderly, improved patient reported HR-QoL in a clinically meaningful way, compared to the control group.  

Trial registration: ClinicalTrials.gov (identifier: NCT02541474) and published protocol (1) 

 

References:

1.          Berntsen  G, Dalbakk M, Hurley JS, Bergmo T, Solbakken B, Spansvoll L, JG B, Skrøvseth SO, Brattland T, Rumpsfeld M: Person-centred, integrated and pro-active care for multi-morbid elderly with advanced care needs: a propensity score-matched controlled trial. BMC Health Serv Res 2019(19):682.

2.          Clement ND, Weir D, Holland J, Gerrand C, Deehan DJ: Meaningful changes in the Short Form 12 physical and mental summary scores after total knee arthroplasty. Knee 2019, 26(4):861-868.

Keywords:  Comprehensive care, Person-centered, Integrated, Pro-active, Frailty, Multimorbidity, Inverse Propensity Score Weights, Controlled trial, Health related quality of Life