Abstract
ObjectivesHealth utility combines health related quality of life and mortality to produce a generic outcome measure reflecting both morbidity and mortality. It has not been widely used as an outcome measure in evaluations of emergency care and little is known about the feasibility of measurement, typical values obtained or baseline factors that predict health utility. We aimed to measure health utility after emergency medical admission, to compare health utility to age, gender and regional population norms, and identify independent predictors of health utility.MethodsWe selected 5760 patients across three hospitals who were admitted to hospital by ambulance as a medical emergency. The EQ-5D questionnaire was mailed to all who were still alive 30 days after admission. Health utility was estimated by applying tariff values to the EQ-5D responses or imputing a value of zero for those who had died. Multivariable analysis was used to identify independent predictors of health utility at 30 days.ResultsResponses were received from 2488 (47.7%) patients, while 541 (9.4%) had died. Most respondents reported some or severe problems with each aspect of health. Mean health utility was 0.49 (standard deviation 0.35) in survivors and 0.45 (0.36) including non-survivors. Some 75% had health utility below their expected value (mean loss 0.32, 95% confidence interval 0.31 to 0.33) and 11% had health utility below zero (worse than death). On multivariable modelling, reduced health utility was associated with increased age and lower GCS, varied according to ICD10 code and was lower among females, patients with recent hospital admission, steroid therapy, or history of chronic respiratory disease, malignancy, diabetes or epilepsy.ConclusionsHealth utility can be measured after emergency medical admission, although responder bias may be significant. Health utility after emergency medical admission is poor compared to population norms. We have identified independent predictors or health utility that need to be measured and taken into account in non-randomized evaluations of emergency care.
Highlights
Patient outcomes need to be measured after emergency medical care for research, quality improvement and benchmarking of performance [1]
Health related quality of life has been measured after hospital admission for major trauma [9,10,11] and specific illnesses, such as myocardial infarction [12] and stroke [13]
We valued health utility using the EQ-5D for survivors and attributed a value of zero to those who had died by 30 days
Summary
Patient outcomes need to be measured after emergency medical care for research, quality improvement and benchmarking of performance [1]. Some important emergency interventions, such as thrombolysis for stroke [8], affect health related quality of life rather than mortality. Health related quality of life has been measured after hospital admission for major trauma [9,10,11] and specific illnesses, such as myocardial infarction [12] and stroke [13]. We need to measure health related quality of life in the general emergency medical population if we are to estimate the effect of interventions and changes in service delivery upon the whole relevant population
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