Patient-reported outcomes among patients undergoing total hip replacement in an integrated care system and in a standard care system in Region Stockholm, Sweden

BACKGROUND

Coordination, cooperation and efficient use of resources is vital for the health- and social care sector if it is to meet the needs of an aging population. Integrated care is a patient-centred approach to provision of care aiming to improve quality of care and overcome fragmented care through co-productive partnerships and may positively affect quality of care and health outcomes, especially among those in need of highly coordinated care services.

AIM

To compare patient-reported outcomes (PROs) among patients undergoing total hip replacement (THR) in the integrated care system in Norrtälje Municipality and in the standard care system in other municipalities in Region Stockholm, Sweden.

METHODS

Swedish Hip Arthroplasty Register PRO data during 2008-2015 were compared 1 year after THR among patients (≥50 years) in integrated care (n = 407) and standard care (n = 3501) systems using linear (EQ VAS score), logistic (EQ-5D-3L dimensions) and negative binomial (hip pain VAS score) regressions. Analyses were adjusted for the preoperative factors age, sex, BMI, ASA class and type of incision.

RESULTS

1-year postoperatively, patients in the integrated care system did not report their health significantly different from patients receiving standard care. Exceptions: Female patients in integrated care reported less problems with self-care (OR:0.52; 0.29-0.96) and patients above 70 years reported more problems with mobility (OR: 1.37; 1.01-1.87).

CONCLUSION

No significant differences were found between the two care systems for postoperative PROs. A longer follow-up time and analyses by socioeconomic groups would be valuable.

EQ-5D-Y as a health-related quality of life measure in children and adolescents with functional disability in Sweden: testing feasibility and validity

AIM

The EQ-5D-Y is a newly developed generic instrument measuring health-related quality of life in children and adolescents. The aim of the study was to test the feasibility and validity of the EQ-5D-Y in a Swedish patient sample of children and adolescents with functional motor, orthopaedic and medical disabilities and to compare the results with a general population sample.

METHODS

Two samples of children and adolescents answered the EQ-5D-Y and a core set of internationally standardised instruments, variables and socio-demographic questions. Patients with functional disability (n = 71, aged seven to 17 years) and individuals from the general population (n = 407, aged eight to 16 years) were included in this study.

RESULTS

There was a low number of missing answers. Significantly more problems were reported in all dimensions in the patient sample, and the mean visual analogue scale (VAS) score was significantly lower. Any problems were reported by 83% of the patients and by 37% of the general population. In the patient sample, 21% reported problems at the most severe level, compared with 1.5% in the general population sample. By subgroup analyses by diagnoses, the frequency of reported problems in the different dimensions varied.

CONCLUSION

Even though feasibility and discriminative validity of the EQ-5D-Y were supported in our study, further studies are needed including more patients and patient groups.

Changing healthcare utilization patterns in diabetes mellitus: case-control studies 1 year and 8 years after diagnosis

AIMS

To describe healthcare utilization patterns in young and middle-aged patients with diabetes 1 year and 8 years after diagnosis and to compare with the general population at two time points, 16 years apart.

METHODS

Four cohorts with disease duration of 1 year or 8 years were selected from the Diabetes Incidence Study in Sweden, which registers all incident cases of diabetes in the 15- to 34-year age group. Control subjects were selected from the population register matched by age, sex and county of residence. A postal questionnaire was sent to the 1983 and 1992 cohorts in 1991 and 1993, and to the 1999 and 2008 cohorts in 2007 and 2009. Nine hundred and thirteen patients with diabetes and 1679 control subjects responded.

RESULTS

One year after diagnosis, 49% of patients with diabetes in the 1992 cohort compared with 4.2% in the 2008 cohort reported visits to departments of internal medicine and endocrinology. A similar pattern was seen 8 years after diagnosis. The use of day care was 4-5 times higher among patients with diabetes compared with control subjects. Utilization of outpatient hospital care was higher among patients with diabetes compared with control subjects, even when excluding visits to diabetes clinics.

CONCLUSIONS

Excess use of health care among patients with diabetes remained 16 years after the first follow-up. Utilization patterns were stable, except for a major decrease in inpatient care 1 year after diagnosis and an increase in day care 8 years after diagnosis. Observed changes probably reflect successive reforming of diabetes care in Sweden.

Swedish population health-related quality of life results using the EQ-5D

Health-related quality of life (HRQoL) measured on population level may be useful to guide policies for health. This study aims to describe the HRQoL; in EQ-5D dimensions, mean rating scale (RS) scores and mean EQ-5D index values, in the general population, by certain disease and socio-economic groups, in Stockholm County 1998. The EQ-5D self-classifier and a RS were included in the 1998 cross-sectional postal Stockholm County public health survey to a representative sample (n = 4950, 20-88 years), 63% response rate. Mean RS score ranged from 0.90 (20-29 years) to 0.69 (80-88 years), mean EQ-5D index value ranged from 0.89 (20-29 years) to 0.74 (80-88 years). For different diseases mean RS scores ranged from 0.80 (asthma) to 0.69 (angina pectoris), mean EQ-5D index values ranged from 0.79 (asthma) to 0.66 (low back pain). The mean health state scores (RS and EQ-5D index) were 0.06 lower in the unskilled manual group than in the higher non-manual group after controlling for age and sex (p < 0.0001). This difference was 0.03 after controlling also for different diseases (p < 0.0001). In conclusion, our results show that the HRQoL varies greatly between socio-economic and disease groups. Furthermore, after controlling for age, sex and disease, HRQoL is lower in manual than in non-manual groups.

Health-related quality of life by disease and socio-economic group in the general population in Sweden

Measuring health-related quality of life (HRQoL) on population level, is becoming increasingly important for priority setting in health policy. In the health economics field, it is common to measure HRQoL in terms of health-state utilities or QoL weights. This study investigates the feasibility of obtaining mean QoL weights by mapping survey data to the generic HRQoL measure EQ-5D and to describe the HRQoL in terms of mean QoL weights in certain disease and socio-economic groups. Data from the 1996-1997 Survey of Living Conditions, interviews with a representative sample (16-84 years) of the Swedish population (n=11 698) were used. The mean QoL weight decreased from 0.91 among the youngest to 0.61 among the oldest, and was lower for women than for men. The QoL weight was 0.88 in the highest socio-economic group and 0.78 in the lowest socio-economic group. The QoL weight was lowest (0.38) among persons with depression and highest among persons with hypertension (0.71). The QoL weight decreased from 0.95 for persons with very good global self-rated health to 0.20 for persons with very poor global self-rated health. The results support the feasibility and validity of the mapping approach. HRQoL varies greatly between socio-economic groups and different disease groups.