Abstract
BackgroundThe trajectories for health-related quality of life of patients receiving home-based primary care are not well identified. Our objective was to investigate changes in the quality of life (QOL) and factors that affected the QOL of patients receiving home-based primary care.MethodsOur prospective cohort study, the Observational study of Nagoya Elderly with HOme MEdical (ONE HOME) study, recruited 184 patients undergoing home-based primary care with a 5-year follow-up period. Patients’ demographic data, socioeconomic status, physical diseases, medication use, feeding intake status, nutritional status, and functional status were measured annually. The 4-item quality of life index (QOL-HC [home care]) including self-perceived and family-reported QOL ratings that had been developed and previously validated in home care settings was used. Linear regression models were used for cross-sectional and longitudinal analyses.ResultsThe participants’ mean age was 78.8 ± 10.8 years, and 55.9% of the sample was male. Most patients were frail, disabled, and/or malnourished. Self-perceived and family-reported QOL scores dropped sequentially on annual follow-ups. In the multivariate longitudinal analysis, patients who were divorced (β = 1.74) had high baseline QOL scores (β = 0.75) and reported higher QOL ratings. In addition, high functional dependency was associated with a low self-perceived QOL rating, with a β-value of − 1.24 in the pre-bedridden group and − 1.39 in the bedridden group. Given the family-reported QOL rating, the baseline QOL scores (β = 0.50) and Mini-Nutritional Assessment–Short-Form scores (β = 0.37) were found to have positive associations with the QOL rating.ConclusionsFor the disabled receiving home-based primary care, independent functional status and divorce were positively associated with better self-perceived QOL, whereas nutritional status was correlated with better family-reported QOL.
Highlights
The trajectories for health-related quality of life of patients receiving home-based primary care are not well identified
Following recent breakthroughs in medical technology accompanied by high costs, a system of value-based, patient-centered health care was proposed to balance the rapid inflating expenses and to maintain health-related quality of life (HrQOL) [6]
HrQOL Our 4-item questionnaire (QOL-HC) was administered, which we developed for patients receiving home-based medical care [21]
Summary
The trajectories for health-related quality of life of patients receiving home-based primary care are not well identified. Our objective was to investigate changes in the quality of life (QOL) and factors that affected the QOL of patients receiving home-based primary care. Based on the U.S National Health Expenditures Projections in 2012 report, the expense of home-based primary care is estimated to double in 10 years [4]. Following recent breakthroughs in medical technology accompanied by high costs, a system of value-based, patient-centered health care was proposed to balance the rapid inflating expenses and to maintain health-related quality of life (HrQOL) [6]. A patient need-oriented comprehensive community-based care system collaborating with home-based primary care was established in Japan and is managed under a multidisciplinary network of physicians, nurses, occupational therapists, physical therapists, and dieticians [5]
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