DEVELOPMENT OF A CONCEPTUAL CROSSWALK BETWEEN RESIDENT ASSESSMENT INSTRUMENTS AND THE EQ-5D-5L

Purpose:

     To develop a conceptual crosswalk for translating responses on the Resident Assessment Instrument – Home Care (RAI-HC) and Minimum Data Set 2.0 (MDS 2.0) into responses on the EQ-5D-5L.  RAI-HC assesses activities of daily living, cognition, communication, pain, depression, and medical instability in long-stay home care clients.  The MDS 2.0 measures physical, clinical, and psychological well-being, plus psycho-social functioning and life-care wishes, in residents of long-term care facilities.

Method:

    Each of the five EQ-5D-5L dimensions and response options was linked to the related scales and response options on the RAI-HC and MDS 2.0. Once the mapping was complete, we used data from the Home Care Reporting System (HCRS), the Newfoundland and Labrador Well Elderly (NLWE) study, and the Continuing Care Reporting System (CCRS) in Canada to map RAI-HC and MDS 2.0 responses onto the EQ-5D-5L.  Next, we used Canadian preference weights to convert the mapped EQ-5D-5L responses into health utility scores (range 0 to 1).  We assessed the face validity of the conceptual crosswalk by using the two-sample median test to compare median health utility scores between females and males, as well as between persons with and without the following diagnoses: dementia, hemiplegia/hemiparesis, and any psychiatric disorder.

Result:

    After combining the HCRS and NLWE data, we had RAI-HC information for 388,202 persons (63% female, mean age 78 years).  From the CCRS data, we had MDS 2.0 information for 273,716 persons (66% female, mean age 83 years).  Median health utility scores are shown in the table.

	RAI-HC	p-value	MDS 2.0	p-value
Female	0.63	< 0.0001	0.42	< 0.0001
Male	0.66		0.45
Dementia - yes	0.64*	0.0449	0.41	< 0.0001
Dementia - no	0.64*		0.43
Hemiplegia/hemiparesis - yes	0.51	< 0.0001	0.35	< 0.0001
Hemiplegia/hemiparesis - no	0.65		0.43
Any psychiatric - yes	0.56	< 0.0001	0.40	< 0.0001
Any psychiatric - no	0.66		0.44

*Medians appear numerically equivalent due to rounding to two decimal places.

Conclusion:

    The findings suggest the conceptual crosswalk has face validity.  Median health utility scores were lower for women versus men.  This result is expected because elderly women experience lower levels of social support and a higher prevalence of some chronic diseases.  Also as expected, median scores were lower for persons diagnosed with disease.