HEALTH STATUS UTILITIES IN LONG-TERM CARE RESIDENTS IN ONTARIO

Purpose: Utilities are the preferred health status outcome measure for economic models. Utilities for long-term care (LTC) residents have been previously estimated using expert judgment only. In this study, we used health status assessment information to estimate health status utilities in LTC residents in Ontario, both with and without pressure ulcers (PU).

Methods: LTC population-based data from the Resident Assessment Instrument - Minimum Data Set (RAI-MDS) was used to estimate health status utilities. All residents in 90 LTC facilities in Ontario who had full assessment after admission were included in this analysis. Relevant items, including cognitive, communication/hearing, vision, and mood and behavioral patterns, physical functioning and structural problems, and psychological well-being from the RAI-MDS were mapped on to the Health Utilities Index Mark 2 (HUI2) to derive the Minimum Data Set Health Status Index (MDS-HSI) using a validated algorithm. MDS-HSI scores for both LTC residents with and without PU were calculated using the Canadian HUI2 community preference weights. LTC residents were stratified into high and low risk (co-morbidity) for developing PU stage II-IV, based on the validated RAI-MDS derived risk-adjustment model.

Results: A total of 8,058 LTC residents: 7,319 (90.8%) without PU and 739 (9.2%) with PU completed a full RAI-MDS assessment. The average age of the LTC residents was 83.6 years. In the low risk group (n=2,419), 23 (1%) had PU. In the high risk group (n=5,639), 716 (13%) had PU. The mean MDS-HSI scores between LTC residents with PU and those without PU were significantly different: for low risk, 0.40 vs. 0.47, P=0.031; and for high risk, 0.27 vs. 0.33, P<0.0001. PU stage and age group was not associated with difference in utility scores.

Conclusions: Utility scores for LTC residents are very low. LTC residents with PU had significantly lower health-related quality of life compared to those without PU, regardless of their risk status (co-morbidity). In the absence of self-reported data, LTC residents-derived MDS-HSI provides an important summary outcome measure for the economic evaluation of PU prevention and care among residents in residential LTC settings. Further analysis determining the effect of PU on health-related quality of life in LTC residents is underway.