Use of Health-Related, Quality-of-Life Metrics to Predict Mortality and Hospitalizations in Community-Dwelling Seniors

Abstract

OBJECTIVES: To investigate whether health-related quality-of-life (HRQoL) scores in a primary care population can be used as a predictor of future hospital utilization and mortality.

DESIGN: Prospective cohort study measuring Short Form 12 (SF-12) scores obtained using a mailed survey. SF-12 scores, age, and a comorbidity score were used to predict hospitalization and mortality rate using multivariable logistic regression and Cox proportional hazards during the ensuing 28-month period for elderly patients.

SETTING: Intermountain Health Care, a large integrated-delivery network serving a population of more than 150,000 seniors.

PARTICIPANTS: Participants were senior patients who had one or more chronic diseases, were community dwelling, and were initially treated in primary care clinics.

MEASUREMENTS: SF-12 survey Version 1.

RESULTS: Seven thousand seventy-six surveys were sent to eligible participants; 3,042 (43%) were returned. Of the returned surveys, 2,166 (71%) were complete and scoreable. For the respondent group, a multivariable analysis demonstrated that older age, male sex, higher comorbidity score, and lower mental and physical summary measures of SF-12 predicted higher mortality and hospitalization. On average, nonresponders were older and had higher comorbidity scores and mortality rates than responders.

CONCLUSION: The SF-12 survey provided additional predictive ability for future hospitalizations and mortality. Such predictive ability might facilitate preemptive interventions that would change the course of disease in this segment of the population. However, nonresponder bias may limit the utility of mailed SF-12 surveys in certain populations.