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The predictive ability of EQ-5D-3L compared to the LACE index and its association with 30-day post-hospitalization outcomes

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Abstract

Purpose

To examine whether the EQ-5D-3L at the time of discharge from hospital provides additional prognostic information above the LACE index for 30-day post-discharge hospital readmission and to explore the association of EQ-5D-3L with readmissions, emergency department (ED) visits, and death within the same period.

Methods

Using data (n = 495; mean age 62.9 years (SD 18.6), 50.5% female) from a prospective cohort study of patients discharged from medical wards at two university hospitals, the prognostic ability of EQ-5D-3L was examined using C-statistic, Integrated Discrimination Improvement (IDI) Index, and Akaike’s Information Criterion (AIC). The associations between EQ-5D-3L dimensions, total sum, index and VAS scores at the time of discharge and 30-day post-discharge ED visits, readmission, and readmission/death were examined using multivariate logistic regression.

Results

At the time of discharge, 58.6% of participants reported problems in mobility, 28.3% in self-care, 62.1% in usual activities, 62.7% in pain/discomfort, and 42.4% in anxiety/depression. Mean (SD) total sum score was 7.9 (2.0), index score was 0.69 (0.21), and VAS score was 63.7 (18.4). In adjusted analyses, mobility, self-care, usual activities, and the total sum score were significantly associated with 30-day readmission and readmission/death. Differences in C-statistic for LACE readmission prediction models with and without EQ-5D-3L were small. AIC analysis suggests that readmission prediction models containing EQ-5D-3L dimensions or scores were more often preferred to those with the LACE index only. IDI analysis indicates that the discrimination slope of readmission prediction models is significantly improved with the addition of mobility, self-care, or the total sum score of the EQ-5D-3L.

Conclusion

The EQ-5D-3L, especially the mobility and self-care dimensions as well as the total sum score, improves 30-day readmission prediction of the LACE index and is associated with 30-day readmissions or readmissions/death.

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Funding

This analysis did not receive any financial support from any funding agency, but the PROACTIVE study was supported by an operating grant from Alberta Innovates – Health Solutions. FAM holds the Alberta Health Services Chair in Cardiovascular Outcomes Research at the University of Alberta. SRM was co-PI on the PROACTIVE study; he passed away in January 2018.

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Authors

Contributions

FAS planned and conducted the analysis and drafted the first draft of this manuscript. FAM, AO, and JAJ provided guidance and feedback on the analytical plan and results throughout the analysis, read and provided feedback on various drafts of this manuscript, and approved the submitted draft. SRM was the co-PI of the PROACTIVE study and contributed tremendously to the design and conduction of that study. He passed away two years ago, and his inclusion as a co-author is to honor his contributions to the PROACTIVE study that we analyze in this paper.

Corresponding author

Correspondence to Fatima Al Sayah.

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Conflict of interest

Authors Fatima Al Sayah, Arto Ohinmaa, and Jeffrey A. Johnson are members of the EuroQol Group.

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Al Sayah, F., McAlister, F.A., Ohinmaa, A. et al. The predictive ability of EQ-5D-3L compared to the LACE index and its association with 30-day post-hospitalization outcomes. Qual Life Res 30, 2583–2590 (2021). https://doi.org/10.1007/s11136-021-02835-z

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  • DOI: https://doi.org/10.1007/s11136-021-02835-z

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